- ICH GCP
- US Clinical Trials Registry
- Klinisk forsøg NCT00107172
Surgery With or Without Internal Radiation Therapy in Treating Patients With Stage I Non-Small Cell Lung Cancer
A Randomized Phase III Study of Sublobar Resection Versus Sublobar Resection Plus Brachytherapy in High Risk Patients With Non-Small Cell Lung Cancer (NSCLC), 3cm or Smaller
Studieoversigt
Status
Betingelser
Intervention / Behandling
Detaljeret beskrivelse
PRIMARY OBJECTIVES:
I. To ascertain whether patients treated by sublobar resection (SR) + brachytherhapy (BX) have longer time to local recurrence as compared to the patients treated by SR (local recurrence includes recurrence within the same lobe or hilum [N1 nodes], or progression at the staple line after treatment effects such as scarring have subsided).
SECONDARY OBJECTIVES:
I. To compare procedure specific morbidity and mortality between study arms. II. To compare overall survival and failure-free survival between study arms. III. To assess freedom from regional or distant recurrence. IV. To assess the effect of histological or cytologic positive resection margins on time to local recurrence.
V. To determine the effect of brachytherapy on quality of life (QoL). VI. To determine the effect of brachytherapy on pulmonary function.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients undergo open or thoracoscopic sublobar resection comprising either a wedge resection or anatomical segmentectomy.
ARM II: Patients undergo surgery as in arm I. Patients also undergo intraoperative brachytherapy comprising iodine I 125 implant at the resection margin.
After completion of study treatment, patients are followed at 3, 6, 12, 18, 24, 30, and 36 months and then yearly for 2 years.
Undersøgelsestype
Tilmelding (Faktiske)
Fase
- Fase 3
Kontakter og lokationer
Studiesteder
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Ontario
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London, Ontario, Canada, N6A 4L6
- London Regional Cancer Program at London Health Sciences Centre
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Arizona
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Scottsdale, Arizona, Forenede Stater, 85259-5499
- Mayo Clinic Scottsdale
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California
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Sacramento, California, Forenede Stater, 95817
- University of California Davis Cancer Center
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Florida
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Jacksonville, Florida, Forenede Stater, 32224
- Mayo Clinic - Jacksonville
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Georgia
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Atlanta, Georgia, Forenede Stater, 30322
- Winship Cancer Institute of Emory University
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Illinois
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Evanston, Illinois, Forenede Stater, 60201-1781
- Evanston Hospital
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Springfield, Illinois, Forenede Stater, 62781-0001
- Regional Cancer Center at Memorial Medical Center
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Springfield, Illinois, Forenede Stater, 62794-9677
- Simmons Cooper Cancer Institute
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Springfield, Illinois, Forenede Stater, 62702
- Cancer Institute at St. John's Hospital
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Maryland
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Towson, Maryland, Forenede Stater, 21204
- Cancer Institute at St. Joseph Medical Center
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Massachusetts
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Boston, Massachusetts, Forenede Stater, 02118
- Boston University Cancer Research Center
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Michigan
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Ann Arbor, Michigan, Forenede Stater, 48109-0942
- University of Michigan Comprehensive Cancer Center
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Minnesota
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Rochester, Minnesota, Forenede Stater, 55905
- Mayo Clinic Cancer Center
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Missouri
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Saint Louis, Missouri, Forenede Stater, 63110
- Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis
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New Hampshire
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Lebanon, New Hampshire, Forenede Stater, 03756-0002
- Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center
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New Jersey
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Ridgewood, New Jersey, Forenede Stater, 07450
- Valley Hospital - Ridgewood
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New York
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Oceanside, New York, Forenede Stater, 11572
- South Nassau Communities Hospital
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Rochester, New York, Forenede Stater, 14642
- James P. Wilmot Cancer Center at University of Rochester Medical Center
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Syracuse, New York, Forenede Stater, 13210
- SUNY Upstate Medical University Hospital
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North Carolina
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Charlotte, North Carolina, Forenede Stater, 28233-3549
- Presbyterian Cancer Center at Presbyterian Hospital
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Ohio
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Cincinnati, Ohio, Forenede Stater, 45267
- Charles M. Barrett Cancer Center at University Hospital
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Oregon
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Portland, Oregon, Forenede Stater, 97239-3098
- Knight Cancer Institute At Oregon Health and Science University
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Pennsylvania
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New Castle, Pennsylvania, Forenede Stater, 16105
- Jameson Memorial Hospital - North Campus
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Philadelphia, Pennsylvania, Forenede Stater, 19111-2497
- Fox Chase Cancer Center - Philadelphia
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Philadelphia, Pennsylvania, Forenede Stater, 19104-4283
- Abramson Cancer Center of the University of Pennsylvania
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Philadelphia, Pennsylvania, Forenede Stater, 19107-5541
- Kimmel Cancer Center at Thomas Jefferson University - Philadelphia
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Pittsburgh, Pennsylvania, Forenede Stater, 15232
- UPMC Cancer Centers
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Pittsburgh, Pennsylvania, Forenede Stater, 15212
- Allegheny Cancer Center at Allegheny General Hospital
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Reading, Pennsylvania, Forenede Stater, 19612-6052
- McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center
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Rhode Island
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Providence, Rhode Island, Forenede Stater, 02906
- Miriam Hospital
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Providence, Rhode Island, Forenede Stater, 02903
- Rhode Island Hospital Comprehensive Cancer Center
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Tennessee
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Knoxville, Tennessee, Forenede Stater, 37920-6999
- U.T. Medical Center Cancer Institute
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Texas
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Houston, Texas, Forenede Stater, 77030
- Methodist Hospital
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Utah
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Murray, Utah, Forenede Stater, 84157
- Jon and Karen Huntsman Cancer Center at Intermountain Medical Center
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Virginia
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Charlottesville, Virginia, Forenede Stater, 22908
- University of Virginia Cancer Center
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Washington
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Seattle, Washington, Forenede Stater, 98122-4307
- Swedish Cancer Institute at Swedish Medical Center - First Hill Campus
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Seattle, Washington, Forenede Stater, 98111
- Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Center
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Wisconsin
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Madison, Wisconsin, Forenede Stater, 53792-6164
- University of Wisconsin Paul P. Carbone Comprehensive Cancer Center
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Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- PART I: PRE-OPERATIVE CRITERIA (PRE-REGISTRATION/RANDOMIZATION)
- Patients must have a suspicious lung nodule for clinical stage I non-small cell lung cancer (NSCLC)
- Patient must have a mass =< 3 cm maximum diameter by computed tomography (CT) size estimate: clinical stage Ia or selected Ib (i.e., with visceral pleural involvement)
- Patient must have a CT scan of the chest with upper abdomen within 60 days prior to date of pre-registration
- Eastern Cooperative Oncology Group (ECOG)/Zubrod performance status 0, 1, or 2
Patient must meet at least one major criteria or meet a minimum of two minor criteria as described below:
Major criteria
- Forced expiratory volume in 1 second (FEV1) =< 50% predicted
- Diffusing capacity of the lungs for carbon monoxide (DLCO) =< 50% predicted
Minor criteria
- Age >= 75
- FEV1 51-60% predicted
- DLCO 51-60% predicted
- Pulmonary hypertension (defined as a pulmonary artery systolic pressure greater than 40 mmHg) as estimated by echocardiography or right heart catheterization
- Poor left ventricular function (defined as an ejection fraction of 40% or less)
- Resting or exercise partial pressure of oxygen (pO2) =< 55 mm Hg or peripheral capillary oxygen saturation (SpO2) =< 88%
- Partial pressure of carbon dioxide (pCO2) > 45 mm Hg
- Modified Medical Research Council (MMRC) Dyspnea Scale >= 3
- Patient must not have had previous intra-thoracic radiation therapy
- Women of child-bearing potential must have negative serum or urine pregnancy test
- No prior invasive malignancy, unless disease-free for >= 5 years prior to pre-registration (exceptions: non-melanoma skin cancer, in-situ cancers)
- PART II: INTRA-OPERATIVE CRITERIA (REGISTRATION)
- Patient must have biopsy-proven NSCLC
- Patient must have all suspicious mediastinal lymph nodes (> 1 cm short-axis dimension on CT scan or positive on positron emission tomography [PET] scan) assessed by one of the following methods to confirm negative involvement with NSCLC (mediastinoscopy, endo-esophageal ultrasound guided needle aspiration, CT-guided, video-assisted thoracoscopic or open lymph node biopsy)
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
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Aktiv komparator: Arm I
Patients undergo open or thoracoscopic sublobar resection comprising either a wedge resection or anatomical segmentectomy.
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Eksperimentel: Arm II
Patients undergo surgery as in arm I. Patients also undergo intraoperative brachytherapy comprising an iodine I 125 implant at the resection margin.
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Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
---|---|---|
Time to Local Recurrence
Tidsramme: Up to 3 years
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Local recurrence included the recurrence within the same lobe or hilum (N1 nodes), or progression at the staple line after treatment effects such as scarring have subsided.
Time to local recurrence was censored 1) at the time of a distant recurrence, 2) at the last follow-up time when a patient died within 3 years of randomization without a local recurrence or 3) at 3 years follow-up if the patient remains alive 3 years post-randomization without a local recurrence.
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Up to 3 years
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Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
---|---|---|
Overall Survival (OS)
Tidsramme: Up to 5 years
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OS was defined as the time from randomization to death due to any cause.
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Up to 5 years
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Number of Participants Reported Local Recurrence at 3 Years
Tidsramme: 3 years
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Local recurrence was defined as the recurrence within the same lobe or hilum (N1 nodes), or at the staple line after treatment effects such as scarring have subsided.
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3 years
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Number of Participants Reported Regional Recurrence at 3 Years
Tidsramme: 3 years
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Regional recurrence was defined as the recurrence within another lobe or pleura on the same side as the resection, or the ipsilateral mediastinal (N2) nodes.
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3 years
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Number of Participants Reported Distant Recurrence at 3 Years
Tidsramme: 3 years
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Distant recurrence was defined as the recurrence within contralateral lobe, contralateral mediastinal (N3) nodes or distant> metastatic disease (other organs).
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3 years
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Mortality Rates at 30- and 90-day After Sublobar Resection
Tidsramme: 90 days
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90 days
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Number of Participants Reported Grade 3+ Adverse Events Within 90 Days After Sublobar Resection
Tidsramme: 90 days
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Adverse Events were assessed via the Common Terminology Criteria for Adverse Events (CTCAE) Version 3.0.
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90 days
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Number of Participants Reported Grade 3+ Respiratory Adverse Events Within 90 Days After Sublobar Resection
Tidsramme: 90 days
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The respiratory AE included adult respiratory distress syndrome, aspiration, bronchospasm, bronchostenosis, dyspnea, hypoxia, pleural effusion, pneumonitis, chest tube drainage or leak, prolonged intubation, pulmonary-other, and pneumonia as defined by the CTCAE version 3.0.
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90 days
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Global QOL as Measured Using SF36 at Baseline, Month 3, 12 and 24
Tidsramme: 24 months
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Short-form health survey (SF36) consist of 36 items, where scores can be reported as 8 domains of functional health and well-being, or transformed into a physical component summary (PCS) score and a mental component summary (MCS) score.
Standardized scores of SF36 PCS and MCS scores were calculated using the mean, SD, and scoring coefficients from the US general population.
The standardized scores were then adjusted for age and gender using the mean and SD of the US general population according to age and gender grouping, and employing a linear transformation.
Scores <50 indicate below-average health status.
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24 months
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Dyspnea as Measured Using SOBQ at Baseline, Months 3, Months 12 and 24
Tidsramme: 24 months
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Dyspnea was evaluated using the University of California, San Diego Shortness of Breath Questionnaire (SOBQ).
It consists of 24-item on a scale of 0 to 5 with 0=not at all and 5=maximal or unable to do because of breathlessness.
The total scores was calculated by summation of the 24 items scores and transformed into 0-100, with 0= poor quality of life , and 100= excellent quality of life..
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24 months
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FEV1% Measured at Baseline and Month 3
Tidsramme: 3 months
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Pulmonary function tests included percentage predicted forced expiratory volume in 1 second (FEV1%) at baseline and month 3 were compared between arms
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3 months
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DLCO% Measured at Baseline and Month 3
Tidsramme: 3 months
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Pulmonary function tests included percentage predicted carbon > monoxide diffusing capacity of the lung (DLCO%) at baseline and month 3 were compared between arms. |
3 months
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Samarbejdspartnere og efterforskere
Samarbejdspartnere
Efterforskere
- Studiestol: Hiran C. Fernando, MD, Boston Medical Center
Publikationer og nyttige links
Generelle publikationer
- Smith RP, Schuchert M, Komanduri K, Burton S, Heron DE, Luketich JD, d'Amato T, Landreneau R. Dosimetric evaluation of radiation exposure during I-125 vicryl mesh implants: implications for ACOSOG z4032. Ann Surg Oncol. 2007 Dec;14(12):3610-3. doi: 10.1245/s10434-007-9624-0. Epub 2007 Oct 2.
- Fernando HC, Landreneau RJ, Mandrekar SJ, Hillman SL, Nichols FC, Meyers B, DiPetrillo TA, Heron DE, Jones DR, Daly BD, Starnes SL, Tan A, Putnam JB. Thirty- and ninety-day outcomes after sublobar resection with and without brachytherapy for non-small cell lung cancer: results from a multicenter phase III study. J Thorac Cardiovasc Surg. 2011 Nov;142(5):1143-51. doi: 10.1016/j.jtcvs.2011.07.051. Epub 2011 Aug 26.
- Fernando HC, Landreneau RJ, Mandrekar SJ, Hillman SL, Nichols FC, Meyers B, DiPetrillo TA, Heron D, Jones DR, Daly BD, Starnes SL, Hatter JE, Putnam JB. The impact of adjuvant brachytherapy with sublobar resection on pulmonary function and dyspnea in high-risk patients with operable disease: preliminary results from the American College of Surgeons Oncology Group Z4032 trial. J Thorac Cardiovasc Surg. 2011 Sep;142(3):554-62. doi: 10.1016/j.jtcvs.2010.10.061. Epub 2011 Jul 2.
- Fernando HC, Landreneau RJ, Mandrekar SJ, Nichols FC, Hillman SL, Heron DE, Meyers BF, DiPetrillo TA, Jones DR, Starnes SL, Tan AD, Daly BD, Putnam JB Jr. Impact of brachytherapy on local recurrence rates after sublobar resection: results from ACOSOG Z4032 (Alliance), a phase III randomized trial for high-risk operable non-small-cell lung cancer. J Clin Oncol. 2014 Aug 10;32(23):2456-62. doi: 10.1200/JCO.2013.53.4115. Epub 2014 Jun 30.
- Fernando HC, Landreneau RJ, Mandrekar SJ, Nichols FC, DiPetrillo TA, Meyers BF, Heron DE, Hillman SL, Jones DR, Starnes SL, Tan AD, Daly BD, Putnam JB; Alliance for Clinical Trials in Oncology. Analysis of longitudinal quality-of-life data in high-risk operable patients with lung cancer: results from the ACOSOG Z4032 (Alliance) multicenter randomized trial. J Thorac Cardiovasc Surg. 2015 Mar;149(3):718-25; discussion 725-6. doi: 10.1016/j.jtcvs.2014.11.003. Epub 2014 Nov 13.
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Primær færdiggørelse (Faktiske)
Studieafslutning (Faktiske)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Skøn)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- ACOSOG-Z4032
- CDR0000422346 (Registry Identifier: NCI Physician Data Query)
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