- ICH GCP
- Yhdysvaltain kliinisten tutkimusten rekisteri
- Kliininen tutkimus 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
Tutkimuksen yleiskatsaus
Yksityiskohtainen kuvaus
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.
Opintotyyppi
Ilmoittautuminen (Todellinen)
Vaihe
- Vaihe 3
Yhteystiedot ja paikat
Opiskelupaikat
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Ontario
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London, Ontario, Kanada, N6A 4L6
- London Regional Cancer Program at London Health Sciences Centre
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Arizona
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Scottsdale, Arizona, Yhdysvallat, 85259-5499
- Mayo Clinic Scottsdale
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California
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Sacramento, California, Yhdysvallat, 95817
- University of California Davis Cancer Center
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Florida
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Jacksonville, Florida, Yhdysvallat, 32224
- Mayo Clinic - Jacksonville
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Georgia
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Atlanta, Georgia, Yhdysvallat, 30322
- Winship Cancer Institute of Emory University
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Illinois
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Evanston, Illinois, Yhdysvallat, 60201-1781
- Evanston Hospital
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Springfield, Illinois, Yhdysvallat, 62781-0001
- Regional Cancer Center at Memorial Medical Center
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Springfield, Illinois, Yhdysvallat, 62794-9677
- Simmons Cooper Cancer Institute
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Springfield, Illinois, Yhdysvallat, 62702
- Cancer Institute at St. John's Hospital
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Maryland
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Towson, Maryland, Yhdysvallat, 21204
- Cancer Institute at St. Joseph Medical Center
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Massachusetts
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Boston, Massachusetts, Yhdysvallat, 02118
- Boston University Cancer Research Center
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Michigan
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Ann Arbor, Michigan, Yhdysvallat, 48109-0942
- University of Michigan Comprehensive Cancer Center
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Minnesota
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Rochester, Minnesota, Yhdysvallat, 55905
- Mayo Clinic Cancer Center
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Missouri
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Saint Louis, Missouri, Yhdysvallat, 63110
- Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis
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New Hampshire
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Lebanon, New Hampshire, Yhdysvallat, 03756-0002
- Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center
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New Jersey
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Ridgewood, New Jersey, Yhdysvallat, 07450
- Valley Hospital - Ridgewood
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New York
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Oceanside, New York, Yhdysvallat, 11572
- South Nassau Communities Hospital
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Rochester, New York, Yhdysvallat, 14642
- James P. Wilmot Cancer Center at University of Rochester Medical Center
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Syracuse, New York, Yhdysvallat, 13210
- SUNY Upstate Medical University Hospital
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North Carolina
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Charlotte, North Carolina, Yhdysvallat, 28233-3549
- Presbyterian Cancer Center at Presbyterian Hospital
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Ohio
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Cincinnati, Ohio, Yhdysvallat, 45267
- Charles M. Barrett Cancer Center at University Hospital
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Oregon
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Portland, Oregon, Yhdysvallat, 97239-3098
- Knight Cancer Institute At Oregon Health and Science University
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Pennsylvania
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New Castle, Pennsylvania, Yhdysvallat, 16105
- Jameson Memorial Hospital - North Campus
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Philadelphia, Pennsylvania, Yhdysvallat, 19111-2497
- Fox Chase Cancer Center - Philadelphia
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Philadelphia, Pennsylvania, Yhdysvallat, 19104-4283
- Abramson Cancer Center of the University of Pennsylvania
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Philadelphia, Pennsylvania, Yhdysvallat, 19107-5541
- Kimmel Cancer Center at Thomas Jefferson University - Philadelphia
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Pittsburgh, Pennsylvania, Yhdysvallat, 15232
- UPMC Cancer Centers
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Pittsburgh, Pennsylvania, Yhdysvallat, 15212
- Allegheny Cancer Center at Allegheny General Hospital
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Reading, Pennsylvania, Yhdysvallat, 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, Yhdysvallat, 02906
- Miriam Hospital
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Providence, Rhode Island, Yhdysvallat, 02903
- Rhode Island Hospital Comprehensive Cancer Center
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Tennessee
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Knoxville, Tennessee, Yhdysvallat, 37920-6999
- U.T. Medical Center Cancer Institute
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Texas
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Houston, Texas, Yhdysvallat, 77030
- Methodist Hospital
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Utah
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Murray, Utah, Yhdysvallat, 84157
- Jon and Karen Huntsman Cancer Center at Intermountain Medical Center
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Virginia
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Charlottesville, Virginia, Yhdysvallat, 22908
- University of Virginia Cancer Center
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Washington
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Seattle, Washington, Yhdysvallat, 98122-4307
- Swedish Cancer Institute at Swedish Medical Center - First Hill Campus
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Seattle, Washington, Yhdysvallat, 98111
- Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Center
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Wisconsin
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Madison, Wisconsin, Yhdysvallat, 53792-6164
- University of Wisconsin Paul P. Carbone Comprehensive Cancer Center
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Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
Hyväksyy terveitä vapaaehtoisia
Sukupuolet, jotka voivat opiskella
Kuvaus
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)
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
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Active Comparator: Arm I
Patients undergo open or thoracoscopic sublobar resection comprising either a wedge resection or anatomical segmentectomy.
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Kokeellinen: 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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Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
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Time to Local Recurrence
Aikaikkuna: 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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Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
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Overall Survival (OS)
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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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Yhteistyökumppanit ja tutkijat
Yhteistyökumppanit
Tutkijat
- Opintojen puheenjohtaja: Hiran C. Fernando, MD, Boston Medical Center
Julkaisuja ja hyödyllisiä linkkejä
Yleiset julkaisut
- 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.
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Todellinen)
Ensisijainen valmistuminen (Todellinen)
Opintojen valmistuminen (Todellinen)
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Arvio)
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
Lisää tietoa
Tähän tutkimukseen liittyvät termit
Avainsanat
Muita asiaankuuluvia MeSH-ehtoja
Muut tutkimustunnusnumerot
- ACOSOG-Z4032
- CDR0000422346 (Rekisterin tunniste: NCI Physician Data Query)
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