- ICH GCP
- Registre américain des essais cliniques
- Essai clinique NCT07667192
Reirradiation and Total Ablative Strategies for Recurrent Gynecologic Cancer (Regynera-RT)
REGYNERA(Dia)TION: An Ambispective International Multicenter Patient Registry of Reirradiation and Total Ablative Strategies for Recurrent Gynecologic Malignancies
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
This study is a non-interventional patient registry designed to describe real-world outcomes after reirradiation and total ablative strategies in recurrent gynecologic malignancies. Eligible participants are adults with histologically confirmed uterine, cervical, vaginal, vulvar, ovarian, fallopian tube, primary peritoneal, or other rare gynecologic malignancy; documented prior radiotherapy; and recurrent or progressive disease for which reirradiation and/or a local ablative treatment strategy has been delivered, is ongoing, or is planned according to local multidisciplinary decision-making.
The registry has an ambispective cohort structure. Historical retrospective participants are entered from medical records and treatment-planning data after local approval. Ambispective follow-up participants were treated before registry activation but remain under follow-up, allowing subsequent outcomes and adverse events to be captured prospectively where permitted. Prospective registry participants are enrolled before or at the time of reirradiation or total ablative strategy decision-making. Participation does not mandate, delay, prohibit, or modify any clinically indicated treatment, imaging, or follow-up.
The registry will capture a common core dataset across participating centers, including demographics, performance status, primary tumor site and histology, primary treatment, prior radiotherapy details, recurrence anatomy, disease extent, number and site of active foci, treatment modality, dose and fractionation, equivalent dose metrics, systemic therapy timing, surgery or other metastasis-directed therapy, response at approximately 3 and 6 months, progression pattern, survival status, acute and late adverse events, severe morbidity, fistula events, and patient-reported outcomes where implemented. Recommended extended data domains include cumulative dose assessment, organ-at-risk metrics, imaging response method, molecular markers, systemic therapy sequencing, dosimetric data, and quality-of-life or symptom questionnaires.
The primary registry endpoint is radiographic progression-free survival after reirradiation/total ablative strategy. Key safety analyses will describe grade 3 or higher treatment-related genitourinary, gastrointestinal, vaginal, soft-tissue, neurologic, vascular, or bone adverse events and fistula events within 24 months and during longer follow-up. Secondary analyses will describe complete response, overall survival, local, regional, and distant progression, freedom from oligometastatic or polymetastatic progression, and disease-site-specific outcomes when adequate sample size and event numbers are reached.
Type d'étude
Inscription (Estimé)
Contacts et emplacements
Coordonnées de l'étude
- Nom: Mateusz Bilski, MD, PhD
- Numéro de téléphone: 048 84 535 99 10
- E-mail: mateusz.bilski@affidea.com
Sauvegarde des contacts de l'étude
- Nom: Paulina Kleban, MGR
- Numéro de téléphone: 048 84 535 99 10
- E-mail: paulina.kleban@affidea.com
Lieux d'étude
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Lublin Voivodeship
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Zamość, Lublin Voivodeship, Pologne, 22-400
- Recrutement
- Affidea Nu-med Center of Oncological DIagnostics and Therapy
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Contact:
- Mateusz Bilski, MD, PhD
- Numéro de téléphone: 048 84 535 99 10
- E-mail: mateusz.bilski@affidea.com
-
Contact:
- Paulina Kleban, MGR
- Numéro de téléphone: 048 84 535 99 10
- E-mail: paulina.kleban@affidea.com
-
-
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
- Adulte
- Adulte plus âgé
Accepte les volontaires sains
Méthode d'échantillonnage
Population étudiée
La description
Inclusion Criteria:
- - Age 18 years or older at the time of reirradiation or prospective enrollment.
- Histologically confirmed gynecologic malignancy, including uterine, cervical, vaginal, vulvar, ovarian, fallopian tube, primary peritoneal, or rare gynecologic primary.
- Documented prior radiotherapy delivered as part of previous treatment.
- Recurrent or progressive disease for which reirradiation and/or total ablative strategy has been delivered, is ongoing, or is planned according to local multidisciplinary decision-making.
- Recurrence or progression documented by imaging, clinical examination, pathology, and/or multidisciplinary tumor board assessment according to institutional practice.
- Availability of minimum essential data, including prior radiotherapy information, date of reirradiation or planned reirradiation, disease extent at reirradiation, and at least one follow-up, outcome, or survival-status record for retrospective patients.
- For prospective patients, written informed consent where required by local regulations and ethics approval.
Exclusion Criteria:
- No evidence of prior radiotherapy.
- No reirradiation or clinically meaningful local ablative radiotherapy component delivered or planned.
- Insufficient minimum data preventing assignment of reirradiation date, disease extent, or survival/follow-up status.
- Exclusively polymetastatic disease with more than 5 active non-regional lesions treated without a meaningful local reirradiation or total ablative component, unless included in an exploratory non-core substudy approved by the steering committee.
- Prospective refusal of consent when consent is required by local law or ethics approval.
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
Cohortes et interventions
Groupe / Cohorte |
Intervention / Traitement |
|---|---|
|
Historical Retrospective Cohort
Patients treated with reirradiation and/or total ablative strategies before registry activation at a participating site.
Baseline, prior radiotherapy, recurrence, treatment exposure, response, toxicity, progression, and survival data are abstracted retrospectively from medical records and treatment-planning systems according to local approval.
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Observed standard-of-care radiotherapy delivered in a previously irradiated patient or to a target region overlapping with or clinically affected by prior radiotherapy.
Modalities may include brachytherapy, external-beam radiotherapy, stereotactic body radiotherapy, proton therapy, intraoperative radiotherapy, or combinations.
Dose and fractionation are selected by the treating team.
Observed standard-of-care curative-intent or ablative-intent treatment strategy directed at all visible active disease sites when technically feasible and clinically appropriate.
This may include radiotherapy, surgery, ablation, metastasis-directed therapy, systemic therapy, or combinations, as selected by the treating multidisciplinary team.
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Ambispective Follow-Up Cohort
Patients treated before registry activation who remain under follow-up.
Baseline, prior treatment, recurrence, and reirradiation data may be collected retrospectively, while subsequent imaging, response, adverse events, fistula events, progression, survival, and patient-reported outcomes may be collected prospectively where permitted
|
Observed standard-of-care radiotherapy delivered in a previously irradiated patient or to a target region overlapping with or clinically affected by prior radiotherapy.
Modalities may include brachytherapy, external-beam radiotherapy, stereotactic body radiotherapy, proton therapy, intraoperative radiotherapy, or combinations.
Dose and fractionation are selected by the treating team.
Observed standard-of-care curative-intent or ablative-intent treatment strategy directed at all visible active disease sites when technically feasible and clinically appropriate.
This may include radiotherapy, surgery, ablation, metastasis-directed therapy, systemic therapy, or combinations, as selected by the treating multidisciplinary team.
|
|
Prospective Registry Cohort
Patients enrolled before or at the time of the reirradiation or total ablative strategy decision.
Treatment is not assigned by the registry and is selected by the treating multidisciplinary team according to routine clinical practice.
Registry data are collected prospectively according to the protocol follow-up schedule.
|
Observed standard-of-care radiotherapy delivered in a previously irradiated patient or to a target region overlapping with or clinically affected by prior radiotherapy.
Modalities may include brachytherapy, external-beam radiotherapy, stereotactic body radiotherapy, proton therapy, intraoperative radiotherapy, or combinations.
Dose and fractionation are selected by the treating team.
Observed standard-of-care curative-intent or ablative-intent treatment strategy directed at all visible active disease sites when technically feasible and clinically appropriate.
This may include radiotherapy, surgery, ablation, metastasis-directed therapy, systemic therapy, or combinations, as selected by the treating multidisciplinary team.
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Radiographic Progression-Free Survival
Délai: From treatment start to progression or death, up to 5 years
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Time from the start of reirradiation and/or total ablative strategy to first radiographic disease progression at any site or death from any cause, whichever occurs first.
Progression will be assessed using routine clinical imaging and investigator assessment according to local practice.
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From treatment start to progression or death, up to 5 years
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Severe Treatment-Related Adverse Events
Délai: From treatment start through 24 months and longer follow-up, up to 5 years
|
Incidence of grade 3 or higher treatment-related genitourinary, gastrointestinal, vaginal, soft-tissue, neurologic, vascular, bone, or other clinically relevant adverse events after reirradiation and/or total ablative strategy, graded according to the version of CTCAE used at the participating site.
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From treatment start through 24 months and longer follow-up, up to 5 years
|
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Overall Survival
Délai: From treatment start to death or last follow-up, up to 5 years
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Time from the start of reirradiation and/or total ablative strategy to death from any cause.
Participants alive at last follow-up will be censored at the last known alive date.
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From treatment start to death or last follow-up, up to 5 years
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Fistula Events
Délai: From treatment start through 24 months and long-term follow-up, up to 5 years
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Incidence of new or worsening fistula events, including anatomical type, timing, suspected relationship to treatment, management, surgical intervention, and resolution or persistence.
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From treatment start through 24 months and long-term follow-up, up to 5 years
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Complete Response
Délai: From treatment completion through 5 years, with response assessed at approximately 3 and 6 months after treatment completion and during scheduled follow-up.
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Proportion of participants with disappearance of all treated measurable active disease sites and no new disease, assessed by routine imaging and/or clinical assessment.
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From treatment completion through 5 years, with response assessed at approximately 3 and 6 months after treatment completion and during scheduled follow-up.
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Local Recurrence-Free Survival
Délai: From treatment completion to local progression or death, up to 5 years
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Time from completion of reirradiation and/or total ablative strategy to local recurrence or progression in the treated region, or death.
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From treatment completion to local progression or death, up to 5 years
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From treatment completion to local progression or death, up to 5 years
Délai: From treatment completion to regional progression or death, up to 5 years
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Time from treatment completion to regional nodal recurrence or progression, or death.
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From treatment completion to regional progression or death, up to 5 years
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Distant Metastasis-Free Survival
Délai: From treatment completion to event or last follow-up, up to 5 years
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Time from completion of reirradiation and/or total ablative strategy to distant metastatic progression or death from any cause.
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From treatment completion to event or last follow-up, up to 5 years
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Freedom From Oligometastatic Reccurence/Progression
Délai: From treatment completion to event or last follow-up, up to 5 years
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Time to new oligometastatic recurrence or oligometastatic progression after reirradiation and/or total ablative strategy, assessed according to investigator review and local imaging practice.
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From treatment completion to event or last follow-up, up to 5 years
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Freedom From Polymetastatic Recurrence/Progression
Délai: From treatment completion to polymetastatic progression, up to 5 years
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Time from completion of reirradiation and/or total ablative strategy to development of polymetastatic progression, typically defined as more than 5 new and/or regrowing non-regional lesions.
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From treatment completion to polymetastatic progression, up to 5 years
|
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Pattern of First Failure
Délai: From treatment completion to first progression, up to 5 years
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Distribution of first progression pattern after reirradiation and/or total ablative strategy, classified as local, regional, distant, oligometastatic, polymetastatic, or mixed progression according to investigator assessment.
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From treatment completion to first progression, up to 5 years
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Autres mesures de résultats
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Pelvic Exenteration-Free Survival
Délai: From treatment completion to pelvic exenteration or death, up to 5 years.
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Time from completion of reirradiation and/or total ablative strategy to pelvic exenteration or death, assessed in selected pelvic recurrence cohorts where applicable.
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From treatment completion to pelvic exenteration or death, up to 5 years.
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Systemic Therapy-Free Survival
Délai: From treatment completion to initiation or escalation of systemic therapy, up to 5 years.
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Time from completion of reirradiation and/or total ablative strategy to initiation or escalation of systemic anticancer therapy, assessed as an exploratory endpoint where clinically applicable.
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From treatment completion to initiation or escalation of systemic therapy, up to 5 years.
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Collaborateurs et enquêteurs
Publications et liens utiles
Publications générales
- Andratschke N, Willmann J, Appelt AL, Alyamani N, Balermpas P, Baumert BG, Hurkmans C, Hoyer M, Langendijk JA, Kaidar-Person O, van der Linden Y, Meattini I, Niyazi M, Reynaert N, De Ruysscher D, Tanadini-Lang S, Hoskin P, Poortmans P, Nieder C. European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus on re-irradiation: definition, reporting, and clinical decision making. Lancet Oncol. 2022 Oct;23(10):e469-e478. doi: 10.1016/S1470-2045(22)00447-8.
- Mulani J, Jain J, Gupta A, Swamidas J, Paul S, Mittal P, Gurram L, Chopra S. Dose Accumulation for Multicourse Gynecological Reirradiation: A Methodological Narrative and Clinical Examples. Int J Radiat Oncol Biol Phys. 2022 Aug 1;113(5):1085-1090. doi: 10.1016/j.ijrobp.2022.04.046. Epub 2022 May 7.
- Ling DC, Vargo JA, Burton SA, Heron DE, Beriwal S. Salvage Curative-Intent Reirradiation Stereotactic Body Radiation Therapy for Isolated Pelvic and/or Paraortic Recurrences of Gynecologic Malignancies. Pract Radiat Oncol. 2019 Nov;9(6):418-425. doi: 10.1016/j.prro.2019.05.012. Epub 2019 May 28.
- Ling DC, Vargo JA, Glaser SM, Kim H, Beriwal S. Outcomes after definitive re-irradiation with 3D brachytherapy with or without external beam radiation therapy for vaginal recurrence of endometrial cancer. Gynecol Oncol. 2019 Mar;152(3):581-586. doi: 10.1016/j.ygyno.2018.12.022. Epub 2018 Dec 29.
- Lee LJ, Alban GM, Cheng T, Buzurovic I, Pretz J, Singer L, King MT. Clinical outcomes and dosimetric predictors of toxicity for re-irradiation of vaginal recurrence of endometrial cancer. Brachytherapy. 2022 May-Jun;21(3):263-272. doi: 10.1016/j.brachy.2021.12.010. Epub 2022 Jan 22.
- Bockel S, Espenel S, Sun R, Dumas I, Gouy S, Morice P, Chargari C. Image-Guided Brachytherapy for Salvage Reirradiation: A Systematic Review. Cancers (Basel). 2021 Mar 11;13(6):1226. doi: 10.3390/cancers13061226.
- Critelli P, Pezzulla D, Lillo S, Arpa D, Scricciolo M, Di Carlo C, Argenone A, Borzillo V, Marsella AR, Tamburo M, Di Franco R, Di Marzo A, Settineri N, Mondello S, Macchia G, Belgioia L, Cerrotta A, Pontoriero A. Outcomes and toxicity in re-irradiation of gynecologic cancer: Systematic review of the Italian association of radiation and clinical oncology (AIRO). Gynecol Oncol. 2023 Dec;179:33-41. doi: 10.1016/j.ygyno.2023.10.016. Epub 2023 Oct 30.
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Réel)
Achèvement primaire (Estimé)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
- Radiothérapie
- Curiethérapie
- Fistule
- Protonthérapie
- Réirradiation
- Radiothérapie peropératoire
- La survie globale
- Radiothérapie corporelle stéréotaxique
- Registre des patients
- Radiothérapie externe
- Metastasis-Directed Therapy
- Total Ablative Strategy
- Oligometastatic Recurrence
- Radiographic Progression-Free Survival
- Treatment-Related Adverse Events
Termes MeSH pertinents supplémentaires
- Maladies urogénitales
- Maladies génitales
- Maladies du système endocrinien
- Tumeurs urogénitales
- Tumeurs par site
- Tumeurs
- Conditions pathologiques, anatomiques
- Maladies urogénitales féminines
- Maladies urogénitales féminines et complications de la grossesse
- Maladies utérines
- Maladies génitales, femme
- Tumeurs des glandes endocrines
- Maladies ovariennes
- Maladies annexielles
- Tumeurs génitales, femme
- Troubles gonadiques
- Maladies du col de l'utérus
- Maladies vulvaires
- Maladies des trompes de Fallope
- Maladies vaginales
- Conditions pathologiques, signes et symptômes
- Tumeurs ovariennes
- Tumeurs du col de l'utérus
- Tumeurs vulvaires
- Tumeurs des trompes de Fallope
- Tumeurs utérines
- Fistule
- Tumeurs vaginales
- Thérapeutique
- Radiothérapie
- Retraitement
- Repeuplement
Autres numéros d'identification d'étude
- REGYNE(RA)DIATION
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
Description du régime IPD
Informations sur les médicaments et les dispositifs, documents d'étude
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