Efficacy Study of Adding Chemotherapy to Radiotherapy for Treating Bladder Cancer.
A Randomised Trial of Radical Chemo/Radiotherapy vs Radiotherapy Alone in the Definitive Management of Localised Muscle Invasive TCC of the Urinary Bladder
Studieöversikt
Status
Betingelser
Intervention / Behandling
Detaljerad beskrivning
Whilst concurrent chemo-radiation is increasingly being looked upon as the treatment of choice for patients referred for bladder preservation, the study by the NCI of Canada (Coppin CM, Gospodarowicz MK et al.Improved Local Control of Invasive Bladder Cancer by Concurrent Cisplatin and Pre-operative or Definitive Radiation.J. of Clinical Oncol. 14(11): 2901-2907, 1996) is the only randomised trial to show some superiority of concurrent Cisplatin and radiation treatment over radiation alone in increasing pelvic tumour control. There was no impact on overall survival. However, this study had relatively small subject numbers and included two distinct treatment options. In one group the patients were treated with a bladder sparing approach and in the other by pre-operative therapy and cystectomy with the type of definitive treatment being decided upon by both the treating Specialist and patient. At 5 years the pelvic failure rates in the radiation alone and chemo-radiation arms were 59% and 40% respectively. With half of the patients in each group having had planned cystectomy as part of their treatment regimen, the above rates of local relapse (especially in the chemo-radiation arm) are disappointing.
Given the concerns with the above study, and the continuing paucity of randomised phase III studies comparing chemo-radiation with radiation alone, there lies an opportunity for Australasian centres to take up the challenge. For this study, the proposed schedule for the chemo-radiation arm is to be the same as that being investigated in our previous phase II study (six weekly doses of Cisplatin plus radiation to a dose of 64Gy in 32 fractions over 6.5 weeks). This will be compared with radical radiation alone (64Gy in 32 fractions over 6.5 weeks).
Studietyp
Inskrivning (Faktisk)
Fas
- Fas 3
Kontakter och platser
Studieorter
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New South Wales
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Liverpool, New South Wales, Australien, 1871
- Liverpool Hospital
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Newcastle, New South Wales, Australien, 2298
- Calvary Mater Newcastle
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Penrith, New South Wales, Australien, 2751
- Nepean Cancer Care Centre
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Randwick, New South Wales, Australien, 2031
- Prince of Wales Hospital
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Wentworthville, New South Wales, Australien, 2145
- Westmead Hospital
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Queensland
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Brisbane, Queensland, Australien, 4120
- Mater Centre - South Brisbane
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Douglas, Queensland, Australien, 4814
- Townsville Hospital
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Herston, Queensland, Australien, 4029
- Royal Brisbane Hospital
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Tugun, Queensland, Australien, 4224
- East Coast Cancer Centre
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Woolloongabba, Queensland, Australien, 4102
- Princess Alexandra Hospital
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South Australia
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Adelaide, South Australia, Australien, 5000
- Royal Adelaide Hospital
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Tasmania
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Launceston, Tasmania, Australien, 7250
- Launceston General Hospital
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Victoria
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East Melbourne, Victoria, Australien, 3002
- Peter MacCallum Cancer Centre
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Geelong, Victoria, Australien, 3220
- Andrew Love Cancer Care Centre, Geelong Hospital
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Prahran, Victoria, Australien, 3181
- Alfred Hospital
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Western Australia
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Nedlands, Western Australia, Australien, 6009
- Sir Charles Gairdner Hospital
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Perth, Western Australia, Australien, 6000
- Royal Perth Hospital
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Auckland, Nya Zeeland, 1001
- Auckland Hospital
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Christchurch, Nya Zeeland, 4710
- Christchurch Hospital
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Dunedin, Nya Zeeland
- Dunedin Hospital
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Palmerston North, Nya Zeeland
- Palmerston North Hospital
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Wellington, Nya Zeeland, 7902
- Wellington Hospital
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Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
Inclusion Criteria:
- Histologically proven TCC of the urinary bladder. Mixed tumours comprising predominantly TCC and elements of squamous or adenomatous metaplasia or carcinoma are also eligible.
- Clinically and radiologically localised T2, T3 or T4a non-bulky disease (<= 7cm in maximum dimension), N0, M0.
If radiological evaluation of a lymph node is interpreted as "positive" this must be evaluated further by either lymph node sampling or percutaneous needle biopsy. Patients with histologically confirmed lymph node metastases will not be eligible.
- Maximal TUR.
N.B. Previous:
- partial cystectomy;
- endoscopic resection of bladder tumour/s;
- intravesical chemotherapy; or
- intravesical BCG
does not exclude the patient from being eligible. However, the patient should have an adequate functioning bladder (this should be clarified with the referring Urologist and if need be voiding volumes should be measured).
- Creatinine clearance >= 50ml/minute by calculation or measurement.
- A white blood cell count >= 3.5 x 10^9/L with an absolute neutrophil count >= 1.5 x 10^9/L and a platelet count >= 100 x 10^9/L.
- ECOG status of 0, 1 or 2.
- No age limit applies provided the patient is mentally, physically and geographically capable of undergoing treatment and follow-up.
- No significant intercurrent morbidity.
Exclusion Criteria:
- Pure squamous carcinomas or adenocarcinomas.
- Extensive or multifocal CIS change in the bladder.
- T3 or T4a tumours unsuitable for curative treatment (i.e. > 7cm in any dimension), T4b, node positive and metastatic disease.
- Presence of ureteric obstruction due to tumour infiltration at the UO not amenable to stenting.
- Previous radiation treatment to the pelvis.
- Previous significant pelvic surgery.
- Significant bowel or gynaecological inflammatory disease.
- Creatinine clearance < 50ml/minute by calculation or measurement. A white blood cell count < 3.5 x 10^9/L with an absolute neutrophil count < 1.5 x 10^9L and/or a platelet count < 100 x 10^9/L.
- Other considerations making patient unfit for Cisplatin therapy.
Prior or concurrent malignancy of any other site unless disease-free for greater than 5 years, except for:
- non-melanoma skin cancer, and/or
- (a) Stage T1 well differentiated prostatic carcinoma in men, and In situ carcinoma of the cervix in women.
- Bladder tumour - biopsy only. These patients must be referred back for more adequate resections or else should not be included
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Behandling
- Tilldelning: Randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Ingen (Open Label)
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
|---|---|
|
Experimentell: A
Synchronous chemo / radiation therapy
|
Weekly Cisplatin 35mg/m2 x 6 doses, IV administration
Andra namn:
64Gy reference dose in 32 fractions over 6.5 weeks
Andra namn:
|
|
Aktiv komparator: B
Radiation Alone
|
64Gy reference dose in 32 fractions over 6.5 weeks
Andra namn:
|
Vad mäter studien?
Primära resultatmått
Resultatmått |
Tidsram |
|---|---|
|
Invasive local failure at 3 years
Tidsram: 3 years
|
3 years
|
Sekundära resultatmått
Resultatmått |
Tidsram |
|---|---|
|
Complete response (CR) rate at 3 months from randomisation
Tidsram: 3 months
|
3 months
|
|
Disease-free survival
Tidsram: Final analysis when all patients have been followed for 3 years. (approx. 7 years from start of trial)
|
Final analysis when all patients have been followed for 3 years. (approx. 7 years from start of trial)
|
|
Overall survival
Tidsram: Final analysis when all patients have been followed for 3 years. (approx. 7 years from start of trial)
|
Final analysis when all patients have been followed for 3 years. (approx. 7 years from start of trial)
|
|
Cystectomy-free survival
Tidsram: Final analysis when all patients have been followed for 3 years. (approx. 7 years from start of trial)
|
Final analysis when all patients have been followed for 3 years. (approx. 7 years from start of trial)
|
|
Acute and late toxicity
Tidsram: Interim analyses will be performed on an annual basis.
|
Interim analyses will be performed on an annual basis.
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Pattern of failure (local, regional, distant)
Tidsram: Final analysis when all patients have been followed for 3 years. (approx. 7 years from start of trial)
|
Final analysis when all patients have been followed for 3 years. (approx. 7 years from start of trial)
|
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Quality of life measures
Tidsram: Final analysis when all patients have been followed for 3 years. (approx. 7 years from start of trial)
|
Final analysis when all patients have been followed for 3 years. (approx. 7 years from start of trial)
|
Samarbetspartners och utredare
Samarbetspartners
Utredare
- Studiestol: Kumar Gogna, Mater Centre - South Brisbane
Publikationer och användbara länkar
Studieavstämningsdatum
Studera stora datum
Studiestart
Primärt slutförande (Faktisk)
Avslutad studie (Faktisk)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Uppskatta)
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Ytterligare relevanta MeSH-villkor
Andra studie-ID-nummer
- TROG 02.03
- NHMRC 243100
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