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Chemotherapy and Pelvic Hypofractionated Radiation Followed by Brachytherapy for Cervical Cancer

Primary Purpose

Cervical Cancer

Status
Unknown status
Phase
Not Applicable
Locations
Mexico
Study Type
Interventional
Intervention
Hypofractionated therapy
Standard therapy
Sponsored by
National Institute of Cancerología
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cervical Cancer focused on measuring hypofractionated radiotherapy, Brachytherapy

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Women over 18 years old
  • Cervical Cancer at IIIA, IIIB y IIIC1 FIGO´s clinical stages
  • Histology: squamous, adenosquamous or adenocarcinoma
  • No previous treatment
  • No distance metastases, discard by Positron Emission Tomography (PET)/CT
  • Functional State ECOG (Eastern Cooperative Oncology Group) 0-2
  • Complete Blood count obtained at least 14 days before admission to the study with adequate bone marrow function defined as:
  • Absolute neutrophil count ≥ 1,500 cell/mm3
  • Platelets ≥ 100,000 cell/mm3
  • Hemoglobin ≥ 10.0 g/dl
  • Leukocyte count ≥ 4000 cell/mm3
  • Adequate Renal Function defined as:
  • Serum Creatinine ≤ 1.5 mg/dl within 14 days before admission to the study
  • Patients with HIV infection (human immunodeficiency virus) must have a CD4 cell count ≥ 350 cells / mm3 measured within 14 days prior to study entry (no HIV test is required)
  • The patient must understand the protocol and provide the specific informed consent of the study before admission
  • Negative pregnancy test

Exclusion Criteria:

  • Patients who had chemotherapeutic, surgical and/or radiotherapy treatment for female reproductive tract pathologies
  • Previous invasive neoplasia (except non-melanoma skin cancer) unless there is complete remission of the disease of 3 years minimum (For example, breast cancer or oral cavity cancer)
  • Previous systemic chemotherapy for current cervical cancer, take into account that prior chemotherapy for a different cancer is accepted, as long as they have been at least 3 years
  • Severe active or non-controlled co-morbidities, defined as:
  • Unstable angina and/or congestive heart failure that required hospitalization in the last 6 months.
  • Transmural myocardial infarction in the last 6 months.
  • Acute bacterial or fungal infection requiring intravenous antibiotics at the beginning of the study.
  • Chronic obstructive pulmonary disease exacerbation or another respiratory disease that requires hospitalization or that contraindicates the trial therapy at the time of admission.
  • Crohn's disease or ulcerative colitis.
  • Prior allergic reaction to cisplatin or other drugs based on platinum.
  • Other factors that contraindicate experimental therapy.

Sites / Locations

  • David Cantu de LeonRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Standard treatment

Experimental treatment

Arm Description

Cisplatin 40mg/m2 weekly and concomitant pelvic radiotherapy (45 Gray/25 fractions) followed by brachytherapy 28Gray at point A.

Cisplatin 40mg/m2 weekly and hypofractionated concomitant external radiotherapy (37,50 Gray/15 fractions) followed by brachytherapy 28 Gray at point A.

Outcomes

Primary Outcome Measures

Acute and late toxicity
Number of Participants With Treatment-Related Adverse Events as Assessed by RTOG

Secondary Outcome Measures

Treatment efficacy
Hypofractionated radiotherapy is similar in toxicity and disease control compared to standard external beam treatment
Disease-free survival rate
Number of participants dead of disease at two years according to kaplan-meyer analysis
Overall survival rate
Number ofpParticipants dead at two years according to kaplan-meyer analysis
Satisfaction assessed by EORTC
Assessed individual's overall satisfaction with life and general sense of personal well-being by ERTC QLQ-C30 and QLQ-CX24 questionaire
Direct and indirect costs related to treatment.
Direct costs related to the treatment. Indirect costs related to the treatment (transport, housing, food, etc.)

Full Information

First Posted
August 22, 2019
Last Updated
September 1, 2020
Sponsor
National Institute of Cancerología
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1. Study Identification

Unique Protocol Identification Number
NCT04070976
Brief Title
Chemotherapy and Pelvic Hypofractionated Radiation Followed by Brachytherapy for Cervical Cancer
Official Title
Phase II Randomized Controlled Trial of Concomitant Chemoradiotherapy With Standard Fractionation Compared to Hypofractionated Concomitant Chemoradiotherapy Followed by Brachytherapy, for Clinical Stage III Cervical Cancer Patients
Study Type
Interventional

2. Study Status

Record Verification Date
September 2020
Overall Recruitment Status
Unknown status
Study Start Date
July 1, 2019 (Actual)
Primary Completion Date
July 30, 2022 (Anticipated)
Study Completion Date
December 30, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
National Institute of Cancerología

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The main goal of this trial is to assess the safety and response rate to concomitant chemotherapy and external hypofractionated radiotherapy followed by brachytherapy in patients with clinical stage III cervical cancer. The trial will take place in the National Cancer Institute (INCan). Patients will be randomized into two groups: chemotherapy with external standard fractionated radiotherapy (45 Gy in 25 fractions) followed by brachytherapy or chemotherapy with external hypofractionated radiotherapy (37.5 Gy in 15 fractions) followed by brachytherapy.
Detailed Description
The primary endpoint will be to assess the safety and efficacy to concomitant chemoradiotherapy followed by brachytherapy in cervical cancer clinical stage III. Secondary endpoints comprises security profile, survival rates, quality of life and related costs. The data obtained by this protocol will allow to determine the effect of hypofractionated radiation therapy and its possible adverse effects. Side effects will be classified according to version 4.03 of CTCAE guidelines. The highest CTCAE grade will be obtained for each type of event, for each patient and the Radiation Therapy Oncology Group (RTOG) scale will be applied to evaluate the events related to conventional and hypofractionated radiotherapy, as well as brachytherapy. Quality of life (QOL) will be evaluated using EORTC QLQ-CX24 and EORTC QLQ-C30, both have been validated and available in Mexican Spanish. Direct and indirect expenses related to the treatment will be evaluated based on the treatment costs stipulate by the institution and the information obtained by the social workers.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cervical Cancer
Keywords
hypofractionated radiotherapy, Brachytherapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
82 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Standard treatment
Arm Type
Active Comparator
Arm Description
Cisplatin 40mg/m2 weekly and concomitant pelvic radiotherapy (45 Gray/25 fractions) followed by brachytherapy 28Gray at point A.
Arm Title
Experimental treatment
Arm Type
Experimental
Arm Description
Cisplatin 40mg/m2 weekly and hypofractionated concomitant external radiotherapy (37,50 Gray/15 fractions) followed by brachytherapy 28 Gray at point A.
Intervention Type
Radiation
Intervention Name(s)
Hypofractionated therapy
Intervention Description
All patients will be treated with an external beam of 37.5 Gray in 15 fractions (2.5 Gray / fraction). They will be treated once a day, 5 days a week. If photon energy 6 MV or 10 MV is used, the patient should be treated with a 4-field technique using the anterior/posterior field and 2 lateral fields. The specification of the dose is in terms of a dose to a point at or near the center of the target volume. For all field dispositions, the dose specification point is the common isocenter of all beams.
Intervention Type
Radiation
Intervention Name(s)
Standard therapy
Intervention Description
All patients will be treated with external beam radiotherapy with 50 Gray in 25 fractions (1.8-2 Gray / fraction). They will be treated once a day, 5 days a week. If photon energy 6 MV or 10 MV is used, the patient should be treated with a 4-field technique using anterior/posterior fields and 2 lateral fields. The specification of the dose is in terms of a dose to a point at or near the center of the target volume. For all field dispositions, the dose specification point is the common isocenter of all beams.
Primary Outcome Measure Information:
Title
Acute and late toxicity
Description
Number of Participants With Treatment-Related Adverse Events as Assessed by RTOG
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Treatment efficacy
Description
Hypofractionated radiotherapy is similar in toxicity and disease control compared to standard external beam treatment
Time Frame
2 years
Title
Disease-free survival rate
Description
Number of participants dead of disease at two years according to kaplan-meyer analysis
Time Frame
2 years
Title
Overall survival rate
Description
Number ofpParticipants dead at two years according to kaplan-meyer analysis
Time Frame
2 years
Title
Satisfaction assessed by EORTC
Description
Assessed individual's overall satisfaction with life and general sense of personal well-being by ERTC QLQ-C30 and QLQ-CX24 questionaire
Time Frame
2 years
Title
Direct and indirect costs related to treatment.
Description
Direct costs related to the treatment. Indirect costs related to the treatment (transport, housing, food, etc.)
Time Frame
2 years

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Women over 18 years old Cervical Cancer at IIIA, IIIB y IIIC1 FIGO´s clinical stages Histology: squamous, adenosquamous or adenocarcinoma No previous treatment No distance metastases, discard by Positron Emission Tomography (PET)/CT Functional State ECOG (Eastern Cooperative Oncology Group) 0-2 Complete Blood count obtained at least 14 days before admission to the study with adequate bone marrow function defined as: Absolute neutrophil count ≥ 1,500 cell/mm3 Platelets ≥ 100,000 cell/mm3 Hemoglobin ≥ 10.0 g/dl Leukocyte count ≥ 4000 cell/mm3 Adequate Renal Function defined as: Serum Creatinine ≤ 1.5 mg/dl within 14 days before admission to the study Patients with HIV infection (human immunodeficiency virus) must have a CD4 cell count ≥ 350 cells / mm3 measured within 14 days prior to study entry (no HIV test is required) The patient must understand the protocol and provide the specific informed consent of the study before admission Negative pregnancy test Exclusion Criteria: Patients who had chemotherapeutic, surgical and/or radiotherapy treatment for female reproductive tract pathologies Previous invasive neoplasia (except non-melanoma skin cancer) unless there is complete remission of the disease of 3 years minimum (For example, breast cancer or oral cavity cancer) Previous systemic chemotherapy for current cervical cancer, take into account that prior chemotherapy for a different cancer is accepted, as long as they have been at least 3 years Severe active or non-controlled co-morbidities, defined as: Unstable angina and/or congestive heart failure that required hospitalization in the last 6 months. Transmural myocardial infarction in the last 6 months. Acute bacterial or fungal infection requiring intravenous antibiotics at the beginning of the study. Chronic obstructive pulmonary disease exacerbation or another respiratory disease that requires hospitalization or that contraindicates the trial therapy at the time of admission. Crohn's disease or ulcerative colitis. Prior allergic reaction to cisplatin or other drugs based on platinum. Other factors that contraindicate experimental therapy.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
David F Cantú-de León, Md, MSc. PhD
Phone
+525537093156
Email
dfcantu@gmail.com
First Name & Middle Initial & Last Name or Official Title & Degree
Lenny N Gallardo-Alvarado, MD, MSc
Phone
+52553702118
Email
dra.ngallardo@yahoo.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David F Cantú-deLeón
Organizational Affiliation
Instituto Nacional de Cancerología
Official's Role
Principal Investigator
Facility Information:
Facility Name
David Cantu de Leon
City
Mexico City
State/Province
Tlalpan
ZIP/Postal Code
14080
Country
Mexico
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
David F Cantu-de Leon, MD. Msc. Phd
Phone
+5215537093116
Email
dfcantu@gmail.com

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
all IPD that underlie results in a publication
IPD Sharing Time Frame
2 years
IPD Sharing Access Criteria
the data will be shared with scientific and academic institutions or research groups that study the same topic and with the regulatory and ethical authorities that require it, to ensure the quality and accuracy of the data.
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Links:
URL
https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer
Description
Human papillomavirus (HPV) and cervical cancer [Internet]

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Chemotherapy and Pelvic Hypofractionated Radiation Followed by Brachytherapy for Cervical Cancer

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