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Radiofrequency Ablation for Patients With Esophageal Squamous Cell Neoplasia

Primary Purpose

ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Status
Completed
Phase
Not Applicable
Locations
China
Study Type
Interventional
Intervention
Radiofrequency Ablation
Sponsored by
Covidien, GI Solutions
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for ESOPHAGEAL SQUAMOUS CELL CARCINOMA focused on measuring ESCN, RFA

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Subject is 18-80 years of age, inclusive
  2. Subject meets at least one of the following inclusion criteria:

    1. Within the last 3 months, subject demonstrated a new diagnosis or a reconfirmed diagnosis of squamous MGIN and/or HGIN of the esophagus, or...
    2. within the last 3 months, subject demonstrated a new diagnosis of a flat-type (type 0-IIb) SCCA (G1/G2 only)
  3. On endoscopic examination, subject has at least one USL that measures at least 3 cm in at least one dimension and has MGIN or worse (MGIN+) on biopsy
  4. The maximum allowable linear length of "USL-bearing esophagus" is 12 cm
  5. Baseline EUS (all patients) shows no exclusionary findings for the trial
  6. CT scan of chest and upper third of the abdomen (all HGIN and SCCA patients) shows no exclusionary findings for the trial
  7. Subject is not pregnant nor has plans to become pregnant in the ensuing 12 months (confirmation of non-pregnant status in women of child-bearing age and ability required with urine or blood test)
  8. Subject is eligible for treatment and follow-up endoscopy and biopsy as required by the protocol
  9. The subject is willing to provide written, informed consent to participate in this clinical study and understands the responsibilities of trial participation

Exclusion Criteria:

the Eligibility CRF.

  1. Esophageal stricture preventing passage of a therapeutic endoscope
  2. Any prior endoscopic resection
  3. Any esophageal dilation in the past 12 months
  4. Any history of a non-squamous cell cancer of the esophagus, or any history of a squamous cell cancer of the esophagus (any stage) prior to 3 months before screening for this trial
  5. Any N or M positive status, if patient has a present diagnosis of esophageal SCCA
  6. Any previous ablative therapy within the esophagus (photodynamic therapy, multipolar electrical coagulation, argon plasma coagulation, laser treatment, or other) or any radiation therapy to the esophagus.
  7. Any previous esophageal surgery, except fundoplication without complications (i.e. no slippage, dysphagia, etc)
  8. Evidence of esophageal varices detected within last 6 months or at initial RFA procedure
  9. Evidence of eosinophilic esophagitis on endoscopy and/or histology
  10. Report of uncontrolled coagulopathy with international normalized ratio (INR) > 2 or platelet count <75,000 platelets per µL (note: a complete blood count is not required for all subjects in this study)
  11. Subject is using aspirin, clopidogrel, or non-steroidal anti-inflammatory drugs that can not be discontinued 7 days before and after therapeutic sessions
  12. Subject has a known history of unresolved drug or alcohol dependency that would limit ability to comprehend or follow instructions related to informed consent, post-treatment instructions, or follow-up guidelines
  13. Subject has an implantable pacing device (examples; AICD, neurostimulator, cardiac pacemaker) and has not received clearance for enrollment in this study by specialist responsible for the pacing device
  14. Subject suffers from psychiatric or other illness deemed by the investigator as an inability to comply with protocol
  15. Subject has life expectancy less than 2 years

Sites / Locations

  • Cancer Institute and Hospital, Chinese Academy of Medical Sciences

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Radiofrequency ablation

Arm Description

To study the safety and effectiveness of radiofrequency ablation (RFA) using the HALO ablation system in completely eradicating the diseased epithelium in patients with ESCN

Outcomes

Primary Outcome Measures

Complete Response
The percentage of subjects demonstrating complete response (CR) defined as complete histological clearance of MGIN, HGIN and SCCA in the treatment area at 12 months after the initial ablation procedure

Secondary Outcome Measures

Full Information

First Posted
January 24, 2014
Last Updated
May 11, 2020
Sponsor
Covidien, GI Solutions
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1. Study Identification

Unique Protocol Identification Number
NCT02047305
Brief Title
Radiofrequency Ablation for Patients With Esophageal Squamous Cell Neoplasia
Official Title
A Single-center Trial of Endoscopic Radiofrequency Ablation of Moderate and High-grade Intra-epithelial Squamous Neoplasia and Early Flat-type Squamous Cell Carcinoma Using the HALO Ablation System
Study Type
Interventional

2. Study Status

Record Verification Date
March 2020
Overall Recruitment Status
Completed
Study Start Date
January 2009 (undefined)
Primary Completion Date
August 2016 (Actual)
Study Completion Date
November 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Covidien, GI Solutions

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Patients with MGIN, HGIN or flat-type early SCCA of the esophagus will be treated on 3 month intervals with Radiofrequency Ablation (RFA) until complete eradication (CR: no MGIN or worse in the biopsies) will be achieved. All patients will undergo an endoscopy at 12 months after baseline, and the patients with CR will undergo annual endoscopy with biopsies for 5 years.
Detailed Description
A patient population with a histopathological diagnosis of moderate-grade intra-epithelial neoplasia (MGIN), high-grade intra-epithelial neoplasia (HGIN) and/or early flat-type SCCA of the esophagus, in lesions measuring 3 to 12cm in length, will be treated with radiofrequency ablation (RFA) using the HALO ablation system. Additional RFA sessions will be performed on 3 month intervals until complete response (CR; no MGIN or worse in biopsies) will be achieved. All patients will then undergo an endoscopy at 12 months after baseline. Patients with CR at 12 months will be followed-up for 5 years with annual endoscopy and biopsies, and additional treatment if necessary. Patients with no CR at 12 months are considered failures.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Keywords
ESCN, RFA

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
96 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Radiofrequency ablation
Arm Type
Experimental
Arm Description
To study the safety and effectiveness of radiofrequency ablation (RFA) using the HALO ablation system in completely eradicating the diseased epithelium in patients with ESCN
Intervention Type
Device
Intervention Name(s)
Radiofrequency Ablation
Other Intervention Name(s)
RFA, Barrx ablation system, HALO ablation system
Intervention Description
Patients with a histopathological diagnosis of moderate-grade intra-epithelial neoplasia (MGIN), high-grade intra-epithelial neoplasia (HGIN) and/or early flat-type SCCA of the esophagus, are treated with radiofrequency ablation, with repeat endoscopy and follow-up treatment at 3 month intervals.
Primary Outcome Measure Information:
Title
Complete Response
Description
The percentage of subjects demonstrating complete response (CR) defined as complete histological clearance of MGIN, HGIN and SCCA in the treatment area at 12 months after the initial ablation procedure
Time Frame
12 Month

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject is 18-80 years of age, inclusive Subject meets at least one of the following inclusion criteria: Within the last 3 months, subject demonstrated a new diagnosis or a reconfirmed diagnosis of squamous MGIN and/or HGIN of the esophagus, or... within the last 3 months, subject demonstrated a new diagnosis of a flat-type (type 0-IIb) SCCA (G1/G2 only) On endoscopic examination, subject has at least one USL that measures at least 3 cm in at least one dimension and has MGIN or worse (MGIN+) on biopsy The maximum allowable linear length of "USL-bearing esophagus" is 12 cm Baseline EUS (all patients) shows no exclusionary findings for the trial CT scan of chest and upper third of the abdomen (all HGIN and SCCA patients) shows no exclusionary findings for the trial Subject is not pregnant nor has plans to become pregnant in the ensuing 12 months (confirmation of non-pregnant status in women of child-bearing age and ability required with urine or blood test) Subject is eligible for treatment and follow-up endoscopy and biopsy as required by the protocol The subject is willing to provide written, informed consent to participate in this clinical study and understands the responsibilities of trial participation Exclusion Criteria: the Eligibility CRF. Esophageal stricture preventing passage of a therapeutic endoscope Any prior endoscopic resection Any esophageal dilation in the past 12 months Any history of a non-squamous cell cancer of the esophagus, or any history of a squamous cell cancer of the esophagus (any stage) prior to 3 months before screening for this trial Any N or M positive status, if patient has a present diagnosis of esophageal SCCA Any previous ablative therapy within the esophagus (photodynamic therapy, multipolar electrical coagulation, argon plasma coagulation, laser treatment, or other) or any radiation therapy to the esophagus. Any previous esophageal surgery, except fundoplication without complications (i.e. no slippage, dysphagia, etc) Evidence of esophageal varices detected within last 6 months or at initial RFA procedure Evidence of eosinophilic esophagitis on endoscopy and/or histology Report of uncontrolled coagulopathy with international normalized ratio (INR) > 2 or platelet count <75,000 platelets per µL (note: a complete blood count is not required for all subjects in this study) Subject is using aspirin, clopidogrel, or non-steroidal anti-inflammatory drugs that can not be discontinued 7 days before and after therapeutic sessions Subject has a known history of unresolved drug or alcohol dependency that would limit ability to comprehend or follow instructions related to informed consent, post-treatment instructions, or follow-up guidelines Subject has an implantable pacing device (examples; AICD, neurostimulator, cardiac pacemaker) and has not received clearance for enrollment in this study by specialist responsible for the pacing device Subject suffers from psychiatric or other illness deemed by the investigator as an inability to comply with protocol Subject has life expectancy less than 2 years
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Guiqi Wang, MD
Organizational Affiliation
Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
Official's Role
Principal Investigator
Facility Information:
Facility Name
Cancer Institute and Hospital, Chinese Academy of Medical Sciences
City
Beijing
ZIP/Postal Code
100021
Country
China

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
25668428
Citation
He S, Bergman J, Zhang Y, Weusten B, Xue L, Qin X, Dou L, Liu Y, Fleischer D, Lu N, Dawsey SM, Wang GQ. Endoscopic radiofrequency ablation for early esophageal squamous cell neoplasia: report of safety and effectiveness from a large prospective trial. Endoscopy. 2015 May;47(5):398-408. doi: 10.1055/s-0034-1391285. Epub 2015 Feb 10.
Results Reference
result
PubMed Identifier
21839994
Citation
Bergman JJ, Zhang YM, He S, Weusten B, Xue L, Fleischer DE, Lu N, Dawsey SM, Wang GQ. Outcomes from a prospective trial of endoscopic radiofrequency ablation of early squamous cell neoplasia of the esophagus. Gastrointest Endosc. 2011 Dec;74(6):1181-90. doi: 10.1016/j.gie.2011.05.024. Epub 2011 Aug 15.
Results Reference
result
PubMed Identifier
30905354
Citation
Yu X, van Munster SN, Zhang Y, Xue L, Fleischer DE, Weusten BLAM, Lu N, Dawsey SSM, Bergman JJGHM, Wang G. Durability of radiofrequency ablation for treatment of esophageal squamous cell neoplasia: 5-year follow-up of a treated cohort in China. Gastrointest Endosc. 2019 Apr;89(4):736-748.e2. doi: 10.1016/j.gie.2018.10.030. Epub 2018 Oct 26.
Results Reference
derived

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Radiofrequency Ablation for Patients With Esophageal Squamous Cell Neoplasia

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