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Combination Chemotherapy Followed By Chemoradiotherapy, With or Without Surgery, in Treating Patients With Resectable Locally Advanced Cancer of the Esophagus or Gastroesophageal Junction

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Radiation Therapy Oncology Group
ClinicalTrials.gov Identifier:
NCT00069953
First received: October 3, 2003
Last updated: October 14, 2014
Last verified: October 2014

October 3, 2003
October 14, 2014
September 2003
March 2007   (final data collection date for primary outcome measure)
Overall Survival (1-year Rate Reported) [ Time Frame: From registration to date of death or last follow-up. Analysis occurs after all patients have been potentially followed for 1 year. ] [ Designated as safety issue: No ]
One-year survival estimate is reported. Survival time is defined as time from registration to date of death from any cause and is estimated by the Kaplan-Meier method. Patients last known to be alive are censored at date of last contact. This analysis was planned to occur when all patients had been potentially followed for 1 year. On the basis of a 1-year survival rate of 60% from the Radiation Therapy Oncology Group (RTOG) esophageal database, 38 analyzable patients with a 1-year survival rate of 77.5% or better was needed for this trial to be deemed promising enough for development of a Phase III protocol (type I error of 0.05 and type II error of 0.20).
Not Provided
Complete list of historical versions of study NCT00069953 on ClinicalTrials.gov Archive Site
  • Frequency of Major (Grade 4) Acute Treatment-related Toxicities [ Time Frame: From start of chemotherapy to surgery or 2 months after chemoradiation (for patients not undergoing surgery). ] [ Designated as safety issue: Yes ]
  • Frequency of Patients With Persistent or Recurrent Disease Eligible for Surgical Salvage Resection [ Time Frame: Analysis occurs with the primary outcome measure. ] [ Designated as safety issue: No ]
Not Provided
Not Provided
Not Provided
 
Combination Chemotherapy Followed By Chemoradiotherapy, With or Without Surgery, in Treating Patients With Resectable Locally Advanced Cancer of the Esophagus or Gastroesophageal Junction
A Phase II Study Of Paclitaxel-Based Chemoradiotherapy Regimen With Selective Surgical Salvage For Resectable Locoregionally Advanced Carcinoma Of The Esophagus

RATIONALE: Drugs used in chemotherapy such as paclitaxel, fluorouracil, and cisplatin use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining chemotherapy with radiation therapy may kill more tumor cells

PURPOSE: This phase II trial is studying how well combination chemotherapy followed by chemoradiotherapy, with or without surgery, works in treating patients with resectable locally advanced cancer of the esophagus or gastroesophageal junction.

OBJECTIVES:

  • Determine the feasibility of treatment with paclitaxel, cisplatin, and fluorouracil followed by chemoradiotherapy and possible surgical salvage in patients with resectable locally advanced carcinoma of the esophagus or gastroesophageal junction.
  • Determine the overall and disease-free survival of patients treated with this regimen.
  • Determine the treatment-related toxicity of this regimen in these patients.
  • Determine the tolerance to surgical salvage in patients treated with this regimen.
  • Determine the morbidity and mortality of surgical salvage in patients treated with this regimen.

OUTLINE: This is a multicenter study.

  • Induction therapy: Patients receive fluorouracil (5-FU) IV continuously over 96 hours beginning on days 1 and 29; cisplatin IV over 1 hour on days 1-5 and 29-33; paclitaxel IV over 2 hours on days 1 and 29; and pegfilgrastim subcutaneously (SC) on days 6 and 34 OR filgrastim (G-CSF) SC on days 6-15 and 34-42. Treatment continues in the absence of unacceptable toxicity.
  • Chemoradiotherapy: Patients receive cisplatin IV over 1 hour on days 57-61 and 5-FU IV continuously on days 57-61, 64-68, 71-75, 78-82, 85-89, and 92-96. Patients concurrently undergo external beam radiotherapy on days 57-61, 64-68, 71-75, 78-82, 85-89, and 92-96.

Patients with residual or recurrent esophageal disease 4-6 weeks after completion of chemoradiotherapy may undergo salvage esophagectomy.

Patients are followed periodically.

PROJECTED ACCRUAL: A total of 42 patients will be accrued for this study within 18 months.

Interventional
Phase 2
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Esophageal Cancer
  • Biological: filgrastim
    During induction therapy, patients ≤ 70 kg will receive 300 μg OR patients >70 kg will receive 480 μg subcutaneously on days 6-15 and 34-42.
    Other Name: G-CSF
  • Biological: pegfilgrastim
    During induction therapy, patients receive 6 mg subcutaneously on days 6 and 34.
    Other Name: PEG-G-CSF
  • Drug: cisplatin
    During induction therapy, patients receive 15 mg/m^2/day by IV over 1 hour on days 1-5 and 29-33. During radiotherapy, patients receive 15 mg/m^2/day by IV over 1 hour beginning on days 57-61.
  • Drug: fluorouracil
    During induction therapy, patients receive 650 mg/m^2/day by IV continuously over 96 hours beginning on days 1 and 29. During radiotherapy, patients receive 300 mg/m^2/day by IV continuously over 96 hours beginning on day 57 for 5 cycles.
    Other Name: 5-FU
  • Drug: paclitaxel
    During induction therapy, patients receive 200 mg/m^2/day by IV over 2 hours on days 1 and 29.
  • Procedure: conventional surgery
    Patients with residual or recurrent esophageal disease 4-6 weeks after completion of chemoradiotherapy may undergo salvage esophagectomy.
  • Radiation: radiation therapy
    External beam radiotherapy with megavoltage linear accelerators (> 6 MV) will be used to deliver multiple (> 2) field techniques. Patients will be treated 5 days/week at 1.8 Gy/day for 28 days for a total dose of 50.4 Gy.
Experimental: ChemoRT and selective surgery
Induction therapy of fluorouracil, cisplatin, paclitaxel, and pegfilgrastim OR filgrastim, then chemoradiotherapy of concurrent cisplatin and fluorouracil with external beam radiotherapy (RT), followed by selective salvage therapy.
Interventions:
  • Biological: filgrastim
  • Biological: pegfilgrastim
  • Drug: cisplatin
  • Drug: fluorouracil
  • Drug: paclitaxel
  • Procedure: conventional surgery
  • Radiation: radiation therapy

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Active, not recruiting
43
Not Provided
March 2007   (final data collection date for primary outcome measure)

DISEASE CHARACTERISTICS:

  • Histologically confirmed squamous cell carcinoma or adenocarcinoma of the esophagus or gastroesophageal junction

    • Primary (non-recurrent) disease
    • Amenable to resection
    • Stage greater than T1, N0 by endoscopic ultrasound
    • Must be entirely confined to the esophagus or gastroesophageal junction and periesophageal soft tissue
    • Tumor may not extend more than 2 cm into the stomach
  • No multiple primary carcinomas of the esophagus
  • No cervical esophageal carcinoma or tumors less than 5 cm from cricopharyngeus
  • No evidence of disseminated cancer

    • Suggestion of liver metastases by positron emission tomography must be proven negative by biopsy or other imaging studies
    • Palpable supraclavicular nodes must be negative for cancer by biopsy
  • Bronchoscopy required for lesions less than 26 cm from the incisors to exclude tracheoesophageal fistula or invasion
  • No celiac adenopathy greater than 2 cm

PATIENT CHARACTERISTICS:

Age

  • 18 and over

Performance status

  • Zubrod 0-1

Life expectancy

  • Not specified

Hematopoietic

  • Absolute granulocyte count at least 1,500/mm^3
  • Platelet count at least 150,000/mm^3
  • Hemoglobin at least 10 g/dL

Hepatic

  • Not specified

Renal

  • Creatinine no greater than 1.5 mg/dL AND/OR
  • Creatinine clearance at least 65 mL/min
  • Calcium no greater than 11 mg/dL

Cardiovascular

  • No uncontrolled heart disease
  • No uncontrolled hypertension

Other

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • Able to comprehend study requirements and considered likely to comply with study parameters
  • No other malignancy within the past 5 years except curable nonmelanoma skin cancer or carcinoma in situ of the cervix
  • No uncontrolled diabetes
  • No hypersensitivity to E. coli-derived products

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • Not specified

Chemotherapy

  • More than 5 years since prior systemic chemotherapy

Endocrine therapy

  • Not specified

Radiotherapy

  • No prior chest or upper abdomen radiotherapy

Surgery

  • No prior esophageal or gastric surgery

Other

  • No concurrent photodynamic therapy
  • No other concurrent investigational agents for esophageal carcinoma
Both
18 Years and older
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00069953
RTOG-0246, CDR0000306455
Yes
Radiation Therapy Oncology Group
Radiation Therapy Oncology Group
National Cancer Institute (NCI)
Study Chair: Stephen G. Swisher, MD M.D. Anderson Cancer Center
Radiation Therapy Oncology Group
October 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP