Regional Anesthesia and Lung Cancer Recurrence

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01179308
Recruitment Status : Terminated (The principal investigator decided to close this study site.)
First Posted : August 11, 2010
Last Update Posted : September 15, 2016
Information provided by (Responsible Party):
Andrea Kurz, The Cleveland Clinic

Brief Summary:
Test the effect of combined regiona/general anesthesia on lung cancer recurrence compared to general anesthesia alone.

Condition or disease Intervention/treatment Phase
Lung Cancer Other: General-epidural anesthesia Other: Balanced general anesthesia and postoperative opioids Not Applicable

Detailed Description:

Surgery is the primary treatment of lung cancer, but surgery releases tumor cells into the systemic circulation. Whether this minimal residual disease results in clinical metastases is a function of host defense. At least three perioperative factors shift the balance toward initiation and progression of minimal residual disease. (1) Surgery per se depresses cell-mediated immunity, reduces concentrations of tumor-related anti-angiogenic factors (e.g., angiostatin and endostatin), and increases concentrations of pro-angiogenic factors such as VEGF. (2) Anesthesia impairs numerous immune functions, including neutrophil, macrophages, dendritic cells, T lymphocytes (T-cell), and Natural killer cell (NK-cell) functions. (3) Opioid analgesics inhibit both cellular and humoral immune function in humans, and promote tumor growth in rodents. Regional analgesia attenuates each of these adverse effects. For example, regional anesthesia largely prevents the neuroendocrine stress response to surgery by blocking afferent neural transmission. With combined regional and general anesthesia/analgesia, the amount of general anesthetic required is much reduced — as is, presumably, immune suppression. And finally, regional analgesia provides superb pain relief, essentially obliterating the need for postoperative opioids. Animal studies show that regional anesthesia improves natural kill cell function and reduces the metastatic burden in animals inoculated with carcinoma cells. Preliminary retrospective data in cancer patients showed, that paravertebral analgesia for breast cancer surgery reduced risk of recurrence or metastasis by 40% during a 2.5 to 4-year follow-up period.

The investigators thus propose to evaluate the effect of combined epidural-general anesthesia compared to general anesthesia on cancer recurrence semi-annually over a period of 5 years.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 67 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Supportive Care
Official Title: The Effect of Adding Intraoperative Regional Anesthesia on Cancer Recurrence in Patients Undergoing Lung Cancer Resection
Study Start Date : August 2010
Actual Primary Completion Date : August 2015
Actual Study Completion Date : August 2015

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: General-epidural anesthesia
Epidural and general anesthesia
Other: General-epidural anesthesia
General anesthesia combined with epidural anesthesia

Active Comparator: General anesthesia
General anesthesia alone
Other: Balanced general anesthesia and postoperative opioids
General anesthesia alone

Primary Outcome Measures :
  1. disease-free survival [ Time Frame: up to 5 years after surgery ]
    The effect of regional versus general anesthesia on the primary outcome of disease-free survival (time to the earlier or recurrence or death from any cause)

Secondary Outcome Measures :
  1. NK cell function [ Time Frame: up to three years post procedure ]
    Secondary outcomes measured at repeated perioperative time points, include NK cell function, immune-function markers (cytokines, cortisol) and pain.

  2. Immune function markers [ Time Frame: for up to 3 years post procedure ]
    Secondary outcomes measured at repeated perioperative time points, include NK cell function, immune-function markers (cytokines, cortisol) and pain.

  3. Pain [ Time Frame: up to 3 years post proceudure ]
    Secondary outcomes measured at repeated perioperative time points, include NK cell function, immune-function markers (cytokines, cortisol) and pain.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Primary non-small cell lung cancer (stage 1-3) as determined according to the IASLC Lung Cancer Staging Project;
  • Scheduled for potentially curative tumor resection;
  • Written informed consent, including willingness to be randomized to epidural anesthesia/analgesia plus general anesthesia or to general anesthesia and postoperative opioid analgesia.

Exclusion Criteria:

  • Any contraindication to epidural anesthesia, (including coagulopathy, abnormal anatomy).
  • Any contraindication to midazolam, propofol, sevoflurane, fentanyl, morphine, or hydromorphone.
  • Age < 18 or > 85 years old.
  • Other cancer not believed by the attending surgeon to be in long-term remission.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01179308

United States, Ohio
Cleveland Clinic
Cleveland, Ohio, United States, 44195
Shanghai Chest Hospital
Shanghai, China
Sponsors and Collaborators
The Cleveland Clinic
Principal Investigator: Andrea Kurz, M.D. The Cleveland Clinic

Responsible Party: Andrea Kurz, Principal Investigator, The Cleveland Clinic Identifier: NCT01179308     History of Changes
Obsolete Identifiers: NCT00999726
Other Study ID Numbers: 10-610
First Posted: August 11, 2010    Key Record Dates
Last Update Posted: September 15, 2016
Last Verified: September 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Keywords provided by Andrea Kurz, The Cleveland Clinic:
regional analgesia
routine general anesthesia
immune system response
lung cancer (stage 1-3)

Additional relevant MeSH terms:
Lung Neoplasms
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Lung Diseases
Respiratory Tract Diseases
Disease Attributes
Pathologic Processes
Central Nervous System Depressants
Physiological Effects of Drugs