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Transanal Endoscopic Microsurgery (TEM) After Radiochemotherapy for Rectal Cancer (CARTS)

The recruitment status of this study is unknown. The completion date has passed and the status has not been verified in more than two years.
Verified April 2012 by Radboud University.
Recruitment status was:  Recruiting
Information provided by (Responsible Party):
Radboud University Identifier:
First received: November 22, 2010
Last updated: April 10, 2012
Last verified: April 2012

In the Netherlands approximately 2300 new patients are diagnosed with rectal cancer each year. Standard treatment for patients with a T2 or T3 rectal cancer consists of preoperative short course of radiotherapy followed by surgery. In advanced cases long course of radiotherapy combined with chemotherapy is used instead of a short cause. In some of these advanced cases a complete remission is observed after a long course of radio-/chemotherapy. Patients who respond well to neo-adjuvant treatment carry a better prognosis.

Objective of this research is to evaluate whether neo-adjuvant chemo-/radiotherapy in small non-advanced rectal cancers can be used to obtain a complete or near complete remission. In these patients could a complete resection of the rectum as an organ be avoided by treating them with a local excision with the TEM-technique (Transanal Endoscopic Microsurgery) of the scar. The advantage for these patients is, that they do not need major abdominal surgery and in a substantial number of these patients the rectum can be preserved with a better function of continence.

Condition Intervention Phase
Rectal Tumour
Drug: Capecitabine
Radiation: radiotherapy
Procedure: TME resection
Procedure: TEM surgery
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment

Resource links provided by NLM:

Further study details as provided by Radboud University:

Primary Outcome Measures:
  • Response [ Time Frame: Baseline and 6 weeks after chemoradiation therapy ]
    the response of the rectal carcinoma to chemo-/radiotherapy defined as complete response (no visible disease); partial response (more than 50% reduction of the tumour mass); no response (meaning an increase of the tumour mass less than 25% or a decrease of the tumour mass less than 50%); or progressive disease when the tumour mass increase more than 25% of the original tumour mass.

Secondary Outcome Measures:
  • Quality of life [ Time Frame: baseline, 6-12-24 and 35 months after surgery ]
    Quality of life form EORTC-QLQC30 and 38. Determine the faecal continence and QOL after treatment with TEM surgery will be compared with TME treated patients.

  • Local Recurrence [ Time Frame: 36 months, 60 months after surgery last enrolled patient ]
    Careful follow-up will determine the local recurrence rate of patients treated with TEM and TME surgery. This will be standard colorectal cancer follow-up with additional endo-anal endography and MRI for patients treated with TEM surgery during the first two years.

  • Toxicity [ Time Frame: 4 weeks after surgery last enrolled patient ]

    Regional and systemic Toxicity/Side effects will be recorded according to the CTC-Toxicity Grading system, CTC-NCIC Toxicity Criteria v. 3.0. (See appendix to the protocol).

    Surgical and postoperative complications will be collected and assessed during interim analysis.

  • Number of positive lymph nodes in patient who have been treated with classical surgery [ Time Frame: 4 weeks after surgery last enrolled patient ]
    The number of patients with positive lymph nodes after chemo radiation is expected to be less than 20%, this will carefully be monitored.

  • The number of sphincter saving procedures [ Time Frame: 4 weeks after surgery last enrolled patient ]
    after organ sparing surgery by classical TEM or after TME surgery:

Estimated Enrollment: 55
Study Start Date: November 2010
Estimated Primary Completion Date: July 2013 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: Capecitabine
    Capecitabine will be administered at a dose of 825 mg/m2 bid during radiotherapy treatment
    Radiation: radiotherapy
    radiation 25x2 Gy
    Procedure: TME resection
    All patients undergo a MRI of the pelvis and a rectoscopy and endorectal ultrasound 6 weeks after chemo radiation. Patients who do not respond or clinically have a T3 tumour either on visual measurements or post therapy MRI or endoanal ultrasound will be operated on with a TME resection 8 - 10 weeks after the last chemo radiation treatment.
    Procedure: TEM surgery

    All patients undergo a MRI of the pelvis and a rectoscopy and endorectal ultrasound 6 weeks after chemo radiation.Patients with a significant downsizing of the tumour (T0-T2) will be operated on by TEM surgery 8 -10 weeks after the last chemo radiation treatment.

    After TEM surgery, pathological assessment will dictate further treatment. Conservative treatment with careful follow-up will be performed in patients with a complete resection of a ypT0-1 rectal tumour. Patients with lymphangio invasion, an incomplete resected ypT1 (<2 mm margin), an ypT2 or ypT3 tumour after TEM will subsequently undergo TME surgery to remove the rectum within 4 weeks.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients (aged >18 years) with histological proven adenocarcinoma of the distal part of the rectum (below 10 cm) without signs of distant metastases.
  • T1-3 tumour without lymph nodes > 5 mm at CT, MRI and endoanal ultrasound.
  • ANC > 1.5 x 109/l.
  • Thrombocytes > 100 x 109/l.
  • Creatinin clearance >50ml/min (according to the Cockcroft-Gault formula)
  • Total serum bilirubin < 24 mol/l or below <1.5 times the upper limit of the normal.
  • ASAT,ALAT: up to 5 times the upper limit.
  • Colonoscopy, colonography or virtual colonoscopy should exclude synchronous colorectal lesions in other parts of the colon.
  • ECOG performance score 0-2.
  • Fertile women should have adequate birth control during treatment.
  • Mental/physical/geographical ability to undergo treatment and follow-up.
  • Written informed consent (Dutch language).

Exclusion Criteria:

  • Patients with Grade 1-2 T1 tumors (can be treated with TEM surgery without chemoradiation therapy)
  • Patients with circular rectal tumor or tumors who are by other means unacceptable for TEM surgery (e.g. intra anal tumors).
  • Patients with faecal incontinence prior to the diagnosis of rectal cancer (complaints of soiling due to the tumor will not be an exclusion criterium).
  • Severe uncontrollable medical or neurological disease.
  • Patients with secondary prognosis determining malignancies.
  • Patients who have been treated with radiotherapy on the pelvis.
  • Use of Vitamin K antagonists.
  • Fenytoine and Allopurinol use.
  • Known DPD deficiency
  • Uncontrolled active infection, compromised immune status, psychosis, or CNS disease.
  • Pregnant or lactating women.
  • Clinically significant (i.e. active) cardiovascular disease for example cerebrovascular accidents (≤ 6 months prior to randomisation), myocardial infarction (≤ 6 months prior to randomisation), unstable angina, New York Heart Association (NYHA) grade II or greater congestive heart failure, serious cardiac arrhythmia requiring medication.
  • Evidence of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates use of Capecitabine or patients at high risk for treatment complications. History or evidence upon physical examination of CNS disease unless adequately treated (e.g., seizure not controlled with standard medical therapy).
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01273051

Contact: J.H.W. de Wilt, Md PhD +31 24 361 73 65
Contact: G.M.J. Bokkerink, md +31 24 361 73 65

University Medical Centre Nijmegen Recruiting
Nijmegen, Gelderland, Netherlands, 6500 HB
Contact: J.H.W. de Wilt, Md Phd    +31 24 361 73 65   
Contact: G.M.J. Bokkerink, Md    +31 24 361 73 65   
Principal Investigator: J.H.W. de Wilt, Md PhD         
Sub-Investigator: G.M.J. Bokkerink, Md         
Academisch Medisch Centrum Recruiting
Amsterdam, Netherlands
Contact: P.J. Tanis, Md         
Principal Investigator: P.J. Tanis, Md         
NKI AVL Not yet recruiting
Amsterdam, Netherlands
Contact: A. Cats, Md   
Contact: S. Vanhoutvin   
Principal Investigator: A. Cats, Md         
Slotervaart Ziekenhuis Not yet recruiting
Amsterdam, Netherlands
Contact: E.J. Derksen, Md   
Principal Investigator: E.J. Derksen, Md         
Amphia Ziekenhuis Not yet recruiting
Breda, Netherlands
Contact: B.J. ten Tije, dr    +31 76 595 5000   
Principal Investigator: B.J. ten Tije, dr         
IJsselland Ziekenhuis Recruiting
Capelle aan de IJssel, Netherlands
Contact: E.J.R. de Graaf, Md   
Principal Investigator: E.J.R. de Graaf, Md         
Catharina Ziekenhuis Recruiting
Eindhoven, Netherlands, 5602 ZA
Contact: I de Hingh, Md    +31 40 2399111   
Principal Investigator: I. de Hingh, Md         
LUMC Recruiting
Leiden, Netherlands
Contact: C.A.M. Marijnen, Md   
Principal Investigator: C.A.M. Marijnen, Md         
Sub-Investigator: R. Tollenaar, Md. Phd         
MAASTRO Clinic Not yet recruiting
Maastricht, Netherlands
Contact: G. Lammering, Md   
Principal Investigator: G. Lammering, Md         
Laurentius Ziekenhuis Not yet recruiting
Roermond, Netherlands
Contact: J. Leijtens, Md       []   
Principal Investigator: J. Leijtens, Md         
Erasmus Medical Center Recruiting
Rotterdam, Netherlands
Contact: C. Verhoef, Md   
Contact: J.J.M.E. Nuyttens, Md   
Principal Investigator: C. Verhoef, Md         
Sub-Investigator: J.J.M.E. Nuyttens, Md         
Instituut Verbeeten Recruiting
Tilburg, Netherlands, 5042 SB
Contact: T. Rozema, md    +31 13 - 594 75 65   
Principal Investigator: T. Rozema, Md         
Diakonessenhuis Not yet recruiting
Utrecht, Netherlands
Contact: A. Pronk, dr    +31 88 250 50 00   
Principal Investigator: A. Pronk, dr         
Sponsors and Collaborators
Radboud University
Principal Investigator: J.H.W de Wilt, Md PhD University Medical Centre Nijmegen
  More Information

Additional Information:
Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Radboud University Identifier: NCT01273051     History of Changes
Other Study ID Numbers: CMO 2010_121
Study First Received: November 22, 2010
Last Updated: April 10, 2012

Keywords provided by Radboud University:
Rectal Cancer
Organ preservation

Additional relevant MeSH terms:
Rectal Neoplasms
Colorectal Neoplasms
Intestinal Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Gastrointestinal Diseases
Intestinal Diseases
Rectal Diseases
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents processed this record on March 27, 2017