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Phase I/II Trial Evaluating Carbon Ion Radiotherapy for the Treatment of Recurrent Rectal Cancer (PANDORA)

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 February 2013 by University Hospital Heidelberg.
Recruitment status was:  Recruiting
Information provided by (Responsible Party):
Stephanie Combs, University Hospital Heidelberg Identifier:
First received: December 31, 2011
Last updated: February 18, 2013
Last verified: February 2013

Treatment standard for patients with rectal cancer depends on the initial staging and includes surgical resection, radiotherapy as well as chemotherapy. For stage II and III tumors, radiochemotherapy should be performed in addition to surgery, preferentially as preoperative radiochemotherapy or as short-course hypofractionated radiation. Advances in surgical approaches, especially the establishment of the total mesorectal excision (TME) in combination with sophisticated radiation and chemotherapy have reduced local recurrence rates to only few percent. However, due to the high incidence of rectal cancer, still a high absolute number of patients present with recurrent rectal carcinomas, and effective treatment is therefore needed.

Carbon ions offer physical and biological characteristics. Due to their inverted dose profile and the high local dose deposition within the Bragg peak precise dose application and sparing of normal tissue is possible. Moreover, in comparison to photons, carbon ions offer an increase relative biological effectiveness (RBE), which can be calculated between 2 and 5 depending on the cell line as well as the endpoint analyzed.

Japanese data on the treatment of patients with recurrent rectal cancer previously not treated with radiation therapy have shown local control rates of carbon ion treatment superior to those of surgery. Therefore, this treatment concept should also be evaluated for recurrences after radiotherapy, when dose application using conventional photons is limited. Moreover, these patients are likely to benefit from the enhanced biological efficacy of carbon ions.

In the current Phase I/II-PANDORA-01-Study the recommended dose of carbon ion radiotherapy for recurrent rectal cancer will be determined in the Phase I part, and feasibility and progression-free survival will be assessed in the Phase II part of the study.

Within the Phase I part, increasing doses from 12 x 3 Gy E to 18 x 3 Gy E will be applied.

The primary endpoint in the Phase I part is toxicity, the primary endpoint in the Phase II part its progression-free survival.

Condition Intervention Phase
Recurrent Rectal Cancer
Radiation: Carbon Ion Radiotherapy
Phase 1
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase I/II Trial Evaluating Carbon Ion Radiotherapy for the Treatment of Recurrent Rectal Cancer

Resource links provided by NLM:

Further study details as provided by University Hospital Heidelberg:

Primary Outcome Measures:
  • Safety and Efficacy [ Time Frame: 3 months ]

    Phase I part:

    The primary endpoint is toxicity measured by any Grade IV toxicity related to the study treatment according to CTCAE Grade 41. A maximum of 45 patients are projected for the Phase I part of the study. Patients will be followed for at least 3 months after study treatment to document any toxicity according to CTCAE Version 4.0.

    Phase II part:

    The primary endpoint is progression-free survival after re-irradiation at 12 months, therefore patients are followed within the trial protocol for a minimum 12 months after completion of study treatment.

Estimated Enrollment: 45
Study Start Date: December 2012
Estimated Study Completion Date: December 2015
Estimated Primary Completion Date: December 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Carbon Ion Radiotherapy Radiation: Carbon Ion Radiotherapy
Treatment with carbon ion radiotherapy using the rasterscanning technique


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

Inclusion Criteria

  • Locally recurrent rectal cancer
  • Inoperable lesion
  • Macroscopic tumor up to 1000ml volume- prior photon radiation of 20-60 Gy
  • time between initial radiotherapy and re-irradiation of at least 12 months
  • age ≥ 18 years of age
  • Karnofsky Performance Score >60
  • For women with childbearing potential, (and men) adequate contraception.
  • Ability of subject to understand character and individual consequences of the clinical trial
  • Written informed consent (must be available before enrolment in the trial)

Exclusion Criteria

  • refusal of the patients to take part in the study
  • advanced metastatic disease
  • Patients who have not yet recovered from acute toxicities of prior therapies
  • Known carcinoma < 5 years ago (excluding Carcinoma in situ of the cervix, basal cell carcinoma, squamous cell carcinoma of the skin) requiring immediate treatment interfering with study therapy- Pregnant or lactating women
  • Participation in another clinical study or observation period of competing trials, respectively.
  Contacts and Locations
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Please refer to this study by its identifier: NCT01528683

Contact: Stephanie E Combs, MD +49-6221-56-8202
Contact: Jürgen Debus, MD PHd +49-6221-56-8202

University Hospital of Heidelberg, Radiation Oncology Recruiting
Heidelberg, Germany
Contact: Stephanie E Combs, MD    +49-6221-56-8202   
Contact: Jürgen Debus, MD PhD    +49-6221-56-8202   
Sponsors and Collaborators
University Hospital Heidelberg
Principal Investigator: Jürgen Debus, MD PhD University Hospital of Heidelberg
  More Information

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Stephanie Combs, Leitende Oberärztin, University Hospital Heidelberg Identifier: NCT01528683     History of Changes
Other Study ID Numbers: PANDORA
Study First Received: December 31, 2011
Last Updated: February 18, 2013

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 processed this record on April 21, 2017