Concomitant Chemoradiation in Advanced Stage Carcinoma Cervix (CRACx)
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ClinicalTrials.gov Identifier: NCT00193791 |
Recruitment Status :
Completed
First Posted : September 19, 2005
Last Update Posted : September 17, 2019
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Condition or disease | Intervention/treatment | Phase |
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Cancer of Cervix | Other: CT + RT | Not Applicable |
Carcinoma cervix is the commonest malignancy seen in Asian women and constitutes approximately 30% of all cancers (1). It is also the leading cause of cancer mortality in India. Nearly 50% of the patients present with advanced stages (FIGO Stage III/IV). The main stay of treatment has traditionally been radical radiation therapy and over decades the survival rates have achieved a plateau of 30 - 45% at 5 years. In developing countries the socioeconomic problems, illiteracy, late presentation and irregular follow-up have further compromised our survivals. Over the last decade there have been studies on the use of chemo-radiotherapy in carcinoma cervix. Over 19 randomized trials have been published addressing the issue of chemo-radiotherapy. However, heterogeneous data, poor randomization, inadequate number of patients, sub-optimal radiotherapy, non-uniform use of chemotherapeutic drugs, its sequencing and poor documentation have not yet provided the evidence to substantially alter the practice. Hence, meta-analysis of these trials was undertaken to further evaluate the role of chemo-radiotherapy in carcinoma cervix (2,3).
The first meta-analysis published by Cochrane Collaborative Group of 4580 randomized patients (19 randomized trials) suggested that chemo-radiation did show an absolute survival benefit improvement both in progression free and overall survivals by 16% and 12% respectively (p<0.0001). The survivals were significantly better with Cisplatin based concomitant chemo-radiation (p<0.0001). Incidentally, the distant metastasis rates were also significantly lower in chemo-radiation (p<0.0001). However, all these benefits were seen only in early stages. In addition, acute grade 3/4 hematological and gastro-intestinal toxicities were higher with chemo-radiation (additional 8% and 5% respectively). The data was insufficient to report on late toxicity (2).
The second meta-analysis of 9 randomized trials, recently published by the Canadian Group to evaluate only cisplatin based concomitant chemo-radiation confirms the improvement in overall survival (4year survival data) in advanced stages, bulky IB tumors (prior to surgery) and high risk early disease (post-surgery). Although acute grade 3/4 hematological and gastro-intestinal toxicities were higher in chemo-radiation, they were short-lived, with only 2 deaths and the remaining resolved with medical treatment. There was no significant increase in the late toxicity from the data available.
Both the Cochrane and Canadian meta-analysis have to a large extent tried to address the role of concomitant chemo-radiation, but Carcinoma Cervix Stage III accounted for only 30-35% and moreover evaluation with optimal radiation schedules and comparison of late toxicities still remains unanswered. What is more important is that the cisplatin is relatively inexpensive and is available worldwide. This means that cisplatin-based chemo-radiation is affordable in the developing countries where carcinoma cervix still forms the major cancer. However, the role of chemo-radiation in Carcinoma Cervix Stage IIIB in a developing countries including India still remains unexplored. We propose this randomized study to evaluate the role and benefit of chemo-radiation in-patients with cervical cancer.
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 850 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Intervention Model Description: | Concomitant chemo-radiation versus radiation alone |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | Concomitant Chemo-radiation in Advanced Stage Carcinoma Cervix: A Phase III Randomized Trial |
Actual Study Start Date : | July 7, 2003 |
Actual Primary Completion Date : | May 2017 |
Actual Study Completion Date : | December 2017 |
Arm | Intervention/treatment |
---|---|
No Intervention: Radiation (RT) Alone
Standard radical radiation therapy alone
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Experimental: CT + RT
Injection Cisplatin 40mg/m2 weekly for 5 weeks during the entire course of external radiation therapy
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Other: CT + RT
Injection Cisplatin 40mg/m2 weekly for 5 weeks during the entire course of external radiation therapy |
- To compare the disease free survivals. [ Time Frame: December 2009 ]
- To compare the overall survivals [ Time Frame: December 2010 ]
- To compare the distant metastasis rates [ Time Frame: December 2010 ]
- To compare the quality of life in both the groups [ Time Frame: December 2010 ]
- To compare the normal tissue toxicities (Acute & Late) of standard radiation therapy with concomitant chemo-radiation. [ Time Frame: June 2017 ]
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Ages Eligible for Study: | 18 Years to 65 Years (Adult, Older Adult) |
Sexes Eligible for Study: | Female |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Histologically proven squamous carcinoma of cervix
- Performance index world health organization (WHO) grade 0 or 1
- Patients below 65 years of age
- FIGO Stage IIIB
- Normal ECG and Cardiovascular system
- Normal hematological parameters
- Normal renal and liver function tests
Exclusion Criteria:
- Co-morbid conditions like medical renal disease
- Medical or Psychological condition that would preclude treatment
- H/o Previous treatment / Pregnancy
- Patient unreliable for treatment completion and follow-up.
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 ClinicalTrials.gov identifier (NCT number): NCT00193791
India | |
Tata Memorial Hospital | |
Mumbai, Maharastra, India, 400 012 |
Principal Investigator: | Shyamkishore J Shrivastava, MD,DNB(RT) | Professor & Head, Department of Radiation Oncology, Tata Memorial Hospital |
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: | Sk Shrivastava, Professor and Head, Radiation Oncology, Tata Memorial Hospital |
ClinicalTrials.gov Identifier: | NCT00193791 |
Other Study ID Numbers: |
TMH/114/2003/CRACX TRIAL |
First Posted: | September 19, 2005 Key Record Dates |
Last Update Posted: | September 17, 2019 |
Last Verified: | September 2019 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | Yes |
Plan Description: | Individual patient data (IPD) related to patient characteristics, treatment and outcome variables. |
Carcinoma Cervix FIGO Stage IIIB Radiation therapy Chemoradiation |
Treatment related toxicities Cervical Cancer Cervix Cancer |
Carcinoma Uterine Cervical Neoplasms Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Neoplasms Uterine Neoplasms Genital Neoplasms, Female Urogenital Neoplasms |
Neoplasms by Site Uterine Cervical Diseases Uterine Diseases Genital Diseases, Female Female Urogenital Diseases Female Urogenital Diseases and Pregnancy Complications Urogenital Diseases Genital Diseases |