A Prospective, Randomized Phase II Trial of Neoadjuvant Chemotherapy Compared With Concomitant Boost Intensity-Modulated Radiotherapy With S-1 in Locally Advanced Gastric Adenocarcinoma
Overview
- Phase
- Phase 2
- Intervention
- SIB-IMRT
- Conditions
- Stomach Neoplasms
- Sponsor
- Chinese Academy of Medical Sciences
- Enrollment
- 71
- Locations
- 1
- Primary Endpoint
- R0 resection rate
- Status
- Completed
- Last Updated
- 6 years ago
Overview
Brief Summary
This prospective, randomized phase II study is designed to evaluate weather neoadjuvant chemoradiotherapy is superior to neoadjuvant chemotherapy with both followed by surgery and postoperative chemotherapy for locally advanced gastric adenocarcinoma.
Investigators
Jing Jin, M.D.
MD
Chinese Academy of Medical Sciences
Eligibility Criteria
Inclusion Criteria
- •Histologically or cytologically proven locally advanced gastric adenocarcinoma in patients staged as cT3-4N0M0 or anyTN+M0
- •No distant metastasis in liver,lung,bone,central nervous system(CNS),no peritoneal transplantation
- •No prior abdominal or pelvic radiotherapy
- •Karnofsky performance status(KPS)≥ 70, predictive life span no less than 6 months
- •Patients must have normal organ and marrow function as defined below: Leukocytes: greater than or equal to 3,000 G/L; Platelets: greater than or equal to 100,000/mm3 .Hemoglobin:greater than or equal to 10g/L .Total bilirubin: within normal institutional limits; AST/ALT: less than or equal to 1.5 times the upper limit; Creatinine within normal upper limits
- •Informed consent
Exclusion Criteria
- •Any prior chemotherapy or other cancer treatment prior to this protocol
- •Patients with other cancer history except cervical carcinoma in situ and non-malignant melanoma skin cancer
- •With any distant metastasis in liver,lung,bone,CNS,or peritoneal transplantation
- •History of allergic reactions attributed to similar chemical or biologic complex to S-1 or Xeloda or Oxaliplatin
- •Uncontrolled illness including, but not limited to, active infection, symptomatic heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness
- •History of myocardial infarction within the past 6 months or history of ventricular arrhythmia
- •History of prior radiation to the abdomen
- •Pregnant or lactating females
Arms & Interventions
Neoadjuvant Chemoradiotherapy (NCRT)
NCRT arm receives intensity-modulated radiotherapy with a simultaneous integrated boost (SIB-IMRT) (45.1Gy and 40.04Gy in 22 fractions) concurrently with oral S-1(40mg/m2, orally twice daily every weekday) followed by surgery and four to six cycles of SOX at the same dosage with NCT arm.
Intervention: SIB-IMRT
Neoadjuvant Chemoradiotherapy (NCRT)
NCRT arm receives intensity-modulated radiotherapy with a simultaneous integrated boost (SIB-IMRT) (45.1Gy and 40.04Gy in 22 fractions) concurrently with oral S-1(40mg/m2, orally twice daily every weekday) followed by surgery and four to six cycles of SOX at the same dosage with NCT arm.
Intervention: S-1
Neoadjuvant Chemoradiotherapy (NCRT)
NCRT arm receives intensity-modulated radiotherapy with a simultaneous integrated boost (SIB-IMRT) (45.1Gy and 40.04Gy in 22 fractions) concurrently with oral S-1(40mg/m2, orally twice daily every weekday) followed by surgery and four to six cycles of SOX at the same dosage with NCT arm.
Intervention: Surgery
Neoadjuvant Chemoradiotherapy (NCRT)
NCRT arm receives intensity-modulated radiotherapy with a simultaneous integrated boost (SIB-IMRT) (45.1Gy and 40.04Gy in 22 fractions) concurrently with oral S-1(40mg/m2, orally twice daily every weekday) followed by surgery and four to six cycles of SOX at the same dosage with NCT arm.
Intervention: SOX
Neoadjuvant Chemotherapy (NCT)
NCT arm consists of neoadjuvant three cycles of SOX(S-1: 40\~60mg, orally twice daily on days 1 to 14, oxaliplatin 130mg/m2 intravenously on day 1, 21 days per cycle followed by radical surgery and another postoperative three cycles of SOX.
Intervention: Surgery
Neoadjuvant Chemotherapy (NCT)
NCT arm consists of neoadjuvant three cycles of SOX(S-1: 40\~60mg, orally twice daily on days 1 to 14, oxaliplatin 130mg/m2 intravenously on day 1, 21 days per cycle followed by radical surgery and another postoperative three cycles of SOX.
Intervention: SOX
Outcomes
Primary Outcomes
R0 resection rate
Time Frame: 2-3 months
The surgical procedure was total or subtotal gastrectomy with recommended D2 lymphadenectomy 4-6 weeks after neoadjuvant therapy.
Secondary Outcomes
- Postoperative complications(2-3 months)
- Pathological response rate(2-3 months)
- Tumor down-staging(2-3 months)
- Acute chemotherapy/Chemoradiotherapy toxicities(6-8 months)
- Locoregional recurrence free survival(3 years)
- Overall survival(3 years)
- Distant metastasis free survival(3 years)