A Phase II Study of Total Neoadjuvant Therapy for Locally Advanced Gastric Cancer
Overview
- Phase
- Phase 2
- Intervention
- SIB-IMRT
- Conditions
- Gastric Cancer
- Sponsor
- Jing Jin, M.D.
- Enrollment
- 82
- Locations
- 1
- Primary Endpoint
- PCR rate
- Last Updated
- 4 years ago
Overview
Brief Summary
This prospective, single arm phase II study is designed to evaluate the rate of pathologic complete response of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy followed by surgery for locally advanced gastric adenocarcinoma
Investigators
Jing Jin, M.D.
Chinese Academy of Medical Sciences and Peking Union Medical College
Chinese Academy of Medical Sciences
Eligibility Criteria
Inclusion Criteria
- •Histologically or cytologically proven locally advanced gastric adenocarcinoma in patients staged as cT3-4N+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
Total Neoadjuvant Chemoradiotherapy
Total neoadjuvant chemoradiotherapy arm receives intensity-modulated neoadjuvant chemoradiotherapy (45Gy in 25 fractions) concurrently with oral S-1(40-60mg/m2, orally twice daily every weekday) followed by six cycles of SOX neoadjuvant chemotherapy and surgery
Intervention: SIB-IMRT
Total Neoadjuvant Chemoradiotherapy
Total neoadjuvant chemoradiotherapy arm receives intensity-modulated neoadjuvant chemoradiotherapy (45Gy in 25 fractions) concurrently with oral S-1(40-60mg/m2, orally twice daily every weekday) followed by six cycles of SOX neoadjuvant chemotherapy and surgery
Intervention: S-1
Total Neoadjuvant Chemoradiotherapy
Total neoadjuvant chemoradiotherapy arm receives intensity-modulated neoadjuvant chemoradiotherapy (45Gy in 25 fractions) concurrently with oral S-1(40-60mg/m2, orally twice daily every weekday) followed by six cycles of SOX neoadjuvant chemotherapy and surgery
Intervention: SOX
Total Neoadjuvant Chemoradiotherapy
Total neoadjuvant chemoradiotherapy arm receives intensity-modulated neoadjuvant chemoradiotherapy (45Gy in 25 fractions) concurrently with oral S-1(40-60mg/m2, orally twice daily every weekday) followed by six cycles of SOX neoadjuvant chemotherapy and surgery
Intervention: Surgery
Outcomes
Primary Outcomes
PCR rate
Time Frame: 6-8 months
Pathological response were classified into three grades.Grade I signifies that there is little shrinkage in the tumor; only mild regression in the tumor cells is observed under telemicroscope. Grade II shows gross reduction in size of the tumor and marked regression in the cancer cells microscopically, yet viable nests of cancer tissue are still visible. Grade III implies complete or almost total resolution of the tumor on exploration, and disappearance of the tumor tissue microscopically; only remnants of degenerated cancer cells can be seen (so-called ghost cancer cells).
Secondary Outcomes
- Acute chemotherapy/Chemoradiotherapy toxicities(6-8 months)
- R0 resection rate(6-8 months)
- surgery complications(6-8 months)
- Tumor down-staging(6-8 months)