Rectal carcinoma
Conditions
Interventions
Study setting
1. University Surgical Unit of the Colombo South Teaching Hospital
2. National Cancer Institute, Maharagama
Method of Randomisation - simple randomisation with 2:1 ratio to intervention
Sponsors
Faculty of Medical Sciences
Eligibility
Inclusion criteria
Inclusion criteria: 1. Male and female patients aged 18 years and older 2. Have a biopsy-confirmed adenocarcinoma 0-15cm from the anal verge (on MRI or rigid sigmoidoscopy). 3. Have locally Advanced Rectal Carcinoma diagnosed by MRI (mrCRM unsafe or >mrT3c [>5mm beyond muscularis propria] or mrEMVI positive disease) 4. Be deemed to require chemoradiotherapy. 5. Scheduled to receive 45Gy - 55Gy long course radiotherapy. 6. Have provided written informed consent to participate in the study.
Exclusion criteria
Exclusion criteria: 1. Have metastatic disease (including resectable liver metastases). 2. Are contraindicated for MRI e.g. non-MR compatible hip prosthesis, cardiac pacemaker. 3. Are scheduled to receive less than 45Gy or more than 55Gy long course radiotherapy. 4. Are contraindicated for chemoradiotherapy (CRT) 5. Hypersensitivity or contraindication to the drug(s) associated with the planned choice of systemic chemotherapy (CAPOX, FOLFOX or single agent 5-FU or capecitabine) as stated in the SmPC for each of the drugs. 6. Are receiving or planned to receive treatment outside of that stipulated by the protocol, such as an alternative cytotoxic or investigational drug. 7. Are pregnant, breastfeeding or unable / unwilling to comply with pregnancy prevention guidelines. 8. Any other malignant disease within the preceding 5 years with the exception of non- melanomatous skin cancer, carcinoma in situ and early stage disease with <5% recurrence risk
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Patient recruitment rate Total number of patients randomised per month during the last 4 months from completion of recruitment [Last 4 months until completion of recruitment ] | — |
Secondary
| Measure | Time frame |
|---|---|
| Pathology circumferential resection margin (pCRM) involvement rate Overall pCRM involvement rate between the control and intervention arm [ pCRM involvement rate: Control arm: at 12 weeks. Intervention arm - poor response subgroup: 6 months. Intervention arm - good response subgroup: a median of 2 years. ] Drug toxicity. Toxicity will be graded using Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Grade 3-5 adverse events will be compared between the control and intervention arms. [Up to 1 year] Surgical morbidity reported according to Clavien-Dindo classification [At 30 days and 12 months ] Quality of surgery determined using the mesorectal grading system. [At time of surgery ] Strength of agreement of reported mrTRG between site and central radiologists. Agreement (kappa) between site and central radiologists for reported mrTRG for MRI scans performed at baseline, post-CRT and during surveillance schedule. [At baseline and 5 years. ] | — |
Countries
Sri Lanka,United Kingdom
Contacts
Public ContactDr. Bawantha Gamage
Senior Lecturer and Consultant Surgeon
Outcome results
None listed