Surgery With or Without Chemotherapy and Radiation Therapy in TreatingPatients With Stage I Rectal Cancer



Status:Completed
Conditions:Colorectal Cancer, Colorectal Cancer, Cancer
Therapuetic Areas:Oncology
Healthy:No
Age Range:18 - Any
Updated:4/21/2016
Start Date:July 2001
End Date:April 2004

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A Phase II Study of Local Excision Alone or Local Excision Plus Adjuvant Chemoradiation Therapy for Small Distal Rectal Cancers

RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing
so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor
cells. Combining surgery with chemotherapy and radiation therapy may kill more tumor cells
and prevent recurrence of the cancer.

PURPOSE: Phase II trial to study the effectiveness of surgery with or without chemotherapy
and radiation therapy in treating patients who have stage I rectal cancer.

OBJECTIVES:

- Determine the overall, disease-free, and colostomy-free survival rates in patients with
stage I rectal cancer treated with local excision with or without adjuvant chemotherapy
and radiotherapy.

- Determine the local, regional, and distant recurrence rates in patients treated with
these regimens.

- Determine whether loco-regional recurrences after local excision can be successfully
salvaged with radical surgery with or without adjuvant therapy for permanent cure in
patients treated with these regimens.

- Determine whether the analysis of certain histological and molecular markers can help
determine prognosis in patients treated with these regimens.

- Determine the anorectal, urinary, and sexual function effects in patients treated with
these regimens.

- Determine the non-functional treatment morbidity and mortality exclusive of anorectal,
urinary, and sexual function effects in patients treated with these regimens.

- Determine the overall survival of patients with pathology exclusions undergoing local
excision.

- Determine the efficacy of the current standard in detecting recurrence during
follow-up, including office visits, blood tests, and proctoscopy in patients treated
with these regimens.

OUTLINE: This is a multicenter study.

All patients undergo full thickness disc excision. Patients with T3 disease or positive
surgical margins after surgery are removed from study. Patients with T1 disease and negative
surgical margins after surgery are observed. Patients with T2 disease and negative surgical
margins after surgery receive adjuvant therapy.

Beginning 42 days after surgery, T2 patients receive leucovorin calcium (CF) IV over 2 hours
with fluorouracil (5-FU) IV bolus 1 hour into the infusion once weekly for 6 weeks.
Beginning 2 weeks after the completion of chemotherapy, patients receive chemoradiotherapy
comprising radiotherapy once daily 5 times a week for 5 weeks and 5-FU IV continuously while
receiving radiotherapy. Beginning 2 weeks after the completion of chemoradiotherapy,
patients again receive CF IV over 2 hours with 5-FU IV bolus 1 hour into the infusion once
weekly for 6 weeks. Chemotherapy repeats after 2 weeks rest for a total of 2 courses.

Patients are followed every 3 months for 2 years and then every 6 months for 5 years.

DISEASE CHARACTERISTICS:

- Histologically confirmed adenocarcinoma of the rectum

- T1 or T2 by physical and endoscopic exams

- No T3 lesions by clinical or radiological exam

- Villous adenomas or in situ carcinoma allowed without histologicalconfirmation
if clinical appearance of cancer

- No multi-focal disease within the rectum at time of initial diagnosis

- No non-adenocarcinomatous rectal cancer or anal cancer

- Less than 4 cm at greatest diameter

- Less than 40% of rectal wall circumference involved

- Proximal margin no greater than 8 cm from dentate line

- No tumor fixation to the perirectal tissues regardless of size

- No malignant regional lymph node or distant metastases by clinical exam
orradiographical imaging

- No palpable perirectal lymph nodes or nodes larger than 1 cm

- No evidence of malignant perirectal lymph nodes by endorectal ultrasound
orendorectal MRI

PATIENT CHARACTERISTICS:

Age:

- 18 and over

Performance status:

- CTC 0-2

Life expectancy:

- Not specified

Hematopoietic:

- WBC at least 4,000/mm^3

- Platelet count at least 100,000/mm^3

Hepatic:

- Bilirubin less than 1.5 times normal

Renal:

- Creatinine less than 1.8 mg/dL

Other:

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- No other prior or concurrent malignancy within the past 5 years except inactive
nonmelanomatous skin cancer or carcinoma in situ of the cervix

PRIOR CONCURRENT THERAPY:

Biologic therapy:

- Not specified

Chemotherapy:

- No prior chemotherapy

Endocrine therapy:

- Not specified

Radiotherapy:

- No prior radiotherapy

Surgery:

- No prior surgery for rectal cancer including prior attempts at transanal or
transcoccygeal surgical excision with unclear or positive margins

- Prior incision or operative biopsy or colonoscopic removal allowed
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Boston, Massachusetts 02115
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Brigham and Women's Hosp Boston’s Brigham and Women’s Hospital (BWH) is an international leader in...
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666 Elm Street
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675 N Saint Clair St # 21-100
Chicago, Illinois 60611
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Robert H. Lurie Comprehensive Cancer Center at Northwestern University The cancer center was first established...
274
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2010 E 90th St
Cleveland, Ohio 44195
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Cleveland Clinic Taussig Cancer Center At Taussig Cancer Institute, more than 250 highly skilled doctors,...
138
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4100 John R
Detroit, Michigan 48201
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Barbara Ann Karmanos Cancer Institute Karmanos is based in southeast Michigan, in midtown Detroit, and...
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1500 E Duarte Rd
Duarte, California 91010
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City of Hope Comprehensive Cancer Center City of Hope is a leading research and treatment...
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125 Science Dr
Durham, North Carolina 27710
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Duke Comprehensive Cancer Center Leading-edge cancer care and research have been a hallmark of Duke...
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3551 Roger Brooke Dr
Fort Sam Houston, Texas 78234
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301 University Blvd
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33 Villa Road, Suite 400
Greenville, South Carolina 29615
(864) 404-2045
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701 Ilalo Street Suite 600
Honolulu, Hawaii 96813
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Cancer Research Center of Hawaii The University of Hawaii Cancer Center is the only National...
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2500 N State St
Jackson, Mississippi 39216
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529 West Markham Street
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8700 Beverly Blvd # 8211
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10833 Le Conte Avenue # 8-950
Los Angeles, California 90095
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Jonsson Comprehensive Cancer Center at UCLA In the late 1960s, a group of scientists and...
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300 Community Drive
Manhasset, New York 11030
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1335 Dublin Road, Suite 124A
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100 Michigan Street, NE, MC012
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1 Jarrett White Rd
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