A Phase 2 interventional study of 3-Dimensional Conformal Radiation Therapy and Cisplatin in Endometrial Endometrioid Adenocarcinoma, Variant With Squamous Differentiation, Endometrial Mucinous Adenocarcinoma and Endometrial Squamous Cell Carcinoma, sponsored by GOG Foundation. Status unknown at 441 sites in 2 countries. Open to female participants. Per ClinicalTrials.gov, last updated 2023-03-29.
Sponsored by GOG Foundation · Phase 2, Interventional, and Treatment
This randomized phase II trial studies radiation therapy and cisplatin to see how well they work compared with radiation therapy alone in treating patients with endometrial cancer that has come back. Radiation therapy uses high-energy x-rays and other types of radiation to kill tumor cells. Drugs used in chemotherapy, such as cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether giving radiation therapy together with cisplatin is more effective than radiation therapy alone in treating patients with endometrial cancer.
PRIMARY OBJECTIVES:
I. To assess whether pelvic radiation therapy with concurrent cisplatin is more promising with respect to progression-free survival than pelvic radiation therapy alone in the treatment of recurrent uterine carcinoma limited to the pelvis and vagina.
SECONDARY OBJECTIVES:
I. To capture the sites of recurrence subsequent to treatment with pelvic radiation with or without concurrent weekly cisplatin in women with recurrent uterine carcinoma.
II. To estimate overall survival of patients with recurrent uterine carcinoma treated with pelvic radiation therapy with or without concurrent weekly cisplatin.
III. To estimate the prognostic significance of the location (central pelvis versus vagina) and size of the recurrence, in addition to the prognostic significance in the salvage setting of the histological subtype, grade, patient age, race, performance status, and the presence of lymph-vascular space involvement of the original tumor at the time of initial hysterectomy.
IV. To evaluate toxicity derived from the combined cisplatin and radiation compared with radiation alone in this patient population.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM I: Patients undergo external-beam radiotherapy (EBRT) to the pelvis daily on days 1-5 for 5 weeks. After completion of EBRT, patients undergo intracavitary low-dose rate or high-dose rate brachytherapy* or low-dose rate interstitial brachytherapy*.
ARM II: Patients undergo EBRT as in Arm I and receive cisplatin intravenously (IV) over 1-2 hours on days 1, 8, 15, 22, and 29. Patients then undergo brachytherapy* as in Arm I.
NOTE: *IMRT boost is allowed for patients who are not candidates for brachytherapy. IMRT may also be used for the entire course of therapy for the treatment of the whole pelvis and/or the boost in patients not undergoing brachytherapy. In both arms, treatment continues in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every month for 3 months, 3 months for 2 years and then every 6 months for 3 years.
6,741 studies on the registry are indexed under Carcinoma; 1,161 are open to participants now.
This study's enrollment of 165 is above the median of 45 across 5,170 interventional studies indexed under Carcinoma.
Browse Carcinoma studies →GOG Foundation is the lead sponsor of 18 studies on the registry; 4 are open to participants now.
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Primary surgical debulking before protocol therapy is permissible; this would include removal of gross symptomatic disease in the pelvis and/or vagina
Exclusion Criteria:
Patients undergo EBRT to the pelvis daily on days 1-5 for 5 weeks. After completion of EBRT, patients undergo intracavitary low-dose rate or high-dose rate brachytherapy or low-dose rate interstitial brachytherapy.
Radiation: 3-Dimensional Conformal Radiation Therapy · Radiation: Intensity-Modulated Radiation Therapy · Radiation: Internal Radiation Therapy
Patients undergo EBRT as in Arm I and receive cisplatin IV over 1-2 hours on days 1, 8, 15, 22, and 29. Patients then undergo brachytherapy as in Arm I.
Radiation: 3-Dimensional Conformal Radiation Therapy · Drug: Cisplatin · Radiation: Intensity-Modulated Radiation Therapy · Radiation: Internal Radiation Therapy
Undergo 3-dimensional conformal radiation therapy
Also known as: 3-dimensional radiation therapy, 3D Conformal, 3D CONFORMAL RADIATION THERAPY, 3D CRT, 3D-CRT, Conformal Therapy, Radiation Conformal Therapy, Radiation, 3D Conformal
Given IV
Also known as: Abiplatin, Blastolem, Briplatin, CDDP, Cis-diammine-dichloroplatinum, Cis-diamminedichloridoplatinum, Cis-diamminedichloro Platinum (II), Cis-diamminedichloroplatinum, Cis-dichloroammine Platinum (II), Cis-platinous Diamine Dichloride, Cis-platinum, Cis-platinum II, Cis-platinum II Diamine Dichloride, Cismaplat, Cisplatina, Cisplatinum, Cisplatyl, Citoplatino, Citosin, Cysplatyna, DDP, Lederplatin, Metaplatin, Neoplatin, Peyrone''s Chloride, Peyrone''s Salt, Placis, Plastistil, Platamine, Platiblastin, Platiblastin-S, Platinex, Platinol, Platinol- AQ, Platinol-AQ, Platinol-AQ VHA Plus, Platinoxan, Platinum, Platinum Diamminodichloride, Platiran, Platistin, Platosin
Undergo IMRT
Also known as: IMRT, Intensity Modulated RT, Intensity-Modulated Radiotherapy, Radiation, Intensity-Modulated Radiotherapy
Given intracavitarily or interstitially
Also known as: Brachytherapy, Brachytherapy, NOS, Internal Radiation, Internal Radiation Brachytherapy, Radiation Brachytherapy, Radiation, Internal
Number of Participants With Disease Progression or Death.
The number of participants with disease progression or death from study entry to progression or death. Participants who experienced progression or death were reported by treatment arm.
Time frame: Median follow-up for progression-free survival was 62 months with a maximum of 128 months. Patients were followed from study entry until disease progression, death, or date of last contact
Number of Participants That Experienced Death on Study
Overall survival is the period from study entry until death or date of last contact. The treatment regimens were compared with regard to overall survival.
Time frame: Participants were followed from study entry until death or date of last contact. Median follow-up for overall survival was 62 months with a maximum of 128 months.
Number of Participants in Select Prognostic Groups Who Experienced Progression or Death on Study.
Participants were put in prognostic groups including baseline factors of tumor location (vagina only vs. all others) and histology (serious and clear cell vs. all others). They were assessed for prognostic associations with progression-free survival. Participant factors were collected at baseline. Participants were followed from study entry until disease progression, death, or date of last contact for progression-free survival.
Time frame: Median follow-up for progression-free survival was 62 months with a maximum of 128 months.
Number of Participants That Experienced Adverse Effects Grade 3 or Higher
Number of treated participants with adverse events of grade 3 or higher. Graded by Common Terminology Criteria for Adverse Events version 3.0. Treated patients were evaluated for adverse events during the treatment period, every month for the first three months after completion of therapy up to 2 years, and then every six months for the next 3 years.
Time frame: Maximum follow-up for adverse events was 61 months.
Enrollment onto this study began February 25, 2008. Enrollment of the study ended August 12, 2020 after 165 patients had been enrolled.
| Milestone | Arm I (Brachytherapy, Radiation Therapy) | Arm II (Brachytherapy, Radiation Therapy, Cisplatin) |
|---|---|---|
| Started | 82 | 83 |
| Completed | 74 | 82 |
| Not completed | 8 | 1 |
| Withdrew: Ineligible by pathology review | 8 | 1 |
The number of participants with disease progression or death from study entry to progression or death. Participants who experienced progression or death were reported by treatment arm.
| Participants | Arm I (Brachytherapy, Radiation Therapy) | Arm II (Brachytherapy, Radiation Therapy, Cisplatin) |
|---|---|---|
| Number of Participants With Disease Progression or Death. | 27 | 35 |
Overall survival is the period from study entry until death or date of last contact. The treatment regimens were compared with regard to overall survival.
| Participants | Arm I (Brachytherapy, Radiation Therapy) | Arm II (Brachytherapy, Radiation Therapy, Cisplatin) |
|---|---|---|
| Number of Participants That Experienced Death on Study | 18 | 21 |
Participants were put in prognostic groups including baseline factors of tumor location (vagina only vs. all others) and histology (serious and clear cell vs. all others). They were assessed for prognostic associations with progression-free survival. Participant factors were collected at baseline. Participants were followed from study entry until disease progression, death, or date of last contact for progression-free survival.
| Participants | Prognostic Group 1 | Prognostic Group 2 | Prognostic Group 3 | Prognostic Group 4 |
|---|---|---|---|---|
| Number of Participants in Select Prognostic Groups Who Experienced Progression or Death on Study. | 45 | 4 | 0 | 13 |
Number of treated participants with adverse events of grade 3 or higher. Graded by Common Terminology Criteria for Adverse Events version 3.0. Treated patients were evaluated for adverse events during the treatment period, every month for the first three months after completion of therapy up to 2 years, and then every six months for the next 3 years.
| Participants | Treated Regimen I | Treated Regimen II |
|---|---|---|
| Number of Participants That Experienced Adverse Effects Grade 3 or Higher | 37 | 49 |
Collected over Treated patients were evaluated for adverse events during the treatment period, every month for the first three months after completion of therapy up to 2 years, and then every six months for the next 3 years. Maximum follow-up for adverse events was 61 months. Deaths were reported up to 5 years after study treatment discontinuation. Median follow up for overall survival was 62 months with a maximum of 128 months.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Arm I (Brachytherapy, Radiation Therapy) | 18/74 (24.3%) | 3/74 (4.1%) | 72/74 (97.3%) |
| Arm II (Brachytherapy, Radiation Therapy, Cisplatin) | 21/82 (25.6%) | 12/82 (14.6%) | 76/82 (92.7%) |
| Event | Arm I (Brachytherapy, Radiation Therapy) | Arm II (Brachytherapy, Radiation Therapy, Cisplatin) |
|---|---|---|
| Thrombosis/Thrombus/EmbolismVascular disorders | 0/74 | 3/82 |
| DiarrheaGastrointestinal disorders | 2/74 | 0/82 |
| Conduction Abnml: AsystoleCardiac disorders | 1/74 | 0/82 |
| ColitisGastrointestinal disorders | 1/74 | 0/82 |
| Allergic Reaction/HypersensitivityImmune system disorders | 0/74 | 1/82 |
| Cardiac Ischemia/InfarctionCardiac disorders | 0/74 | 1/82 |
| HypotensionCardiac disorders | 0/74 | 1/82 |
| Fistula, Gi - Small Bowel NosGastrointestinal disorders | 0/74 | 1/82 |
| VomitingGastrointestinal disorders | 0/74 | 1/82 |
| Hemorrhage, Gi - EsophagusVascular disorders | 0/74 | 1/82 |
| Event | Arm I (Brachytherapy, Radiation Therapy) | Arm II (Brachytherapy, Radiation Therapy, Cisplatin) |
|---|---|---|
| DiarrheaGastrointestinal disorders | 62/74 | 65/82 |
| FatigueGeneral disorders | 52/74 | 64/82 |
| LeukocytesBlood and lymphatic system disorders | 34/74 | 61/82 |
| NauseaGastrointestinal disorders | 28/74 | 53/82 |
| HemoglobinBlood and lymphatic system disorders | 27/74 | 50/82 |
| PlateletsBlood and lymphatic system disorders | 22/74 | 47/82 |
| NeutrophilsBlood and lymphatic system disorders | 6/74 | 37/82 |
| ConstipationGastrointestinal disorders | 21/74 | 29/82 |
| HypomagnesemiaMetabolism and nutrition disorders | 9/74 | 29/82 |
| Pain: Abdominal Pain NosGeneral disorders | 26/74 | 14/82 |
Eligible and Evaluable
| Age, Customized(Participants) | Arm I (Brachytherapy, Radiation Therapy) | Arm II (Brachytherapy, Radiation Therapy, Cisplatin) | Total |
|---|---|---|---|
| < 60 years | 16 | 19 | 35 |
| 60-80 years | 49 | 59 | 108 |
| > 80 years | 9 | 4 | 13 |
| Sex: Female, Male(Participants) | Arm I (Brachytherapy, Radiation Therapy) | Arm II (Brachytherapy, Radiation Therapy, Cisplatin) | Total |
|---|---|---|---|
| Female | 74 | 82 | 156 |
| Male | 0 | 0 | 0 |
| Ethnicity (NIH/OMB)(Participants) | Arm I (Brachytherapy, Radiation Therapy) | Arm II (Brachytherapy, Radiation Therapy, Cisplatin) | Total |
|---|---|---|---|
| Hispanic or Latino | 4 | 6 | 10 |
| Not Hispanic or Latino | 65 | 74 | 139 |
| Unknown or Not Reported | 5 | 2 | 7 |
| Race (NIH/OMB)(Participants) | Arm I (Brachytherapy, Radiation Therapy) | Arm II (Brachytherapy, Radiation Therapy, Cisplatin) | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 1 | 1 |
| Asian | 0 | 3 | 3 |
| Native Hawaiian or Other Pacific Islander | 1 | 2 | 3 |
| Black or African American | 5 | 1 | 6 |
| White | 65 | 74 | 139 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 3 | 1 | 4 |
| Tumor Location(Participants) | Arm I (Brachytherapy, Radiation Therapy) | Arm II (Brachytherapy, Radiation Therapy, Cisplatin) | Total |
|---|---|---|---|
| Both pelvis and vagina | 4 | 7 | 11 |
| Pelvis only | 7 | 4 | 11 |
| Vagina only | 63 | 71 | 134 |
| Histology(Participants) | Arm I (Brachytherapy, Radiation Therapy) | Arm II (Brachytherapy, Radiation Therapy, Cisplatin) | Total |
|---|---|---|---|
| Endometrioid, grade 1 - usually considered non-aggressive and have the most favorable outcome. | 48 | 42 | 90 |
| Endometrioid, grade 2 - more likely to spread outside the uterus. Worse outcome than grade 1. | 16 | 22 | 38 |
| Endometrioid, grade 3 - usually more aggressive with a worse outcome than lower grade tumors. | 2 | 8 | 10 |
| Endometrioid, grade unknown | 1 | 0 | 1 |
| Serous | 2 | 4 | 6 |
| Clear Cell | 1 | 0 | 1 |
| Mixed Epithelial | 3 | 2 | 5 |
| Adenocarcinoma, not specified | 1 | 3 | 4 |
| Other | 0 | 1 | 1 |
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