<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03038256</url>
  </required_header>
  <id_info>
    <org_study_id>2016-12 EXPLORE</org_study_id>
    <nct_id>NCT03038256</nct_id>
  </id_info>
  <brief_title>Effect of Concurrent Capecitabine-based Long-term Radiotherapy Followed by XELOX Plus TME in Patients With High Risk Rectal Cancer: a Multi-centers, Randomized Controlled, Open-Label Trial</brief_title>
  <acronym>EXPLORE</acronym>
  <official_title>Effect of Concurrent Capecitabine-based Long-term Radiotherapy Followed by 4 Cycles XELOX Pre- a Delayed TME Compared With 6 Cycles XELOX post-a Regular Timing TME in Patients With High Risk Rectal Cancer: a Multi-centers, Randomized, Open-Label Trial</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Peking University People's Hospital</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Peking University Cancer Hospital &amp; Institute</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Beijing Friendship Hospital</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Peking Union Medical College Hospital</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Chinese PLA General Hospital</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Shanghai Zhongshan Hospital</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Fujian Medical University Union Hospital</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Nanfang Hospital, Southern Medical University</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Xijing Hospital</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Hebei Medical University Fourth Hospital</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Affiliated Hospital of Hebei University</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>Peking University People's Hospital</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
    <is_us_export>No</is_us_export>
  </oversight_info>
  <brief_summary>
    <textblock>
      The purpose of this study was to evaluate the effect of concurrent capecitabine-based&#xD;
      long-term radiotherapy followed by 4 cycles XELOX pre- a delayed TME compared with 6 cycles&#xD;
      XELOX post- a Regular Timing TME in patients with high-risk rectal cancer defined by MRI.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      This is the randomized controlled, multi-centers, and open-labeled study. Delivering systemic&#xD;
      chemotherapy between concurrent capecitabine-based long-term radiotherapy and total&#xD;
      mesorectal excision (TME) surgery would be more effectively improved local control rates and&#xD;
      improved metastases-free survival rates. The investigators attempted to investigate the&#xD;
      effect on pathological response of delivering 4 cycles XELOX between concurrent&#xD;
      capecitabine-based long-term radiotherapy and TME with lengthening the interval from&#xD;
      radiation to surgery. In this study, the participants with high risk of deeper infiltration,&#xD;
      or extramural vessel invasion, or circumferential resection margin involvement, or&#xD;
      surrounding organs and structures invaded et al. were recruited. The participants will be&#xD;
      randomized (1:1 ratio) to a control and intervention arm. The participants in the control arm&#xD;
      will receive best current practice of concurrent capecitabine-based long-term radiotherapy&#xD;
      followed by TME and then a 6 cycles of XELOX as standard adjuvant chemotherapy. The&#xD;
      participants in the intervention arm will receive concurrent capecitabine-based long-term&#xD;
      radiotherapy followed by 4 cycles XELOX as neoadjuvant chemotherapy pre- a delayed TME.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Recruiting</overall_status>
  <start_date type="Actual">January 31, 2018</start_date>
  <completion_date type="Anticipated">June 1, 2025</completion_date>
  <primary_completion_date type="Anticipated">April 1, 2023</primary_completion_date>
  <phase>Phase 2</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>None (Open Label)</masking>
    <masking_description>Open Label</masking_description>
  </study_design_info>
  <primary_outcome>
    <measure>Pathological complete response rate</measure>
    <time_frame>up to 30days after total mesorectal excision</time_frame>
    <description>Pathological complete response (pCR) rate between control and intervention arm</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Disease Free Survival</measure>
    <time_frame>3-year</time_frame>
    <description>Disease Free Survival was defined as the time from the date of surgery to the date of the local recurrence, and/or distant disease, or tumor-related death.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>R0 of total mesorectal excision rate</measure>
    <time_frame>up to 30days after total mesorectal excision</time_frame>
    <description>Overall R0 of total mesorectal excision rate between the control and intervention arm</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Surgery morbidity</measure>
    <time_frame>30 days and 12-months</time_frame>
    <description>Surgical morbidity reported according to Clavien-Dindo classification</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>quality of surgery</measure>
    <time_frame>Time of surgery</time_frame>
    <description>Quality of surgery determined using the mesorectal grading system</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Anticipated">244</enrollment>
  <condition>Rectal Cancer</condition>
  <condition>Pathological Complete Response</condition>
  <condition>Disease Free Survival</condition>
  <arm_group>
    <arm_group_label>4 Cycles XELOX pre- TME</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>experimental group (arm B): concurrent capecitabine-based long-term radiotherapy, 4 cycles of XELOX as neoadjuvant chemotherapy and TME surgery</description>
  </arm_group>
  <arm_group>
    <arm_group_label>6 Cycles XELOX post- TME</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>control group (arm A): concurrent capecitabine-based long-term radiotherapy, TME surgery and 6 cycles of XELOX as adjuvant chemotherapy.</description>
  </arm_group>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>concurrent capecitabine-based long-term radiotherapy followed by 4 cycles XELOX and a delayed TME</intervention_name>
    <description>concurrent capecitabine-based long-term radiotherapy: capecitabine 825mg/m2,bid,d1-5, q week with Radiation treatment. Radiation treatment was given at 1·8 Gy per day, 5 days per week for 5-6 weeks, after a 45 Gy radiation dose in 25 fractions to the pelvis, a boost dose of 5·4 Gy in 3 fractions to the tumor bed or concurrent boosted.&#xD;
XELOX:&#xD;
Oxaliplatin: 130mg/m2,IV,d1; Capecitabine: 1000mg/m2,bid,d1-14; repeated every 3 weeks&#xD;
Surgery Procedure:&#xD;
Total Mesorectal Excision</description>
    <arm_group_label>4 Cycles XELOX pre- TME</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>concurrent capecitabine-based long-term radiotherapy followed by a Regular TME and 6 Cycles XELOX</intervention_name>
    <description>concurrent capecitabine-based long-term radiotherapy: capecitabine 825mg/m2,bid,d1-5, q week with Radiation treatment. Radiation treatment was given at 1·8 Gy per day, 5 days per week for 5-6 weeks, after a 45 Gy radiation dose in 25 fractions to the pelvis, a boost dose of 5·4 Gy in 3 fractions to the tumor bed or concurrent boosted.&#xD;
XELOX:&#xD;
Oxaliplatin: 130mg/m2,IV,d1; Capecitabine: 1000mg/m2,bid,d1-14; repeated every 3 weeks&#xD;
Surgery Procedure:&#xD;
Total Mesorectal Excision</description>
    <arm_group_label>6 Cycles XELOX post- TME</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          1. Age of 18-75 years;&#xD;
&#xD;
          2. Histologically confirmed adenocarcinoma;&#xD;
&#xD;
          3. The rectal adenocarcinoma 0-12cm from the anal margin on Magnetic resonance imaging&#xD;
             (MRI) and/or rigid sigmoidoscopy;&#xD;
&#xD;
          4. High risk of rectal cancer defined by high-resolution MRI: tumor invasion 5mm beyond&#xD;
             the muscularis propria, or extramural vascular invasion, or circumferential resection&#xD;
             margin unsafe, or the lower rectal cancer invades intersphincteric space, or rectal&#xD;
             cancer invades the adjacent structures.&#xD;
&#xD;
          5. Eastern Collaborative Oncology Group performance status score of 0 or 2&#xD;
&#xD;
          6. Able and willing to give informed consent to participate.&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          1. Received preoperative chemoradiotherapy for rectal cancer before the recruitment of&#xD;
             this study;&#xD;
&#xD;
          2. Have metastatic disease (including non-regional lymph nodes metastases or resectable&#xD;
             liver metastases);&#xD;
&#xD;
          3. Other malignancies, non-adenocarcinoma rectal malignancies or rectal malignancies on&#xD;
             the basis of inflammatory bowel disease;&#xD;
&#xD;
          4. Emergency surgery due to bowel obstruction, perforation, bleeding, etc.;&#xD;
&#xD;
          5. Abnormality of capecitabine absorption due to gastrointestinal disease e.g. short&#xD;
             bowel syndrome, inflammation bowel disease, et al.;&#xD;
&#xD;
          6. Unresectable concurrent intestinal lesions;&#xD;
&#xD;
          7. Concurrent severe infection；&#xD;
&#xD;
          8. Cardiac Disease：uncontrolled or symptomatic cardiac angina，or uncontrolled arrhythmias&#xD;
             and hypertension, or severe congestive heart failure grade II or more based on New&#xD;
             York Heart Association (NYHA); myocardial infarction within the past 12 months&#xD;
&#xD;
          9. Peripheral neuropathy more than grade 1 according to the National Cancer Institute&#xD;
             Common Terminology Criteria for Adverse Events (CTCAE; version 3·0)&#xD;
&#xD;
         10. Bone marrow, liver and kidney function are abnormal e.g., white blood cell ≤ 1.5 × 109&#xD;
             / L; platelet ≤ 100 × 109 / L; Haemoglobin ≤ 80 g/L; Bilirubin &gt; 1.5 times the upper&#xD;
             limit; aspartate aminotransferase and alanine aminotransferase &gt; 2.5 times the upper&#xD;
             limit; creatinine &gt; 1.5 times the upper limit;&#xD;
&#xD;
         11. Pregnant or lactating women;&#xD;
&#xD;
         12. Life prediction less than 3 months, other severe diseases;&#xD;
&#xD;
         13. Contraindication to MRI; e.g. non-MRI compatible hip prosthesis, cardiac pacemaker;&#xD;
&#xD;
         14. Contraindication to standard chemotherapy including drug interactions and glomerular&#xD;
             filtration rate &lt;50 mL/min at baseline;&#xD;
&#xD;
         15. Participators who had been recruited by other clinical trial within three months.&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>75 Years</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_contact>
    <last_name>Yi Wang, MD, PHD</last_name>
    <phone>8610-88325813</phone>
    <email>wangyi@pkuph.edu.cn, jennifer_wy@me.com</email>
  </overall_contact>
  <overall_contact_backup>
    <last_name>Yingjiang Ye, MD, PHD</last_name>
    <phone>8610-88326608</phone>
    <email>yeyingjiang@pkuph.edu.cn, yjye101@sina.com</email>
  </overall_contact_backup>
  <location>
    <facility>
      <name>Peking University People's Hospital</name>
      <address>
        <city>Beijing</city>
        <state>Beijing</state>
        <zip>100044</zip>
        <country>China</country>
      </address>
    </facility>
    <status>Recruiting</status>
    <contact>
      <last_name>Yingjiang Ye, M.D./PhD</last_name>
      <phone>+86-13321163682</phone>
      <email>yeyingjiang@pkuph.edu.cn</email>
    </contact>
    <contact_backup>
      <last_name>Yancheng Cui, M.D.</last_name>
      <phone>+86-15201277974</phone>
      <email>cuiyancheng2007@163.com</email>
    </contact_backup>
    <investigator>
      <last_name>Yingjiang Ye, M.D./PhD</last_name>
      <role>Principal Investigator</role>
    </investigator>
  </location>
  <location>
    <facility>
      <name>Beijing Friendship Hospital</name>
      <address>
        <city>Beijing</city>
        <state>Beijing</state>
        <country>China</country>
      </address>
    </facility>
    <status>Not yet recruiting</status>
    <contact>
      <last_name>Zhongtao Zhang, professor</last_name>
    </contact>
  </location>
  <location_countries>
    <country>China</country>
  </location_countries>
  <results_reference>
    <citation>Valentini V, van Stiphout RG, Lammering G, Gambacorta MA, Barba MC, Bebenek M, Bonnetain F, Bosset JF, Bujko K, Cionini L, Gerard JP, Rodel C, Sainato A, Sauer R, Minsky BD, Collette L, Lambin P. Nomograms for predicting local recurrence, distant metastases, and overall survival for patients with locally advanced rectal cancer on the basis of European randomized clinical trials. J Clin Oncol. 2011 Aug 10;29(23):3163-72. doi: 10.1200/JCO.2010.33.1595. Epub 2011 Jul 11.</citation>
    <PMID>21747092</PMID>
  </results_reference>
  <results_reference>
    <citation>Moran BJ. Predicting the risk and diminishing the consequences of anastomotic leakage after anterior resection for rectal cancer. Acta Chir Iugosl. 2010;57(3):47-50. doi: 10.2298/aci1003047m.</citation>
    <PMID>21066983</PMID>
  </results_reference>
  <results_reference>
    <citation>van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van de Velde CJ; Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011 Jun;12(6):575-82. doi: 10.1016/S1470-2045(11)70097-3. Epub 2011 May 17.</citation>
    <PMID>21596621</PMID>
  </results_reference>
  <results_reference>
    <citation>Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, Becker H, Raab HR, Villanueva MT, Witzigmann H, Wittekind C, Beissbarth T, Rodel C. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012 Jun 1;30(16):1926-33. doi: 10.1200/JCO.2011.40.1836. Epub 2012 Apr 23.</citation>
    <PMID>22529255</PMID>
  </results_reference>
  <results_reference>
    <citation>Lutz MP, Zalcberg JR, Glynne-Jones R, Ruers T, Ducreux M, Arnold D, Aust D, Brown G, Bujko K, Cunningham C, Evrard S, Folprecht G, Gerard JP, Habr-Gama A, Haustermans K, Holm T, Kuhlmann KF, Lordick F, Mentha G, Moehler M, Nagtegaal ID, Pigazzi A, Pucciarelli S, Roth A, Rutten H, Schmoll HJ, Sorbye H, Van Cutsem E, Weitz J, Otto F. Second St. Gallen European Organisation for Research and Treatment of Cancer Gastrointestinal Cancer Conference: consensus recommendations on controversial issues in the primary treatment of rectal cancer. Eur J Cancer. 2016 Aug;63:11-24. doi: 10.1016/j.ejca.2016.04.010. Epub 2016 May 30. Erratum In: Eur J Cancer. 2016 Nov;68:208-209.</citation>
    <PMID>27254838</PMID>
  </results_reference>
  <results_reference>
    <citation>Chua YJ, Barbachano Y, Cunningham D, Oates JR, Brown G, Wotherspoon A, Tait D, Massey A, Tebbutt NC, Chau I. Neoadjuvant capecitabine and oxaliplatin before chemoradiotherapy and total mesorectal excision in MRI-defined poor-risk rectal cancer: a phase 2 trial. Lancet Oncol. 2010 Mar;11(3):241-8. doi: 10.1016/S1470-2045(09)70381-X. Epub 2010 Jan 25.</citation>
    <PMID>20106720</PMID>
  </results_reference>
  <results_reference>
    <citation>Glynne-Jones R, Anyamene N, Moran B, Harrison M. Neoadjuvant chemotherapy in MRI-staged high-risk rectal cancer in addition to or as an alternative to preoperative chemoradiation? Ann Oncol. 2012 Oct;23(10):2517-2526. doi: 10.1093/annonc/mds010. Epub 2012 Feb 23.</citation>
    <PMID>22367706</PMID>
  </results_reference>
  <results_reference>
    <citation>Rodel C, Graeven U, Fietkau R, Hohenberger W, Hothorn T, Arnold D, Hofheinz RD, Ghadimi M, Wolff HA, Lang-Welzenbach M, Raab HR, Wittekind C, Strobel P, Staib L, Wilhelm M, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R, Liersch T; German Rectal Cancer Study Group. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2015 Aug;16(8):979-89. doi: 10.1016/S1470-2045(15)00159-X. Epub 2015 Jul 15.</citation>
    <PMID>26189067</PMID>
  </results_reference>
  <results_reference>
    <citation>Deng Y, Chi P, Lan P, Wang L, Chen W, Cui L, Chen D, Cao J, Wei H, Peng X, Huang Z, Cai G, Zhao R, Huang Z, Xu L, Zhou H, Wei Y, Zhang H, Zheng J, Huang Y, Zhou Z, Cai Y, Kang L, Huang M, Peng J, Ren D, Wang J. Modified FOLFOX6 With or Without Radiation Versus Fluorouracil and Leucovorin With Radiation in Neoadjuvant Treatment of Locally Advanced Rectal Cancer: Initial Results of the Chinese FOWARC Multicenter, Open-Label, Randomized Three-Arm Phase III Trial. J Clin Oncol. 2016 Sep 20;34(27):3300-7. doi: 10.1200/JCO.2016.66.6198. Epub 2016 Aug 1.</citation>
    <PMID>27480145</PMID>
  </results_reference>
  <results_reference>
    <citation>Garcia-Aguilar J, Chow OS, Smith DD, Marcet JE, Cataldo PA, Varma MG, Kumar AS, Oommen S, Coutsoftides T, Hunt SR, Stamos MJ, Ternent CA, Herzig DO, Fichera A, Polite BN, Dietz DW, Patil S, Avila K; Timing of Rectal Cancer Response to Chemoradiation Consortium. Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial. Lancet Oncol. 2015 Aug;16(8):957-66. doi: 10.1016/S1470-2045(15)00004-2. Epub 2015 Jul 14.</citation>
    <PMID>26187751</PMID>
  </results_reference>
  <verification_date>March 2023</verification_date>
  <study_first_submitted>January 25, 2017</study_first_submitted>
  <study_first_submitted_qc>January 28, 2017</study_first_submitted_qc>
  <study_first_posted type="Estimate">January 31, 2017</study_first_posted>
  <last_update_submitted>March 19, 2023</last_update_submitted>
  <last_update_submitted_qc>March 19, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">March 22, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Peking University People's Hospital</investigator_affiliation>
    <investigator_full_name>YE Yingjiang</investigator_full_name>
    <investigator_title>Department of GI Surgery</investigator_title>
  </responsible_party>
  <keyword>High Risk Rectal Cancer</keyword>
  <keyword>Total neoadjuvant chemoradiotherapy</keyword>
  <keyword>Lengthening interval between radiotherapy and surgery</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Rectal Neoplasms</mesh_term>
  </condition_browse>
  <intervention_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Capecitabine</mesh_term>
  </intervention_browse>
  <patient_data>
    <sharing_ipd>Yes</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03038256
org study id: 2016-12 EXPLORE
nct id: NCT03038256
lead sponsor: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
has dmc: Yes
is fda regulated drug: No
is fda regulated device: No
is us export: No
The purpose of this study was to evaluate the effect of concurrent capecitabine-based
      long-term radiotherapy followed by 4 cycles XELOX pre- a delayed TME compared with 6 cycles
      XELOX post- a Regular Timing TME in patients with high-risk rectal cancer defined by MRI.
This is the randomized controlled, multi-centers, and open-labeled study. Delivering systemic
      chemotherapy between concurrent capecitabine-based long-term radiotherapy and total
      mesorectal excision (TME) surgery would be more effectively improved local control rates and
      improved metastases-free survival rates. The investigators attempted to investigate the
      effect on pathological response of delivering 4 cycles XELOX between concurrent
      capecitabine-based long-term radiotherapy and TME with lengthening the interval from
      radiation to surgery. In this study, the participants with high risk of deeper infiltration,
      or extramural vessel invasion, or circumferential resection margin involvement, or
      surrounding organs and structures invaded et al. were recruited. The participants will be
      randomized (1:1 ratio) to a control and intervention arm. The participants in the control arm
      will receive best current practice of concurrent capecitabine-based long-term radiotherapy
      followed by TME and then a 6 cycles of XELOX as standard adjuvant chemotherapy. The
      participants in the intervention arm will receive concurrent capecitabine-based long-term
      radiotherapy followed by 4 cycles XELOX as neoadjuvant chemotherapy pre- a delayed TME.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Treatment
masking: None (Open Label)
masking description: Open Label
measure: Pathological complete response rate
time frame: up to 30days after total mesorectal excision
description: Pathological complete response (pCR) rate between control and intervention arm
measure: Disease Free Survival
time frame: 3-year
description: Disease Free Survival was defined as the time from the date of surgery to the date of the local recurrence, and/or distant disease, or tumor-related death.
measure: R0 of total mesorectal excision rate
time frame: up to 30days after total mesorectal excision
description: Overall R0 of total mesorectal excision rate between the control and intervention arm
measure: Surgery morbidity
time frame: 30 days and 12-months
description: Surgical morbidity reported according to Clavien-Dindo classification
measure: quality of surgery
time frame: Time of surgery
description: Quality of surgery determined using the mesorectal grading system
arm group label: 4 Cycles XELOX pre- TME
arm group type: Experimental
description: experimental group (arm B): concurrent capecitabine-based long-term radiotherapy, 4 cycles of XELOX as neoadjuvant chemotherapy and TME surgery
arm group label: 6 Cycles XELOX post- TME
arm group type: Active Comparator
description: control group (arm A): concurrent capecitabine-based long-term radiotherapy, TME surgery and 6 cycles of XELOX as adjuvant chemotherapy.
intervention type: Drug
intervention name: concurrent capecitabine-based long-term radiotherapy followed by 4 cycles XELOX and a delayed TME
description: concurrent capecitabine-based long-term radiotherapy: capecitabine 825mg/m2,bid,d1-5, q week with Radiation treatment. Radiation treatment was given at 1·8 Gy per day, 5 days per week for 5-6 weeks, after a 45 Gy radiation dose in 25 fractions to the pelvis, a boost dose of 5·4 Gy in 3 fractions to the tumor bed or concurrent boosted.
XELOX:
Oxaliplatin: 130mg/m2,IV,d1; Capecitabine: 1000mg/m2,bid,d1-14; repeated every 3 weeks
Surgery Procedure:
Total Mesorectal Excision
arm group label: 4 Cycles XELOX pre- TME
intervention type: Drug
intervention name: concurrent capecitabine-based long-term radiotherapy followed by a Regular TME and 6 Cycles XELOX
description: concurrent capecitabine-based long-term radiotherapy: capecitabine 825mg/m2,bid,d1-5, q week with Radiation treatment. Radiation treatment was given at 1·8 Gy per day, 5 days per week for 5-6 weeks, after a 45 Gy radiation dose in 25 fractions to the pelvis, a boost dose of 5·4 Gy in 3 fractions to the tumor bed or concurrent boosted.
XELOX:
Oxaliplatin: 130mg/m2,IV,d1; Capecitabine: 1000mg/m2,bid,d1-14; repeated every 3 weeks
Surgery Procedure:
Total Mesorectal Excision
arm group label: 6 Cycles XELOX post- TME
criteria: 
gender: All
minimum age: 18 Years
maximum age: 75 Years
healthy volunteers: No
last name: Yi Wang, MD, PHD
phone: 8610-88325813
email: wangyi@pkuph.edu.cn, jennifer_wy@me.com
last name: Yingjiang Ye, MD, PHD
phone: 8610-88326608
email: yeyingjiang@pkuph.edu.cn, yjye101@sina.com
facility: 
status: Recruiting
contact: 
contact backup: 
investigator: 
facility: 
status: Not yet recruiting
contact: 
country: China
citation: Valentini V, van Stiphout RG, Lammering G, Gambacorta MA, Barba MC, Bebenek M, Bonnetain F, Bosset JF, Bujko K, Cionini L, Gerard JP, Rodel C, Sainato A, Sauer R, Minsky BD, Collette L, Lambin P. Nomograms for predicting local recurrence, distant metastases, and overall survival for patients with locally advanced rectal cancer on the basis of European randomized clinical trials. J Clin Oncol. 2011 Aug 10;29(23):3163-72. doi: 10.1200/JCO.2010.33.1595. Epub 2011 Jul 11.
PMID: 21747092
citation: Moran BJ. Predicting the risk and diminishing the consequences of anastomotic leakage after anterior resection for rectal cancer. Acta Chir Iugosl. 2010;57(3):47-50. doi: 10.2298/aci1003047m.
PMID: 21066983
citation: van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van de Velde CJ; Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011 Jun;12(6):575-82. doi: 10.1016/S1470-2045(11)70097-3. Epub 2011 May 17.
PMID: 21596621
citation: Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, Becker H, Raab HR, Villanueva MT, Witzigmann H, Wittekind C, Beissbarth T, Rodel C. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012 Jun 1;30(16):1926-33. doi: 10.1200/JCO.2011.40.1836. Epub 2012 Apr 23.
PMID: 22529255
citation: Lutz MP, Zalcberg JR, Glynne-Jones R, Ruers T, Ducreux M, Arnold D, Aust D, Brown G, Bujko K, Cunningham C, Evrard S, Folprecht G, Gerard JP, Habr-Gama A, Haustermans K, Holm T, Kuhlmann KF, Lordick F, Mentha G, Moehler M, Nagtegaal ID, Pigazzi A, Pucciarelli S, Roth A, Rutten H, Schmoll HJ, Sorbye H, Van Cutsem E, Weitz J, Otto F. Second St. Gallen European Organisation for Research and Treatment of Cancer Gastrointestinal Cancer Conference: consensus recommendations on controversial issues in the primary treatment of rectal cancer. Eur J Cancer. 2016 Aug;63:11-24. doi: 10.1016/j.ejca.2016.04.010. Epub 2016 May 30. Erratum In: Eur J Cancer. 2016 Nov;68:208-209.
PMID: 27254838
citation: Chua YJ, Barbachano Y, Cunningham D, Oates JR, Brown G, Wotherspoon A, Tait D, Massey A, Tebbutt NC, Chau I. Neoadjuvant capecitabine and oxaliplatin before chemoradiotherapy and total mesorectal excision in MRI-defined poor-risk rectal cancer: a phase 2 trial. Lancet Oncol. 2010 Mar;11(3):241-8. doi: 10.1016/S1470-2045(09)70381-X. Epub 2010 Jan 25.
PMID: 20106720
citation: Glynne-Jones R, Anyamene N, Moran B, Harrison M. Neoadjuvant chemotherapy in MRI-staged high-risk rectal cancer in addition to or as an alternative to preoperative chemoradiation? Ann Oncol. 2012 Oct;23(10):2517-2526. doi: 10.1093/annonc/mds010. Epub 2012 Feb 23.
PMID: 22367706
citation: Rodel C, Graeven U, Fietkau R, Hohenberger W, Hothorn T, Arnold D, Hofheinz RD, Ghadimi M, Wolff HA, Lang-Welzenbach M, Raab HR, Wittekind C, Strobel P, Staib L, Wilhelm M, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R, Liersch T; German Rectal Cancer Study Group. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2015 Aug;16(8):979-89. doi: 10.1016/S1470-2045(15)00159-X. Epub 2015 Jul 15.
PMID: 26189067
citation: Deng Y, Chi P, Lan P, Wang L, Chen W, Cui L, Chen D, Cao J, Wei H, Peng X, Huang Z, Cai G, Zhao R, Huang Z, Xu L, Zhou H, Wei Y, Zhang H, Zheng J, Huang Y, Zhou Z, Cai Y, Kang L, Huang M, Peng J, Ren D, Wang J. Modified FOLFOX6 With or Without Radiation Versus Fluorouracil and Leucovorin With Radiation in Neoadjuvant Treatment of Locally Advanced Rectal Cancer: Initial Results of the Chinese FOWARC Multicenter, Open-Label, Randomized Three-Arm Phase III Trial. J Clin Oncol. 2016 Sep 20;34(27):3300-7. doi: 10.1200/JCO.2016.66.6198. Epub 2016 Aug 1.
PMID: 27480145
citation: Garcia-Aguilar J, Chow OS, Smith DD, Marcet JE, Cataldo PA, Varma MG, Kumar AS, Oommen S, Coutsoftides T, Hunt SR, Stamos MJ, Ternent CA, Herzig DO, Fichera A, Polite BN, Dietz DW, Patil S, Avila K; Timing of Rectal Cancer Response to Chemoradiation Consortium. Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial. Lancet Oncol. 2015 Aug;16(8):957-66. doi: 10.1016/S1470-2045(15)00004-2. Epub 2015 Jul 14.
PMID: 26187751
responsible party type: Principal Investigator
investigator affiliation: Peking University People's Hospital
investigator full name: YE Yingjiang
investigator title: Department of GI Surgery
mesh term: Rectal Neoplasms
mesh term: Capecitabine
sharing ipd: Yes