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Trial details imported from ClinicalTrials.gov

For full trial details, please see the original record at https://clinicaltrials.gov/study/NCT00346164




Registration number
NCT00346164
Ethics application status
Date submitted
28/06/2006
Date registered
29/06/2006
Date last updated
28/04/2022

Titles & IDs
Public title
Observation, Radiation Therapy, Combination Chemotherapy, and/or Surgery in Treating Young Patients With Soft Tissue Sarcoma
Scientific title
Risk-Based Treatment for Non-Rhabdomyosarcoma Soft Tissue Sarcomas (NRSTS) in Patients Under 30 Years of Age
Secondary ID [1] 0 0
NCI-2009-00426
Secondary ID [2] 0 0
ARST0332
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Adult Alveolar Soft-part Sarcoma 0 0
Adult Angiosarcoma 0 0
Adult Epithelioid Sarcoma 0 0
Adult Extraskeletal Chondrosarcoma 0 0
Adult Extraskeletal Osteosarcoma 0 0
Adult Fibrosarcoma 0 0
Adult Leiomyosarcoma 0 0
Adult Liposarcoma 0 0
Adult Malignant Fibrous Histiocytoma 0 0
Adult Malignant Hemangiopericytoma 0 0
Adult Malignant Mesenchymoma 0 0
Adult Neurofibrosarcoma 0 0
Adult Synovial Sarcoma 0 0
Childhood Alveolar Soft-part Sarcoma 0 0
Childhood Angiosarcoma 0 0
Childhood Epithelioid Sarcoma 0 0
Childhood Fibrosarcoma 0 0
Childhood Leiomyosarcoma 0 0
Childhood Liposarcoma 0 0
Childhood Malignant Mesenchymoma 0 0
Childhood Neurofibrosarcoma 0 0
Childhood Synovial Sarcoma 0 0
Dermatofibrosarcoma Protuberans 0 0
Metastatic Childhood Soft Tissue Sarcoma 0 0
Nonmetastatic Childhood Soft Tissue Sarcoma 0 0
Stage I Adult Soft Tissue Sarcoma 0 0
Stage II Adult Soft Tissue Sarcoma 0 0
Stage III Adult Soft Tissue Sarcoma 0 0
Stage IV Adult Soft Tissue Sarcoma 0 0
Condition category
Condition code
Cancer 0 0 0 0
Sarcoma (also see 'Bone') - soft tissue
Cancer 0 0 0 0
Bone
Cancer 0 0 0 0
Children's - Other
Cancer 0 0 0 0
Any cancer
Neurological 0 0 0 0
Other neurological disorders
Skin 0 0 0 0
Other skin conditions
Cancer 0 0 0 0
Other cancer types

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Treatment: Drugs - doxorubicin hydrochloride
Other interventions - clinical observation
Treatment: Surgery - therapeutic conventional surgery
Treatment: Other - 3-dimensional conformal radiation therapy
Treatment: Drugs - ifosfamide

Experimental: Arm A: No adjuvant treatment - Patients with low-grade tumor with either negative or positive microscopic margins or high-grade tumor = 5 cm (in maximum diameter) with negative microscopic margins are assigned to arm A: (observation only).

Experimental: Arm B: Low risk; adjuvant radiotherapy - Patients with high-grade tumor = 5 cm (in maximum diameter) with positive microscopic margins are assigned to arm B: (adjuvant radiotherapy). Beginning between 6-42 days after surgical resection, patients undergo a total of 31 fractions of adjuvant radiotherapy.

Experimental: Arm C: Intermediate & High risk; adjuvant chemoradiotherapy - High risk \[metastatic, resected, incompletely resected, or unresected disease\] patients with high-grade, grossly resected primary tumor, with metastases are assigned to receive arm C: (adjuvant chemoradiotherapy). Patients receive ifosfamide IV; doxorubicin hydrochloride IV; beginning in week 4, patients also undergo a total of 31 fractions of radiotherapy.

Experimental: Arm D: Intermediate & High Risk; Neoadjuvant chemoradiotherapy - High risk \[metastatic, resected, incompletely resected, or unresected disease\] patients with unresected, high-grade metastatic tumor are assigned to receive treatment as in arm D: (neoadjuvant chemoradiotherapy, surgery, and adjuvant chemotherapy with or without radiotherapy): Patients receive ifosfamide IV; doxorubicin hydrochloride IV. Beginning in week 4, patients also undergo a total of 31 fractions of radiotherapy. Patients undergo surgical resection in week 13.


Treatment: Drugs: doxorubicin hydrochloride
Given IV

Other interventions: clinical observation
Patients undergo observation

Treatment: Surgery: therapeutic conventional surgery
Patients undergo surgery

Treatment: Other: 3-dimensional conformal radiation therapy
Patients undergo radiotherapy

Treatment: Drugs: ifosfamide
Given IV
Intervention code [1] 0 0
Treatment: Drugs
Intervention code [2] 0 0
Other interventions
Intervention code [3] 0 0
Treatment: Surgery
Intervention code [4] 0 0
Treatment: Other
Comparator / control treatment
Control group

Outcomes
Primary outcome [1] 0 0
Probability for Event Free Survival.
Timepoint [1] 0 0
5 years
Secondary outcome [1] 0 0
Toxicity Rate
Timepoint [1] 0 0
13 weeks
Secondary outcome [2] 0 0
Complete or Partial Response Rate
Timepoint [2] 0 0
13 weeks
Secondary outcome [3] 0 0
Percent Tumor Necrosis
Timepoint [3] 0 0
13 weeks
Secondary outcome [4] 0 0
Event Free Survival Probability Disease Extent
Timepoint [4] 0 0
5 years
Secondary outcome [5] 0 0
Event Free Survival Probability Histologic Grade
Timepoint [5] 0 0
5 years
Secondary outcome [6] 0 0
Overall Survival Probability Disease Extent
Timepoint [6] 0 0
5 years
Secondary outcome [7] 0 0
Overall Survival Probability Extent of Resection of the Primary Tumor
Timepoint [7] 0 0
5 years
Secondary outcome [8] 0 0
Incidence of Distant Metastasis
Timepoint [8] 0 0
Up to 10 years
Secondary outcome [9] 0 0
Genetic and Gene Expression Profiles
Timepoint [9] 0 0
At diagnosis
Secondary outcome [10] 0 0
Degree of Agreement in Histologic Grade Determined by the Enrolling Institution Versus by Central Pathology Reviewers
Timepoint [10] 0 0
At Diagnosis
Secondary outcome [11] 0 0
Degree of Agreement in Histologic Grade Between Pediatric Oncology Group (POG) and Fédération Nationale Des Centres de Lutte Contre le Cancer (FNCLCC) Pathologic Grading Systems
Timepoint [11] 0 0
At diagnosis

Eligibility
Key inclusion criteria
* Newly diagnosed non-rhabdomyosarcoma soft tissue sarcoma (STS), confirmed by central pathology review via concurrent enrollment on protocol COG-D9902

* Metastatic or non metastatic disease
* Meets 1 of the following criteria:

* Intermediate (i.e., rarely metastasizing) or malignant STS, including any of the following:

* Adipocytic tumor, including liposarcoma of any of the following histology subtypes:

* Dedifferentiated
* Myxoid
* Round cell
* Pleomorphic type
* Mixed-type
* Not otherwise specified (NOS)
* Fibroblastic/myofibroblastic tumors, including any of the following:

* Solitary fibrous tumor
* Hemangiopericytoma
* Low-grade myofibroblastic sarcoma
* Myxoinflammatory fibroblastic sarcoma
* Adult fibrosarcoma*
* Myxofibrosarcoma
* Low-grade fibromyxoid sarcoma or hyalinizing spindle-cell tumor
* Sclerosing epithelioid fibrosarcoma
* So-called fibrohistiocytic tumors, including any of the following:

* Plexiform fibrohistiocytic tumor
* Giant cell tumor of soft tissues
* Pleomorphic malignant fibrous histiocytoma (MFH)/undifferentiated pleomorphic sarcoma
* Giant cell MFH/undifferentiated pleomorphic sarcoma with giant cells
* Inflammatory MFH/undifferentiated pleomorphic sarcoma with prominent inflammation
* Smooth muscle tumor (leiomyosarcoma)
* Pericytic [perivascular] tumor (malignant glomus tumor or glomangiosarcoma)
* Vascular tumor, including angiosarcoma
* Chondro-osseous tumors of any of the following types:

* Mesenchymal chondrosarcoma
* Extraskeletal osteosarcoma
* Tumors of uncertain differentiation, including any of the following:

* Angiomatoid fibrous histiocytoma
* Ossifying fibromyxoid tumor
* Myoepithelioma/parachordoma
* Synovial sarcoma
* Epithelioid sarcoma
* Alveolar soft-part sarcoma
* Clear cell sarcoma of soft tissue
* Extraskeletal myxoid chondrosarcoma ("chordoid type")
* Malignant mesenchymoma
* Neoplasms with perivascular epithelioid cell differentiation (PEComa)
* Clear cell myomelanocytic tumor
* Intimal sarcoma
* Malignant peripheral nerve sheath tumor
* Dermatofibrosarcoma protuberans meeting both of the following criteria:

* Non metastatic disease
* Tumor must be grossly resected prior to study enrollment
* Embryonal sarcoma of the liver
* Unclassified STS that is too undifferentiated to be placed in a specific pathologic category (undifferentiated STS or STS NOS)
* Gross resection of the primary tumor = 42 days prior to enrollment required except if any of the following circumstances apply:

* Non metastatic high-grade tumor > 5 cm in maximal diameter and gross or microscopic residual tumor is anticipated after resection
* Tumor of either high- or- low-grade that cannot be grossly excised without unacceptable morbidity
* High-grade tumor with metastases

* Patients with metastatic low-grade tumor whose disease is amenable to gross resection at all sites must undergo gross resection of all sites prior to study entry
* Patients with a tumor recurrence after a gross total resection are not eligible
* Tumors arising in bone are not eligible
* Patients with epithelioid sarcoma, clear cell sarcoma, or clinical or radiologic evidence of regional lymph node enlargement must undergo sentinel lymph node biopsies or lymph node sampling to confirm the status of regional lymph nodes* NOTE: *Except in cases where the study radiologist reviews the imaging and indicates that a biopsy is not needed to confirm that the patient has lymph node involvement.

* If lymph node biopsies are positive for tumor (or the lymph nodes are classified as positive by the study radiologist), formal lymph node dissection must be done at the time of definitive surgery(prior to study entry for patients assigned to study regimen C)
* Patients with metastatic disease must undergo a biopsy to confirm the presence of metastatic tumor if all metastases are < 1 cm in maximal diameter (except in cases where the study radiologist reviews the imaging and indicated that a biopsy is not needed to confirm that the patient has metastatic disease)
* Lansky performance status (PS) 50-100% (for patients = 16 years of age) OR Karnofsky PS 50-100% (for patients > 16 years of age)
* Life expectancy = 3 months
* Absolute neutrophil count = 1,000/mm³*
* Platelet count = 100,000/mm³*
* Creatinine clearance or radioisotope glomerular filtration rate = 70 mL/min (= 40 mL/min for infants < 1 year of age)* or serum creatinine based on age and/or gender as follows:

* 0.4 mg/dL (1 month to < 6 months of age)
* 0.5 mg/dL (6 months to < 1 year of age)
* 0.6 mg/dL (1 year to < 2 years of age)
* 0.8 mg/dL (2 years to < 6 years of age)
* 1.0 mg/dL (6 years to < 10 years of age)
* 1.2 mg/dL (10 years to < 13 years of age)
* 1.5 mg/dL (male) or 1.4 mg/dL (female) (13 years to < 16 years of age)
* 1.7 mg/dL (male) or 1.4 mg/dL (female) (= 16 years of age)
* Patients with urinary tract obstruction by tumor must meet the renal function criteria listed above AND must have unimpeded urinary flow established via decompression of the obstructed portion of the urinary tract
* Bilirubin = 1.5 times upper limit of normal (ULN)*
* Shortening fraction = 27% by echocardiogram* OR ejection fraction = 50% by radionuclide angiogram*
* Not pregnant or nursing (patients undergoing radiotherapy and/or chemotherapy)

* No nursing for = 1 month after completion of study treatment in study regimens C or D
* Fertile patients must use effective contraception during and for = 1 month after completion of study treatment
* Negative pregnancy test
* No evidence of dyspnea at rest*
* No exercise intolerance*
* Resting pulse oximetry reading > 94% on room air (for patients with respiratory symptoms)*
* Prior treatment for cancer allowed provided the patient meet the prior therapy requirements
* No prior anthracycline (e.g., doxorubicin or daunorubicin) or ifosfamide chemotherapy for patients enrolled on arm C or arm D
* No prior radiotherapy to tumor-involved sites
Minimum age
No limit
Maximum age
29 Years
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria

Study design
Purpose of the study
Treatment
Allocation to intervention
Non-randomised trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Parallel
Other design features
Phase
Phase 3
Type of endpoint/s
Statistical methods / analysis

Recruitment
Recruitment status
Completed
Data analysis
Reason for early stopping/withdrawal
Other reasons
Date of first participant enrolment
Anticipated
Actual
5/02/2007
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
31/03/2022
Sample size
Target
Accrual to date
Final
588
Recruitment in Australia
Recruitment state(s)
NSW,QLD,SA,VIC,WA
Recruitment hospital [1] 0 0
Sydney Children's Hospital - Randwick
Recruitment hospital [2] 0 0
The Children's Hospital at Westmead - Sydney
Recruitment hospital [3] 0 0
Royal Brisbane and Women's Hospital - Herston
Recruitment hospital [4] 0 0
Women's and Children's Hospital-Adelaide - North Adelaide
Recruitment hospital [5] 0 0
Royal Children's Hospital - Parkville
Recruitment hospital [6] 0 0
Princess Margaret Hospital for Children - Perth
Recruitment postcode(s) [1] 0 0
2031 - Randwick
Recruitment postcode(s) [2] 0 0
2145 - Sydney
Recruitment postcode(s) [3] 0 0
4029 - Herston
Recruitment postcode(s) [4] 0 0
5006 - North Adelaide
Recruitment postcode(s) [5] 0 0
3052 - Parkville
Recruitment postcode(s) [6] 0 0
6008 - Perth
Recruitment outside Australia
Country [1] 0 0
United States of America
State/province [1] 0 0
Alabama
Country [2] 0 0
United States of America
State/province [2] 0 0
Arizona
Country [3] 0 0
United States of America
State/province [3] 0 0
Arkansas
Country [4] 0 0
United States of America
State/province [4] 0 0
California
Country [5] 0 0
United States of America
State/province [5] 0 0
Colorado
Country [6] 0 0
United States of America
State/province [6] 0 0
Connecticut
Country [7] 0 0
United States of America
State/province [7] 0 0
Delaware
Country [8] 0 0
United States of America
State/province [8] 0 0
District of Columbia
Country [9] 0 0
United States of America
State/province [9] 0 0
Florida
Country [10] 0 0
United States of America
State/province [10] 0 0
Georgia
Country [11] 0 0
United States of America
State/province [11] 0 0
Hawaii
Country [12] 0 0
United States of America
State/province [12] 0 0
Idaho
Country [13] 0 0
United States of America
State/province [13] 0 0
Illinois
Country [14] 0 0
United States of America
State/province [14] 0 0
Indiana
Country [15] 0 0
United States of America
State/province [15] 0 0
Iowa
Country [16] 0 0
United States of America
State/province [16] 0 0
Kentucky
Country [17] 0 0
United States of America
State/province [17] 0 0
Louisiana
Country [18] 0 0
United States of America
State/province [18] 0 0
Maine
Country [19] 0 0
United States of America
State/province [19] 0 0
Maryland
Country [20] 0 0
United States of America
State/province [20] 0 0
Massachusetts
Country [21] 0 0
United States of America
State/province [21] 0 0
Michigan
Country [22] 0 0
United States of America
State/province [22] 0 0
Minnesota
Country [23] 0 0
United States of America
State/province [23] 0 0
Mississippi
Country [24] 0 0
United States of America
State/province [24] 0 0
Missouri
Country [25] 0 0
United States of America
State/province [25] 0 0
Nebraska
Country [26] 0 0
United States of America
State/province [26] 0 0
Nevada
Country [27] 0 0
United States of America
State/province [27] 0 0
New Hampshire
Country [28] 0 0
United States of America
State/province [28] 0 0
New Jersey
Country [29] 0 0
United States of America
State/province [29] 0 0
New Mexico
Country [30] 0 0
United States of America
State/province [30] 0 0
New York
Country [31] 0 0
United States of America
State/province [31] 0 0
North Carolina
Country [32] 0 0
United States of America
State/province [32] 0 0
North Dakota
Country [33] 0 0
United States of America
State/province [33] 0 0
Ohio
Country [34] 0 0
United States of America
State/province [34] 0 0
Oklahoma
Country [35] 0 0
United States of America
State/province [35] 0 0
Oregon
Country [36] 0 0
United States of America
State/province [36] 0 0
Pennsylvania
Country [37] 0 0
United States of America
State/province [37] 0 0
Rhode Island
Country [38] 0 0
United States of America
State/province [38] 0 0
South Carolina
Country [39] 0 0
United States of America
State/province [39] 0 0
South Dakota
Country [40] 0 0
United States of America
State/province [40] 0 0
Tennessee
Country [41] 0 0
United States of America
State/province [41] 0 0
Texas
Country [42] 0 0
United States of America
State/province [42] 0 0
Utah
Country [43] 0 0
United States of America
State/province [43] 0 0
Vermont
Country [44] 0 0
United States of America
State/province [44] 0 0
Virginia
Country [45] 0 0
United States of America
State/province [45] 0 0
Washington
Country [46] 0 0
United States of America
State/province [46] 0 0
West Virginia
Country [47] 0 0
United States of America
State/province [47] 0 0
Wisconsin
Country [48] 0 0
Canada
State/province [48] 0 0
Alberta
Country [49] 0 0
Canada
State/province [49] 0 0
British Columbia
Country [50] 0 0
Canada
State/province [50] 0 0
Manitoba
Country [51] 0 0
Canada
State/province [51] 0 0
Newfoundland and Labrador
Country [52] 0 0
Canada
State/province [52] 0 0
Nova Scotia
Country [53] 0 0
Canada
State/province [53] 0 0
Ontario
Country [54] 0 0
Canada
State/province [54] 0 0
Quebec
Country [55] 0 0
Canada
State/province [55] 0 0
Saskatchewan
Country [56] 0 0
New Zealand
State/province [56] 0 0
Auckland
Country [57] 0 0
Puerto Rico
State/province [57] 0 0
Santurce

Funding & Sponsors
Primary sponsor type
Other
Name
Children's Oncology Group
Address
Country
Other collaborator category [1] 0 0
Government body
Name [1] 0 0
National Cancer Institute (NCI)
Address [1] 0 0
Country [1] 0 0

Ethics approval
Ethics application status

Summary
Brief summary
This phase III trial is studying observation to see how well a risk based treatment strategy works in patients with soft tissue sarcoma. In the study, patients are assigned to receive surgery +/- radiotherapy +/- chemotherapy depending on their risk of recurrence. Sometimes, after surgery, the tumor may not need additional treatment until it progresses. In this case, observation may be sufficient. Radiation therapy uses high-energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as ifosfamide and doxorubicin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving chemotherapy and radiation therapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Giving these treatments after surgery may kill any tumor cells that remain after surgery.
Trial website
https://clinicaltrials.gov/study/NCT00346164
Trial related presentations / publications
Venkatramani R, Xue W, Randall RL, Wolden S, Anderson J, Lopez-Terrada D, Black J, Kao SC, Shulkin B, Ostrenga A, Pappo A, Spunt SL. Synovial Sarcoma in Children, Adolescents, and Young Adults: A Report From the Children's Oncology Group ARST0332 Study. J Clin Oncol. 2021 Dec 10;39(35):3927-3937. doi: 10.1200/JCO.21.01628. Epub 2021 Oct 8.
Million L, Hayes-Jordan A, Chi YY, Donaldson SS, Wolden S, Morris C, Terezakis S, Laurie F, Morano K, Fitzgerald TJ, Yock TI, Rodeberg DA, Anderson JR, Speights RA, Black JO, Coffin C, McCarville MB, Kao SC, Hawkins DS, Spunt SL, Randall RL. Local Control For High-Grade Nonrhabdomyosarcoma Soft Tissue Sarcoma Assigned to Radiation Therapy on ARST0332: A Report From the Childrens Oncology Group. Int J Radiat Oncol Biol Phys. 2021 Jul 1;110(3):821-830. doi: 10.1016/j.ijrobp.2021.01.051. Epub 2021 Feb 3.
Spunt SL, Million L, Chi YY, Anderson J, Tian J, Hibbitts E, Coffin C, McCarville MB, Randall RL, Parham DM, Black JO, Kao SC, Hayes-Jordan A, Wolden S, Laurie F, Speights R, Kawashima E, Skapek SX, Meyer W, Pappo AS, Hawkins DS. A risk-based treatment strategy for non-rhabdomyosarcoma soft-tissue sarcomas in patients younger than 30 years (ARST0332): a Children's Oncology Group prospective study. Lancet Oncol. 2020 Jan;21(1):145-161. doi: 10.1016/S1470-2045(19)30672-2. Epub 2019 Nov 27.
Spunt SL, Francotte N, De Salvo GL, Chi YY, Zanetti I, Hayes-Jordan A, Kao SC, Orbach D, Brennan B, Weiss AR, van Noesel MM, Million L, Alaggio R, Parham DM, Kelsey A, Randall RL, McCarville MB, Bisogno G, Hawkins DS, Ferrari A. Clinical features and outcomes of young patients with epithelioid sarcoma: an analysis from the Children's Oncology Group and the European paediatric soft tissue Sarcoma Study Group prospective clinical trials. Eur J Cancer. 2019 May;112:98-106. doi: 10.1016/j.ejca.2019.02.001. Epub 2019 Apr 5.
Ferrari A, Chi YY, De Salvo GL, Orbach D, Brennan B, Randall RL, McCarville MB, Black JO, Alaggio R, Hawkins DS, Bisogno G, Spunt SL. Surgery alone is sufficient therapy for children and adolescents with low-risk synovial sarcoma: A joint analysis from the European paediatric soft tissue sarcoma Study Group and the Children's Oncology Group. Eur J Cancer. 2017 Jun;78:1-6. doi: 10.1016/j.ejca.2017.03.003. Epub 2017 Apr 7.
Public notes

Contacts
Principal investigator
Name 0 0
Sheri Spunt, MD
Address 0 0
Children's Oncology Group
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for public queries
Name 0 0
Address 0 0
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for scientific queries



Summary Results

For IPD and results data, please see https://clinicaltrials.gov/study/NCT00346164