Therapeutic Effect of Surgical Debulking of Metastatic Lymph Nodes in Cervical Cancer Stage IIICr

NCT05421650 | Recruiting DMC

• 1 other identifier: KGOG1047_DEBULK
• Study Type: interventional
• Target: 240
• Locations: 5 countries
• Sites: 26

Brief Summary

This study is a prospective, multicenter and randomized clinical trial (DEBULK trial) to determine the therapeutic effect of surgical debulking of bulky or multiple lymph nodes before concurrent chemoradiation therapy (CCRT) in cervical cancer stage IIICr.

Conditions

Cervical Cancer

Keywords

Cervical cancer IIICr; Bulky or multiple lymph nodes; Surgical debulking of lymph nodes; Concurrent chemoradiation therapy

Outcome Measures

Primary Outcomes (1)

• PFS

  Progression-free survival

  3 years

Secondary Outcomes (3)

• OS

  3 years

• Treatment-related complications

  3 years

• False positive rate & positive predictive value of bulky or multiple LN imaging

  6 months

Study Arms (2)

Control group

ACTIVE COMPARATOR

Concurrent chemoradiation therapy (CCRT)

Other: CCRT

Experimental group

EXPERIMENTAL

Surgical debulking of bulky or multiple lymph node + CCRT

Procedure: Surgical debulking of lymph nodes + CCRT

Interventions

CCRT OTHER

CCRT

Control group

Surgical debulking of lymph nodes + CCRT PROCEDURE

Surgical debulking of lymph nodes + CCRT

Experimental group

Eligibility Criteria

• Age: 20 Years - 70 Years
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• (1) Women aged ≥ 20 years and ≤ 70 years (2) Patients newly diagnosed with squamous cell carcinoma (SCC), adenocarcinoma, or adenosquamous carcinoma (3) Patients with a short-axis diameter of the pelvic LN or para-aortic LN under the renal vein of ≥ 1.5 cm or ≥ 2 LNs with a short-axis diameter ≥ 1 cm in CT or MRI (PET-CT can be used as an auxiliary tool) (4) Patients with CCRT planned as a treatment for cervical cancer (5) Patients whose competency is Eastern Cooperative Oncology Group performance score 0-1 (6) Patients who have signed the approved informed consent form for study participants (7) Patients in whom surgical debulking for LN metastasis was possible, as confirmed by radiological examination.

You may not qualify if:

• (1) Patients who have been diagnosed with cancer of any organ other than thyroid cancer (excluding stage 0 cancer) within the previous 5 years (2) Patients who are pregnant or plans to conceive during the clinical study period (3) Patients with any active infectious disease or incurable severe inflammation (4) Patients who cannot undergo surgery due to internal or surgical disease (5) Patients who cannot receive chemotherapy due to internal or surgical disease (6) Patients with a history of pelvic RT (7) Patients with a history of subtotal hysterectomy (8) Patients with remote metastasis other than a pelvic or para-aortic LN (e.g., lung, subclavian, and inguinal LNs)

Sponsors & Collaborators

• CHA University: lead
• Korean Gynecologic Oncology Group: collaborator

Study Sites (26)

Aster CMI Hospital

Bengaluru, India

NOT YET RECRUITING

Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Rome, 00168, Italy

NOT YET RECRUITING

First Obstetrics and Gynecology Clinic, "G. E. Palade" University of Medicine, Pharmacy, Science and Technology

Târgu Mureş, 540136, Romania

NOT YET RECRUITING

Soon Chun Hyang University Hospital Cheonan

Cheonan, Chungcheongnam-do, 31151, South Korea

RECRUITING

Korea University Ansan Hospital

Ansan-si, Gyeonggi-do, 15355, South Korea

RECRUITING

Dongguk University Medical Center

Goyang-si, Gyeonggi-do, 10326, South Korea

RECRUITING

National Cancer Center

Goyang-si, Gyeonggi-do, 10408, South Korea

RECRUITING

CHA Bundang Medical Center, CHA University

Seongnam-si, Gyeonggi-do, 13496, South Korea

RECRUITING

Pusan National University Yangsan Hospital

Yangsan, Gyeongsangbuk-do, 50612, South Korea

RECRUITING

Samsung Changwon Medical Center

Changwon, Gyeongsangnam-do, 51353, South Korea

RECRUITING

Chonnam National University Hwasun Hospital

Hwasun, Jeollanam-do, 58128, South Korea

RECRUITING

Dongnam Institute of Radiological & Medical Sciences

Busan, 46033, South Korea

RECRUITING

Inje University Busan Paik Hospital

Busan, 47392, South Korea

RECRUITING

Kyungpook National University Chilgok Hospital

Daegu, 41404, South Korea

RECRUITING

Keimyung University Dongsan Hospital

Daegu, 42601, South Korea

RECRUITING

Gachon University Gil Medical Center

Incheon, 21565, South Korea

RECRUITING

Korea University Anam Hospital

Seoul, 02841, South Korea

RECRUITING

Seoul National University Hospital

Seoul, 03080, South Korea

RECRUITING

Severance Hospital

Seoul, 03722, South Korea

RECRUITING

Hanyang University Medical Center

Seoul, 04763, South Korea

RECRUITING

Konkuk University Medical Center

Seoul, 05030, South Korea

RECRUITING

Asan Medical Center

Seoul, 05505, South Korea

RECRUITING

Gangnam Severance Hospital

Seoul, 06273, South Korea

RECRUITING

Samsung Medical Center

Seoul, 06351, South Korea

RECRUITING

Seoul ST. Mary's Hospital

Seoul, 06591, South Korea

RECRUITING

Ho Chi Minh City Oncology Hospital

Ho Chi Minh City, Vietnam

ACTIVE NOT RECRUITING

Related Publications (29)

• Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-424. doi: 10.3322/caac.21492. Epub 2018 Sep 12.

  PMID: 30207593 BACKGROUND

• Jung KW, Won YJ, Kong HJ, Lee ES. Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2016. Cancer Res Treat. 2019 Apr;51(2):417-430. doi: 10.4143/crt.2019.138. Epub 2019 Mar 18.

  PMID: 30913865 BACKGROUND

• Bhatla N, Berek JS, Cuello Fredes M, Denny LA, Grenman S, Karunaratne K, Kehoe ST, Konishi I, Olawaiye AB, Prat J, Sankaranarayanan R, Brierley J, Mutch D, Querleu D, Cibula D, Quinn M, Botha H, Sigurd L, Rice L, Ryu HS, Ngan H, Maenpaa J, Andrijono A, Purwoto G, Maheshwari A, Bafna UD, Plante M, Natarajan J. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet. 2019 Apr;145(1):129-135. doi: 10.1002/ijgo.12749. Epub 2019 Jan 17.

  PMID: 30656645 BACKGROUND

• Suprasert P, Srisomboon J, Charoenkwan K, Siriaungul S, Khunamornpong S, Siriaree S, Phongnarisorn C, Lorvidhaya V. Outcomes of abandoned radical hysterectomy in patients with stages IB-IIA cervical cancer found to have positive nodes during the operation. Int J Gynecol Cancer. 2005 May-Jun;15(3):498-502. doi: 10.1111/j.1525-1438.2005.15315.x.

  PMID: 15882176 BACKGROUND

• Abu-Rustum NR, Yashar CM, Bean S, Bradley K, Campos SM, Chon HS, Chu C, Cohn D, Crispens MA, Damast S, Fisher CM, Frederick P, Gaffney DK, Giuntoli R, Han E, Huh WK, Lurain Iii JR, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Sisodia R, Tillmanns T, Ueda S, Urban R, Wyse E, McMillian NR, Motter AD. NCCN Guidelines Insights: Cervical Cancer, Version 1.2020. J Natl Compr Canc Netw. 2020 Jun;18(6):660-666. doi: 10.6004/jnccn.2020.0027.

  PMID: 32502976 BACKGROUND

• Song S, Kim JY, Kim YJ, Yoo HJ, Kim SH, Kim SK, Lim MC, Kang S, Seo SS, Park SY. The size of the metastatic lymph node is an independent prognostic factor for the patients with cervical cancer treated by definitive radiotherapy. Radiother Oncol. 2013 Jul;108(1):168-73. doi: 10.1016/j.radonc.2013.04.015. Epub 2013 May 14.

  PMID: 23684584 BACKGROUND

• Oh J, Seol KH, Choi YS, Lee JW, Bae JY. Clinical significance of lymph node size in locally advanced cervical cancer treated with concurrent chemoradiotherapy. Yeungnam Univ J Med. 2019 May;36(2):115-123. doi: 10.12701/yujm.2019.00143. Epub 2019 Feb 21.

  PMID: 31620623 BACKGROUND

• Pedone Anchora L, Carbone V, Gallotta V, Fanfani F, Cosentino F, Turco LC, Fedele C, Bizzarri N, Scambia G, Ferrandina G. Should the Number of Metastatic Pelvic Lymph Nodes be Integrated into the 2018 Figo Staging Classification of Early Stage Cervical Cancer? Cancers (Basel). 2020 Jun 12;12(6):1552. doi: 10.3390/cancers12061552.

  PMID: 32545508 BACKGROUND

• Zhou J, Wu SG, Sun JY, Liao XL, Li FY, Lin HX, Yang LC, He ZY. Incorporation of the number of positive lymph nodes leads to better prognostic discrimination of node-positive early stage cervical cancer. Oncotarget. 2017 Apr 18;8(16):26057-26065. doi: 10.18632/oncotarget.15220.

  PMID: 28199962 BACKGROUND

• Wang SC, Lin LC, Kuo YT, Lin YW. Radiographic Number of Positive Pelvic Lymph Nodes as a Prognostic Factor in Cervical Cancer Treated With Definitive Concurrent Chemoradiotherapy or Intensity-Modulated Radiotherapy. Front Oncol. 2018 Nov 30;8:546. doi: 10.3389/fonc.2018.00546. eCollection 2018.

  PMID: 30555798 BACKGROUND

• Tohyama A, Murakami M, Yoshino K. Strategies for the Treatment of Cervical Cancer with Bulky Pelvic Lymph Nodes: An Overview of the Current Evidence. J UOEH. 2020;42(4):317-325. doi: 10.7888/juoeh.42.317.

  PMID: 33268608 BACKGROUND

• Marnitz S, Kohler C, Roth C, Fuller J, Hinkelbein W, Schneider A. Is there a benefit of pretreatment laparoscopic transperitoneal surgical staging in patients with advanced cervical cancer? Gynecol Oncol. 2005 Dec;99(3):536-44. doi: 10.1016/j.ygyno.2005.07.005. Epub 2005 Aug 29.

  PMID: 16126259 BACKGROUND

• Yang J, Delara R, Magrina J, Magtibay P, Yi J, Langstraat C, Robertson M, Dinh T, Butler K. Comparing survival outcomes between surgical and radiographic lymph node assessment in locally advanced cervical cancer: A propensity score-matched analysis. Gynecol Oncol. 2020 Feb;156(2):320-327. doi: 10.1016/j.ygyno.2019.12.009. Epub 2019 Dec 14.

  PMID: 31843274 BACKGROUND

• Lee M, Choi CH, Chun YK, Kim YH, Lee KB, Lee SW, Shim SH, Song YJ, Roh JW, Chang SJ, Lee JM. Surgical manual of the Korean Gynecologic Oncology Group: classification of hysterectomy and lymphadenectomy. J Gynecol Oncol. 2017 Jan;28(1):e5. doi: 10.3802/jgo.2017.28.e5. Epub 2016 Aug 19.

  PMID: 27670259 BACKGROUND

• Shin W, Ham TY, Park YR, Lim MC, Won YJ. Comparing survival outcomes for cervical cancer based on the 2014 and 2018 International Federation of Gynecology and Obstetrics staging systems. Sci Rep. 2021 Mar 26;11(1):6988. doi: 10.1038/s41598-021-86283-2.

  PMID: 33772044 BACKGROUND

• Lim MC, Bae J, Park JY, Lim S, Kang S, Seo SS, Kim JY, Rho JW, Park SY. Experiences of pretreatment laparoscopic surgical staging in patients with locally advanced cervical cancer: results of a prospective study. J Gynecol Oncol. 2008 Jun;19(2):123-8. doi: 10.3802/jgo.2008.19.2.123. Epub 2008 Jun 20.

  PMID: 19471562 BACKGROUND

• Lorusso D, Xiang Y, Hasegawa K, Scambia G, Leiva M, Ramos-Elias P, Acevedo A, Cvek J, Randall L, Pereira de Santana Gomes AJ, Contreras Mejia F, Helpman L, Akilli H, Lee JY, Saevets V, Zagouri F, Gilbert L, Sehouli J, Tharavichitkul E, Lindemann K, Colombo N, Chang CL, Bednarikova M, Zhu H, Oaknin A, Christiaens M, Petru E, Usami T, Liu P, Yamada K, Toker S, Keefe SM, Pignata S, Duska LR; ENGOT-cx11/GOG-3047/KEYNOTE-A18 investigators. Pembrolizumab or placebo with chemoradiotherapy followed by pembrolizumab or placebo for newly diagnosed, high-risk, locally advanced cervical cancer (ENGOT-cx11/GOG-3047/KEYNOTE-A18): overall survival results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2024 Oct 5;404(10460):1321-1332. doi: 10.1016/S0140-6736(24)01808-7. Epub 2024 Sep 14.

  PMID: 39288779 BACKGROUND

• Manders DB, Sims TT, Bailey A, Hwang L, Richardson DL, Miller DS, Kehoe SM, Albuquerque KV, Lea JS. The Significance of Para-Aortic Nodal Size and the Role of Adjuvant Systemic Chemotherapy in Cervical Cancer: An Institutional Experience. Am J Clin Oncol. 2018 Dec;41(12):1225-1230. doi: 10.1097/COC.0000000000000458.

  PMID: 29782361 BACKGROUND

• Kodama J, Seki N, Ojima Y, Nakamura K, Hongo A, Hiramatsu Y. Prognostic factors in node-positive patients with stage IB-IIB cervical cancer treated by radical hysterectomy and pelvic lymphadenectomy. Int J Gynaecol Obstet. 2006 May;93(2):130-5. doi: 10.1016/j.ijgo.2006.02.012. Epub 2006 Mar 6.

  PMID: 16563395 BACKGROUND

• Park JW, Bae JW. Prognostic significance of positive lymph node number in early cervical cancer. Mol Clin Oncol. 2016 Jun;4(6):1052-1056. doi: 10.3892/mco.2016.837. Epub 2016 Mar 30.

  PMID: 27284443 BACKGROUND

• Inoue T, Morita K. The prognostic significance of number of positive nodes in cervical carcinoma stages IB, IIA, and IIB. Cancer. 1990 May 1;65(9):1923-7. doi: 10.1002/1097-0142(19900501)65:93.0.co;2-m.

  PMID: 2372764 BACKGROUND

• Sakuragi N, Satoh C, Takeda N, Hareyama H, Takeda M, Yamamoto R, Fujimoto T, Oikawa M, Fujino T, Fujimoto S. Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with Stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy. Cancer. 1999 Apr 1;85(7):1547-54. doi: 10.1002/(sici)1097-0142(19990401)85:73.0.co;2-2.

  PMID: 10193945 BACKGROUND

• Kato T, Watari H, Takeda M, Hosaka M, Mitamura T, Kobayashi N, Sudo S, Kaneuchi M, Kudo M, Sakuragi N. Multivariate prognostic analysis of adenocarcinoma of the uterine cervix treated with radical hysterectomy and systematic lymphadenectomy. J Gynecol Oncol. 2013 Jul;24(3):222-8. doi: 10.3802/jgo.2013.24.3.222. Epub 2013 Jul 4.

  PMID: 23875071 BACKGROUND

• Kim JH, Choi JH, Ki EY, Lee SJ, Yoon JH, Lee KH, Park TC, Park JS, Bae SN, Hur SY. Incidence and risk factors of lower-extremity lymphedema after radical surgery with or without adjuvant radiotherapy in patients with FIGO stage I to stage IIA cervical cancer. Int J Gynecol Cancer. 2012 May;22(4):686-91. doi: 10.1097/IGC.0b013e3182466950.

  PMID: 22398707 BACKGROUND

• Lee J, Byun HK, Im SH, Son WJ, Roh YH, Kim YB. Risk factors for lower extremity lymphedema after surgery in cervical and endometrial cancer. J Gynecol Oncol. 2023 May;34(3):e28. doi: 10.3802/jgo.2023.34.e28. Epub 2022 Dec 19.

  PMID: 36562134 BACKGROUND

• Carlson JW, Kauderer J, Hutson A, Carter J, Armer J, Lockwood S, Nolte S, Stewart BR, Wenzel L, Walker J, Fleury A, Bonebrake A, Soper J, Mathews C, Zivanovic O, Richards WE, Tan A, Alberts DS, Barakat RR. GOG 244-The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients. Gynecol Oncol. 2020 Feb;156(2):467-474. doi: 10.1016/j.ygyno.2019.10.009. Epub 2019 Dec 16.

  PMID: 31837831 BACKGROUND

• Borcinova M, Ragosch V, Jarkovsky J, Bajsova S, Pilka R, Glickman A, Garrido-Mallach S, Raspagliesi F, Szatkowski W, Pakiz M, Snyman LC, Kocian R, Tamussino K, Kalist V, Michal M, Segovia MG, Poka R, Kipp B, Szewczyk G, Wydra D, Toth R, Vinnytska A, Fischerova D, Siegler K, Cibula D. Challenges in lower limb lymphoedema assessment based on limb volume change: Lessons learnt from the SENTIX prospective multicentre study. Gynecol Oncol. 2022 Jan;164(1):76-84. doi: 10.1016/j.ygyno.2021.10.089. Epub 2021 Nov 8.

  PMID: 34763939 BACKGROUND

• Devoogdt N, Lemkens H, Geraerts I, Van Nuland I, Flour M, Coremans T, Christiaens MR, Van Kampen M. A new device to measure upper limb circumferences: validity and reliability. Int Angiol. 2010 Oct;29(5):401-7.

  PMID: 20924341 BACKGROUND

• Yun BS, Lee KB, Lee KH, Chang HK, Kim JY, Lim MC, Choi CH, Cho H, Kim DY, Kim YH, Choi JS, Lee CH, Kim JW, Kim SW, Kim YB, Cho CH, Hong DG, Song YJ, Jeon S, Kim MK, Jeong DH, Park H, Kim SM, Park SI, Song JY, Mukhopadhyay A, Thinh DHQ, Kampan NC, Lee GJ, Kim JH, Eom KY, Roh JW; Korean Gynecologic Oncology Group (KGOG) Investigators. Therapeutic effects of surgical debulking of metastatic lymph nodes in cervical cancer IIICr: a trial protocol for a phase III, multicenter, randomized controlled study (KGOG1047/DEBULK trial). J Gynecol Oncol. 2024 Sep;35(5):e57. doi: 10.3802/jgo.2024.35.e57. Epub 2024 Jan 22.

  PMID: 38330380 DERIVED

Related Links

• L. Framework, Best practice for the management of lymphoedema, International consensus, MEP Ltd, London, 2006.

MeSH Terms

Conditions

Uterine Cervical Neoplasms

Condition Hierarchy (Ancestors)

Uterine Neoplasms; Genital Neoplasms, Female; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Uterine Cervical Diseases; Uterine Diseases; Genital Diseases, Female; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Genital Diseases

Study Officials

• Ju-Won Roh

  CHA University Ilsan Medical Center

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Ju-Won Roh

CONTACT

+82-31-782-8312; rohjuwon@hanmail.net

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: June 13, 2022
• First Posted: June 16, 2022
• Study Start: August 1, 2022
• Primary Completion (Estimated): December 31, 2030
• Study Completion (Estimated): December 31, 2030
• Last Updated: April 9, 2025

Record last verified: 2025-04

Data Sharing

• IPD Sharing: Will not share

Locations

KR (22); VN (1); RO (1); IN (1); IT (1)