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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT02166788
Registration number
NCT02166788
Ethics application status
Date submitted
15/06/2014
Date registered
18/06/2014
Date last updated
7/04/2022
Titles & IDs
Public title
Evaluation of Groin Lymphadenectomy Extent For Metastatic Melanoma
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Scientific title
Inguinal or Ilio-inguinal Lymphadenectomy for Patients With Metastatic Melanoma to Groin Lymph Nodes and no Evidence of Pelvic Disease on PET/CT Scan - A Randomised Phase III Trial (EAGLE FM)
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Secondary ID [1]
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01.12
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Universal Trial Number (UTN)
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Trial acronym
EAGLE FM
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Metastatic Melanoma to the Groin Lymph Nodes
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Condition category
Condition code
Cancer
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Malignant melanoma
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Other: Arm 1: Inguinal Lymphadenectomy - Inguinal Lymphadenectomy (IL) is removal of the easily accessible superficial groin lymph nodes (LNs) and has a median LN retrieval of 11 lymph nodes
Other: Arm 2: Ilio-inguinal Lymphadenectomy - Ilio-inguinal Lymphadenectomy (I-IL) is the removal of the same superficial groin lymp nodes (LN) removed during an IL but also combined with the more surgically complex removal of the ipsilateral pelvic LN. About twice as many LN are removed with I-IL compared to IL.
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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The primary endpoint of the study will be Disease Free Survival following lymphadenectomy, assessed after 60 months of follow-up.
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Assessment method [1]
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The difference between IL and I-IL surgery in DFS 5 years after randomisation
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Timepoint [1]
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60 Months
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Secondary outcome [1]
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Overall Survival
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Assessment method [1]
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time from randomisation to death from any cause
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Timepoint [1]
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0 - 120 months
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Secondary outcome [2]
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Distant Disease Free Survival
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Assessment method [2]
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time to new distant melanoma recurrence
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Timepoint [2]
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0 - 120 Months
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Secondary outcome [3]
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Regional Recurrence Free Survival
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Assessment method [3]
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time to new regional lymph node recurrence
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Timepoint [3]
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0 - 120 Months
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Secondary outcome [4]
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Morbidity differences
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Assessment method [4]
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This includes lymphoedema, wound complications (wound infections, dehiscence/necrosis, and seroma) chronic pain, and restriction in mobility
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Timepoint [4]
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Up to 120 days from lymphadenectomy, and from 0 - 120 months
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Secondary outcome [5]
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Quality Of Life
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Assessment method [5]
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Quality Of Life questionnaires completed by patients
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Timepoint [5]
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0 - 120 Months
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Secondary outcome [6]
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Sensitivity / specificity and positive predictive value and negative predictive value of PET/CT for pelvic disease at diagnosis of groin LN involvement by melanoma.
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Assessment method [6]
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The diagnostic accuracy of PET/CT and CT for detecting pelvic lymph nodes positive for metastatic melanoma as confirmed by histopathology will be assessed in the sub-group of patients screened and shown to have a positive pelvic LN on PET/CT and those patients who had negative pelvic LN on PET/CT and randomised for I-IL treatment.
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Timepoint [6]
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0 - 120 Months
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Secondary outcome [7]
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Resource use and utility based Quality Of Life
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Assessment method [7]
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Resource use will be identified from the trial case report forms, and valued according the relevant Australian Refined Diagnosis Related Groups and Medicare Benefits Schedule item numbers.The cost-effectiveness and cost-utility analyses will calculate total costs and mean per patient costs per surgical group allocation, as well as total and mean benefits per group allocation.
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Timepoint [7]
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0 - 60 Months
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Eligibility
Key inclusion criteria
Patients may be included in the study only if they meet all of the following criteria:
1. Must be 15 and above.
2. Have primary cutaneous melanoma or if the patient presents with stage III melanoma with no known primary tumour then a thorough search for the primary should be documented (including perineal and perianal areas)
3. Life expectancy of at least 10 years from the time of diagnosis, not considering the melanoma in question, as determined by the PI
4. Must have one or multiple inguinal node(s) involved, histologically or cytologically proven as metastatic melanoma. This can can be detected:
* At the time of diagnosis;
* Or by Ultrasound detection;
* Or later after relapse when no Sentinel Node Biopsy (SNB) was performed at the time of primary tumour management;
* Or as a result of SNB;
* Or at the time of regional recurrence after "false negative" SNB;
5. Absent distant disease clinically and on PET/CT scan. (Patients must have NO further distant disease or visceral metastases)
6. ECOG performance status must be between 0 to 2 at randomisation
7. Whole body PET/CT scan, specifically stating there is NO evidence of pelvic lymph node involvement prior to randomisation and a CT Brain or MRI Brain scan. Scans must be performed within 6 weeks prior to randomisation.
8. Able to provide written, informed consent
9. Willing to return to the centre for follow up examinations and procedures, as outlined in the protocol.
10. All patients must be randomised and undergo lymphadenectomy surgery no more than 120 days following diagnosis of inguinal LN involvement
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Minimum age
15
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Distant metastatic disease on clinical examination or staging imaging (CT/MRI brain or whole body PET/CT scan). Scans must be performed within 6 weeks prior to randomisation
2. Pelvic LN involvement on SNB or PET/CT scan suggestive of metastatic disease in the pelvis - criteria for diagnosis include normal size or enlarged lymph nodes (> 1 cm) with increased FDG activity on PET (SUV >3). If there are enlarged, necrotic lymph nodes FDG activity on PET is not required to be present. If unsure central review should be sought.
3. Bilateral inguinal lymph node involvement
4. Patients with a history of major pelvic surgery and / or regional radiotherapy at any time in the past
5. Requiring planned radiotherapy following surgery due to macroscopic, bulky and matted nodes.
6. Unfit for General Anaesthesia
7. Melanoma-related operative procedures not corresponding to criteria described in the protocol
8. Patients with prior cancers, except:
* those with a thin <=1 mm, regionally unrelated melanoma > 5 years ago
* those with a good prognosis regionally unrelated cancer (>90% probability of 10 years disease specific survival)
* other cancers diagnosed more than five years ago with no evidence of disease recurrence within this time
* successfully treated basal cell and squamous cell skin carcinoma
* carcinoma in-situ of the cervix
* 1 episode of in transit melanoma > 3 years ago
9. A medical or psychiatric condition that compromises ability to give informed consent or complete the protocol
10. Positive urine pregnancy test for women of childbearing potential (+/-7 days of randomisation onto the trial)
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Active, not recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
1/01/2015
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
1/08/2030
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Actual
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Sample size
Target
634
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
ACT,NSW,QLD,VIC
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Recruitment hospital [1]
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Calvary Public Hospital Bruce - Canberra
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Recruitment hospital [2]
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Melanoma Institute Australia - The Poche Centre - North Sydney
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Recruitment hospital [3]
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Sydney Adventist Hospital - Sydney
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Recruitment hospital [4]
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Westmead Hospital - Sydney
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Recruitment hospital [5]
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Royal Prince Alfred Hospital - Sydney
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Recruitment hospital [6]
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Mater Hospital Brisbane - Brisbane
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Recruitment hospital [7]
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Peter MacCallum Cancer Centre - Melbourne
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Recruitment postcode(s) [1]
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2617 - Canberra
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Recruitment postcode(s) [2]
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2060 - North Sydney
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Recruitment postcode(s) [3]
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2076 - Sydney
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Recruitment postcode(s) [4]
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2145 - Sydney
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Recruitment postcode(s) [5]
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- Sydney
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Recruitment postcode(s) [6]
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4101 - Brisbane
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Recruitment postcode(s) [7]
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3000 - Melbourne
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Recruitment outside Australia
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Brazil
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SP
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Italy
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State/province [2]
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Veneto
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Netherlands
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State/province [3]
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Gelderland
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Netherlands
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State/province [4]
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Groningen
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Slovenia
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Ljubljana
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United Kingdom
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Norfolk
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United Kingdom
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London
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United Kingdom
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State/province [8]
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St Helens
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Funding & Sponsors
Primary sponsor type
Other
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Name
Melanoma and Skin Cancer Trials Limited
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Address
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Other collaborator category [1]
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Other
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Name [1]
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Cancer Council New South Wales
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Address [1]
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Other collaborator category [2]
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Other
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Name [2]
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Melanoma Institute Australia
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Ethics approval
Ethics application status
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Summary
Brief summary
BACKGROUND: Spread of metastatic melanoma to the groin lymph nodes (LN) is a common event affecting about 350 people a year in Australia. Globally it has been shown that patients with involved groin LN, without proven pelvic LN disease on imaging receive 1 of 3 management strategies in equal proportions - inguinal lymphadenectomy (IL); ilio-inguinal lymphadenectomy (I-IL); or variable use of either depending on circumstances. Different experts have strong and polarised opinions favouring either IL or more extensive I-IL with existing cases series reporting conflicting data on best cancer outcomes. No high level evidence proves which operation is best. HYPOTHESIS: There will be no significant difference in DFS between patients having IL or I-IL, conditional on PET/CT scan showing no evidence of pelvic disease at the time of diagnosis of groin LN metastatic melanoma. AIMS: To provide a rational evidence base for management for melanoma to the groin LNs by randomly assessing the effect of each operation on DFS, distant DFS, overall survival (OS), morbidity - including early complications and longer-term rates of lymphedema as well as comprehensively assessed QOL. Also to clarify the reliability of PET/CT scans for staging pelvic LNs and evaluate any health economic benefits of I-IL over IL. TARGET POPULATION: To recruit 634 patients in 5 years. DESIGN: An Australian led, international, multi-centre, non-inferiority, phase III, prospective, randomised clinical trial comparing IL or I-IL for patients with metastatic melanoma to groin LNs and no evidence of pelvic disease on PET/CT. ENDPOINTS: DFS, Distant DFS, OS and QOL at 5 years. Accuracy of PET/CT for pelvic LN metastases. OUTCOMES: International standardization of care, improved cancer outcomes, improved QOL for patients with groin metastatic melanoma. Proof of principle about extent of surgery when PET/CT is clear in adjacent LN areas, leading to clinical trials investigating management of other lymph node fields.
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Trial website
https://clinicaltrials.gov/study/NCT02166788
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
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Andrew Spillane
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Address
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The University of Sydney, Northern Clinical School
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Contact person for public queries
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Contact person for scientific queries
No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT02166788
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