Condition category
Cancer
Date applied
28/09/2005
Date assigned
06/10/2005
Last edited
23/03/2017
Prospective/Retrospective
Prospectively registered
Overall trial status
Ongoing
Recruitment status
No longer recruiting

Contact information

Type

Scientific

Primary contact

Dr Martin Robinson

ORCID ID

Contact details

Cancer Research Centre
Weston Park Hospital
Whitham Road
Sheffield
S10 2SJ
United Kingdom
+44 (0)114 2265221
m.h.robinson@sheffield.ac.uk

Additional identifiers

EudraCT number

ClinicalTrials.gov number

NCT00423618

Protocol/serial number

SA3002

Study information

Scientific title

Randomised trial of volume of post-operative radiotherapy given to adult patients with extremity soft tissue sarcoma

Acronym

VORTEX

Study hypothesis

The timing of the radiotherapy in relation to surgery, the extent of surgery required, the extent of apparently normal tissue around the tumour bed to be included in the irradiated volume, and the best dose and fractionation schedule are still unresolved issues. There have been no systematic reviews or randomised trials in the field of extremity soft tissue sarcoma in adult patients. It is now time to obtain data from a prospective study of radiotherapy margins in the treatment of adult extremity soft tissue sarcoma. There is no evidence that the international practice of irradiating large volumes of normal tissue is necessary. The VORTEX study has been designed to address this question. A positive result would change international practice and significantly reduce the morbidity of radiotherapy treatment in this group of patients.

Protocol can be found at: http://www.birmingham.ac.uk/Documents/college-mds/trials/crctu/vortex/pdfsindexvortex/VORTEXProtocolversion602082010.pdf

On 15/02/2011 the anticipated end date was updated from 09/01/2010 to 31/07/2011.

Ethics approval

North-East York REC, 08/03/2006, ref: 06/MRE03/3

Study design

Randomised controlled trial

Primary study design

Interventional

Secondary study design

Randomised controlled trial

Trial setting

Hospitals

Trial type

Treatment

Patient information sheet

Not available in web format, please use the contact details below to request a patient information sheet

Condition

Extremity soft tissue sarcoma

Intervention

Patients will have a number of baseline assessments prior to surgery, including:
1. History
2. Physical examination
3. Performance status
4. Vital signs
5. Haematology (full blood count [FBC] with differential)
6. Biochemistry
7. Chest X-ray
8. Computed tomography (CT) scan thorax
9. Magnetic resonance imaging (MRI) local site
10. Completion of the Toronto Extremity Salvage Score (TESS) questionnaire

Post surgery patients will undergo the following assesments:
1. Physical examination
2. Performance status
3. Vital signs
4. Wound assesment
5. Completion of the Toronto Extremity Salvage Score (TESS) questionnaire
6. Completion of the patient perceived change of status

Randomisation will take place after surgery and within a time frame so that treatment can commence within 12 weeks of surgery. Patients who fulfill all the eligibility citeria will then be randomised by the CRCTU into one of the two treatment arms:

Radiotherapy treatment:
Control arm: a total of 33 fractions each of 2 Gy should be given once a day for 5 days per week over 6 weeks and 3 days in week 7, totalling 66 Gy. Treatment should not be given routinely at weekends. The first 25 fractions (50 Gy) will be given to a Clinical Target Volume (CTV) which gives a 5 cm margin to the GTV the surgical bed cranio-caudally or 1 cm margin to the scar, whichever is longer in the cranial caudal direction. Axially a minimum of 2 cm for the CTV unless there is an intact fascial boundary. The phase 2 of 16 Gy in 8 fractions will treat a CTV volume, giving a 1.5 cm margin to the surgical bed longitudinally and 2 cm laterally on an intact fascial boundary.

Research arm: a total of 33 fractions each of 2 Gy should be given once a day for 5 days per week over 6 weeks and 3 days in week 7, totalling 66 Gy. The experimental treatment arm shall be to treat a CTV volume giving a 1.5 cm margin to the surgical bed longitudinally and 2 cm laterally on an intact fascial boundary. The entire treatment shall be given to the volume described as phase 2 in the control arm.

During radiotherapy the acute skin morbidity will be checked weekly.

Follow-up assesments:
6 months post-operation:
1. Physical examination
2. Performance status
3. Vital signs
4. Late radiation morbidity
5. Chest X-ray
6. MRI local site
7. Completion of the Toronto Extremity Salvage Score (TESS) questionnaire
8. Completion of the patient perceived change of status

9 months post-operation:
1. Physical examination
2. Performance status
3. Vital signs
4. Late radiation morbidity
5. Chest X-ray

12 months post-operation:
1. Physical examination
2. Performance status
3. Vital signs
4. Late radiation morbidity
5. Chest X-ray
6. MRI local site
7. Completion of the Toronto Extremity Salvage Score (TESS) questionnaire
8. Completion of the patient perceived change of status

15 months post-operation:
1. Physical examination
2. Performance status
3. Vital signs
4. Late radiation morbidity
5. Chest X-ray

18 months post-operation:
1. Physical examination
2. Performance status
3. Vital signs
4. Late radiation morbidity
5. Chest X-ray
6. MRI local site
7. Completion of the Toronto Extremity Salvage Score (TESS) questionnaire
8. Completion of the patient perceived change of status

24 months post-operation:
1. Physical examination
2. Performance status
3. Vital signs
4. Late radiation morbidity
5. Chest X-ray
6. MRI local site
7. Completion of the Toronto Extremity Salvage Score (TESS) questionnaire
8. Completion of the patient perceived change of status

Intervention type

Other

Phase

Phase III

Drug names

Primary outcome measures

1. Limb functionality: as measured by the Toronto Extremity Salvage Score (TESS)
2. Time to local recurrence: defined in whole days, as the time from randomisation into the trial to the occasion when a biopsy-confirmed local recurrence is first suspected by clinical examination; for those patients who are not observed to have a local relapse during the course of the study, the time to local recurrence will be censored at the last follow-up date
3. Local recurrence rate

Secondary outcome measures

1. Soft tissue and bone toxicity: measured by the RTOG scoring system
2. Disease-free survival time: defined in whole days as time from randomisation into the trial to either local or distant recurrence or death (whichever occurs first)
3. Overall survival time: defined in whole days as time from randomisation into the trial to death

Overall trial start date

28/02/2005

Overall trial end date

16/10/2018

Reason abandoned

Eligibility

Participant inclusion criteria

1. Histologically proven soft tissue sarcoma. Imaging and pathology from first surgery are required.
2. Lesion originates in extremity. For upper extremity this includes lesions from the medial border of the scapula to tumours as far distal as the finger tips. It does not include lesions of the chest wall arising adjacent to the scapula but not originating in the shoulder bone. The lower extremity regions include hip girdle tumours commencing at the iliac crest, excluding lesions arising from within the pelvis, and extends to include lesions as far distal as the toes.
3. The patients who have undergone excisional biopsy with positive margins or other inadequate surgery (macroscopically involved margins) will be eligible for entry into this study only following further definitive re-excision. A microscopically irradical surgical margin is permitted but not a macroscopically involved one. Patients with positive margins in whom no further surgery is possible short of amputation or major functional loss may be included provided there is no macroscopic residual disease.
4. Patient has been evaluated by the surgeon and radiotherapist, who agree that a combination of the two treatments is appropriate and that the patient is fit for protocol therapy
5. No prior radiotherapy to the local site
6. Signed and dated Patient Informed Consent
7. Protocol treatment is to begin within 12 weeks of surgery
8. Patient must be 16 years of age or older

Participant type

Patient

Age group

Adult

Gender

Both

Target number of participants

400

Participant exclusion criteria

1. Patient has rhabdomyosarcoma of the alveolar or embryonal subcategories, primitive neuro-ectodermal tumour (PNET) soft tissue Ewing’s sarcoma, extraskeletal osteosarcoma, aggressive fibromatosis (desmoid tumours) or dermatofibrosarcoma protruberans
2. Patients with local recurrence after previous treatment of a sarcoma are excluded (as they have a significantly higher risk of late recurrence)
3. Prior or concurrent malignancy except adequately treated non-melanomatous carcinoma of the skin or in situ carcinoma of the cervix
4. Stage of disease such that limb conservation treatment by a combination of surgery and radiotherapy is not appropriate
5. The surgery performed has left macroscopic tumour in situ
6. Use of neoadjuvant or adjuvant chemotherapy
7. Patient has regional nodal disease or unequivocal distant metastasis
8. Other major medical illness judged likely by the local investigator to preclude safe administration of protocol treatment
9. Local recurrence more than 3 months after previous definitive surgery (patients with local recurrence within 3 months of previous surgery and who undergo subsequent re-excision may be included as they are considered to have initial inadequate primary excision)

Recruitment start date

20/07/2007

Recruitment end date

16/07/2013

Locations

Countries of recruitment

United Kingdom

Trial participating centre

Cancer Research Centre
Sheffield
S10 2SJ
United Kingdom

Trial participating centre

Addenbrooke’s Hospital
Hills Road
Cambridge
CB2 0QQ
United Kingdom

Trial participating centre

Bristol Haematology & Oncology Centre
Horfield Road
Bristol
BS2 8ED
United Kingdom

Trial participating centre

Cheltenham General Hospital
Sandford Road
Cheltenham
GL53 7AN
United Kingdom

Trial participating centre

Churchill Hospital
Old Road Headington
Oxford
OX3 7LE
United Kingdom

Trial participating centre

Christie Hospital
Wilmslow Road
Manchester
M20 4BX
United Kingdom

Trial participating centre

Freeman Hospital
Freeman Road
Newcastle Upon Tyne
NE7 7DN
United Kingdom

Trial participating centre

Leicester Royal Infirmary
Infirmary Square
Leicester
LE1 5WW
United Kingdom

Trial participating centre

Manchester Royal Infirmary
Oxford Road
Manchester
M13 9WL
United Kingdom

Trial participating centre

Mount Vernon Hospital
Rickmansworth Road
Northwood
HA6 2RN
United Kingdom

Trial participating centre

Robert Jones & Agnes Hunt Orthopaedic Hospital
Gobowen
Oswestry
SY10 7AG
United Kingdom

Trial participating centre

Norfolk & Norwich University Hospital
Colney Lane Norwich
Norfolk
NR4 7UY
United Kingdom

Trial participating centre

Royal Devon and Exeter Hospital
Barrack Road
Exeter
EX2 5DW

Trial participating centre

University Hospital of North Staffordshire
Newcastle Road
Stoke-on-Trent
ST4 6QG
United Kingdom

Trial participating centre

Royal Orthopaedic Hospital Birmingham
Bristol Road South
Birmingham
B31 2AP
United Kingdom

Trial participating centre

Queen Elizabeth Hospital Birmingham
Mindelsohn Way
Birmingham
B15 2TH
United Kingdom

Trial participating centre

Royal Derby Hospital
Uttoxeter Road
Derby
DE22 3DT
United Kingdom

Trial participating centre

Royal Preston Hospital
Sharoe Green Lane Fulwood
Preston
PR2 9HT
United Kingdom

Trial participating centre

Royal Marsden Hospital
Fulham Road
London
SW3 6JJ
United Kingdom

Trial participating centre

St. James’s University Hospital
Beckett Street
Leeds
LS9 7TF
United Kingdom

Trial participating centre

Torbay Hospital
Lowes Bridge Devon
Torquay
TQ2 7AA
United Kingdom

Trial participating centre

University College London Hospitals
250 Euston Road
London
NW1 2PG
United Kingdom

Trial participating centre

The Beatson West Of Scotland Cancer Centre
1053 Great Western Road
Glasgow
G12 0YN
United Kingdom

Trial participating centre

Weston Park Hospital
Whitham Road
Sheffield,
S10 2SJ
United Kingdom

Sponsor information

Organisation

University of Sheffield (UK)

Sponsor details

Research Office
Research Services
231 West Street
Sheffield
S10 2GW
United Kingdom

Sponsor type

University/education

Website

Funders

Funder type

Charity

Funder name

Cancer Research UK

Alternative name(s)

Funding Body Type

private sector organisation

Funding Body Subtype

other non-profit

Location

United Kingdom

Results and Publications

Publication and dissemination plan

Planned publication in a high-impact peer reviewed journal.

IPD sharing plan:
The datasets generated during and/or analysed during the current study are/will be available upon request from vortex@trials.bham.ac.uk

Intention to publish date

16/10/2018

Participant level data

Not provided at time of registration

Results - basic reporting

Publication summary

Publication citations

Additional files

Editorial Notes

23/03/2017: Added a public title, ethics, updated study dates from 09/01/2006 to 31/07/2011 to 28/02/2005 to 16/10/2018. Recruitment dates were updated from 09/01/2006 - 31/07/2011 to 20/07/2007 - 16/07/2013. Added publication and dissemination plan and intention to publish date. Added trial participating centres. 20/03/2017: No publications found in PubMed, verifying study status with principal investigator.