Randomized Carbon Ions vs Standard Radiotherapy for Radioresistant Tumors (ETOILE)

  • End date
    Dec 23, 2026
  • participants needed
  • sponsor
    Hospices Civils de Lyon
Updated on 28 February 2022


This is a transnational prospective randomized trial comparing definitive carbon ion therapy versus photon or combined photon and protontherapy as standard treatment for unresectable or macroscopically uncompleted resected radioresistant tumors. Eligible tumors are axial chordoma (except of base of skull), adenoid cystic carcinoma of head and neck (except of trachea) and sarcomas of any site (except chondrosarcoma of the skull base), non previously irradiated and without pre-planned surgery or chemotherapy after the clinical trial procedure. Randomization is balanced 1 for 1. Patients of the experimental arm are treated in carbon ions centers in Europe and patients of the standard arm are treated in France in their closest participating radiotherapy center. An accrual of 250 patients is needed and an absolute difference of 20% of relapse free survival at five years is awaited. The main endpoint is the progression free survival at five years. The trial is supported by the French program of clinical research and the national health insurance. Two associated studies are carried out: a radiobiological one looking for radioresistance markers in the sarcomas biopsies, and the second one is about medico economics.

Condition Malignant Tumors as Chordoma, Adenoid Cystic Carcinoma and Sarcoma
Treatment Carbon ions therapy, Advanced external radiotherapy by Xrays or protons
Clinical Study IdentifierNCT02838602
SponsorHospices Civils de Lyon
Last Modified on28 February 2022


Yes No Not Sure

Inclusion Criteria

age 18 years
No severe comorbidity, life expectancy above 10 years
Unresectable or inoperable or R2 resection of the tumor
Eligible radioresistant tumor according to the limitative list as following
adenoid cystic carcinoma of head and neck (larynx and trachea excluded)
soft tissue sarcoma
pleomorphic rhabdomyosarcoma only (alveolar and embryonal forms excluded)
retroperitoneal sarcoma under condition of technical feasibility (movement)
osteosarcoma of any grade and localisation (Ewing excluded)
chondrosarcoma (except of skull base) OMS grade >= 2
chordoma axial skeleton or pelvis (except of skull base)
Absence of epidermal invasion (a hypodermic invasion is accepted with fixity of cutaneous plan but not true epidermal permeation)
Larger volume to be irradiated (PTV) less than 25 cm
ECOG Performance Status 2 or Karnovsky index 60
no pregnancy of possibility of pregnancy during the treatment
having an health insurance
signature of a written informed consent
validation of the randomization criteria: namely, a carbon ions therapy indication assessed by the medical team of a hadrontherapy center and able to by treated within two month from registration

Exclusion Criteria

Complete macroscopic or microscopic surgical resection (R0 or R1)
previous irradiation in the volume to be treated
any contra-indication to undergo a radiation therapy by Xray or particle therapy
metastatic disease
disease not candidate to a curative approach (example accelerated progressive diseaseresistant to nay medical treatment especially for sarcoma)
planned surgery or chemotherapy to take place after completion of radiotherapy (example : absence of enough space between an organ risk and the target volume (at least 5 mm) except the possibility of a spacer insertion)
planned surgery or chemotherapy after radiotherapy
Presence in the target volume of metallic material which cannot be removed (carbon fibres matreial authorized)
history of concomittant (except in situ cervix carcinoma; or any cured basocellular cutaneous cancer tor any cured cancer with no sign of relapse during 5 years))
impossible follow-up over 5 years
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