RATIONALE: Radiation therapy uses high energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as cisplatin and fluorouracil, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving radiation therapy together with cisplatin and fluorouracil may kill more tumor cells. It is not yet known whether radiation therapy and cisplatin are more effective with or without fluorouracil in treating patients with head and neck cancer. PURPOSE: This randomized phase III trial is studying radiation therapy and cisplatin to compare how well they work with or without fluorouracil in treating patients with stage III or stage IV head and neck cancer.
OBJECTIVES: * To compare the relapse-free survival of patients treated with radiotherapy and cisplatin with vs without fluorouracil. * To compare the overall survival, local control without surgery, and patterns of failure in patients treated with these regimens. * To compare the acute and long-term toxicity of these regimens in these patients. * To compare the quality of life of patients treated with these regimens. * To prospectively collect biopsy material, mucosal scrapings, and serum in an effort to generate hypotheses for future correlative studies. OUTLINE: This is a multicenter study. Patients are stratified according to radiotherapy schedule (once daily vs twice daily) and radiotherapy planning (2D vs 3D vs intensity-modulated radiotherapy). Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients undergo full-dose radiotherapy once or twice daily 5 days a week for up to 7 weeks and receive cisplatin IV over 1 hour on days 1, 22, and 43 of radiotherapy. * Arm II: Patients undergo radiotherapy as in arm I and receive fluorouracil IV and cisplatin IV continuously on days 1-4 and 22-25 of radiotherapy. Patients with biopsy-verified residual disease at the primary site or local recurrence after achieving a complete response to chemoradiotherapy may undergo salvage surgery 12 weeks after the completion of chemoradiotherapy. Patients complete questionnaires periodically to assess late toxicity and quality of life. After completion of study treatment, patients are followed periodically.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
69
Given IV
Given IV
Patients undergo full-dose radiotherapy once or twice daily 5 days a week for up to 7 weeks
Case Medical Center, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center
Cleveland, Ohio, United States
Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center
Cleveland, Ohio, United States
Relapse Free Survival
Number of patients that are alive without recurrence when recurrence is defined by any subject with new evidence of cancer after achieving a complete response. Complete response is defined by the complete disappearance of all clinically and radiologically detectable tumor..
Time frame: at 2 yrs from start of study
Patterns of Failure
Patients with any new evidence of cancer after achieving a complete response are considered to have recurrent disease. Biopsy verification will be obtained if at all possible and salvage surgery is recommended if possible. Disease recurrence will be characterized as either local, regional(nodal) or distant recurrence. Patients may have more than one kind of recurrence.
Time frame: 2 years from start of study
Overall Survival
Number of patients still alive from 2 years from start of study
Time frame: 2 yrs from start of study
Number of Patients With a Clinical Response-complete Disappearance of Detectable Tumor
Twelve weeks after completing chemoradiotherapy, a formal evaluation for response will be made, to include a careful evaluation by the head and neck surgeon, medical and radiation oncologists, and, as appropriate, a radiologic and an endoscopic examination. Patients will be considered to have achieved either a clinical complete response (i.e. complete disappearance of all clinically and radiologically detectable tumor) or to have clinical persistent disease.
Time frame: at 12 weeks after completing chemoradiotherapy
Number of Patients With a Pathological(Final)Complete Response
A Pathological, or final response will be assigned to subjects after any salvage surgery is performed for clinical persistent disease, and after planned neck dissection in those achieving a clinical complete response. If no surgery is performed after chemoradiotherapy, the clinical and pathological (final) response will be the same. Patient will be coded as having either a pathologic complete response, or as having pathologic persistent disease. A pathologic complete response will be defined as the total disappearance of all clinically and radiologically detectable tumor.
Time frame: at 12 weeks after completing chemoradiotherapy and surgery
Disease Recurrence
Number of patients with any new evidence of cancer after achieving a complete response (at 12 weeks after completing chemoradiotherapy) are considered to have recurrent disease.
Time frame: 2 years after start of study
Number of Patients That Required a Feeding Tube
Time frame: 12 weeks (after treatment)
Number of Patients That Required a Feeding Tube
Time frame: 8 months after start of treatment
Number of Patients That Required a Feeding Tube
Time frame: 12 months after start of treatment
Number of Patients That Required a Feeding Tube
Time frame: 24 months after start of treatment
Nausea Level
Quality of life questionnaire asking "I have nausea". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). N (number of patients analyzed) is based on number of patients who completed the question.
Time frame: 12 weeks (after treatment)
Nausea Level
Quality of life questionnaire asking "I have nausea". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 8 months from start of treatment
Nausea Level
Quality of life questionnaire asking "I have nausea". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 months from start of treatment
Nausea Level
Quality of life questionnaire asking "I have nausea".
Time frame: 24 months from start of treatment
Dry Mouth
Quality of life questionnaire asking "My mouth is dry". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 weeks (after treatment)
Dry Mouth
Quality of life questionnaire asking "My mouth is dry". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 8 months from start of treatment
Dry Mouth
Quality of life questionnaire asking "My mouth is dry". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 months from start of treatment
Dry Mouth
Quality of life questionnaire asking "My mouth is dry". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 24 months from start of treatment
Pain
Quality of life questionnaire asking "I have pain in my mouth, throat or neck". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 weeks (after treatment)
Pain
Quality of life questionnaire asking "I have pain in my mouth, throat or neck". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 8 months from start of treatment
Pain
Quality of life questionnaire asking "I have pain in my mouth, throat or neck". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 months from start of treatment
Pain
Quality of life questionnaire asking "I have pain in my mouth, throat or neck". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 24 months from start of treatment
Quality of Life
Quality of life questionnaire asking "I am content with the quality of my life right now". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 weeks (after treatment)
Quality of Life
Quality of life questionnaire asking "I am content with the quality of my life right now". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 8 months from start of treatment
Quality of Life
Quality of life questionnaire asking "I am content with the quality of my life right now". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 months from start of treatment
Quality of Life
Quality of life questionnaire asking "I am content with the quality of my life right now". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 24 months from start of treatment
Eating
Quality of life questionnaire asking "I am able to eat the foods i like". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 weeks (after treatment)
Eating
Quality of life questionnaire asking "I am able to eat the foods i like". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 8 months from start of treatment
Eating
Quality of life questionnaire asking "I am able to eat the foods i like". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 months from start of treatment
Eating
Quality of life questionnaire asking "I am able to eat the foods i like". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 24 months from start of treatment
Swallowing
Quality of life questionnaire asking "I can swallow naturally and easily". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 weeks (after treatment)
Swallowing
Quality of life questionnaire asking "I can swallow naturally and easily". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 8 months after start of treatment
Swallowing
Quality of life questionnaire asking "I can swallow naturally and easily". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 months after start of treatment
Swallowing
Quality of life questionnaire asking "I can swallow naturally and easily". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 24 months after start of treatment
Alcohol Consumption
Quality of life questionnaire asking "I drink alcohol (e.g. beer, wine)". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 weeks (after treatment)
Alcohol Consumption
Quality of life questionnaire asking "I drink alcohol (e.g. beer, wine)". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 8 months after start of treatment
Alcohol Consumption
Quality of life questionnaire asking "I drink alcohol (e.g. beer, wine)". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 months after start of treatment
Alcohol Consumption
Quality of life questionnaire asking "I drink alcohol (e.g. beer, wine)". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 24 months after start of treatment
Solid Foods
Quality of life questionnaire asking "I can eat solid foods". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 weeks (after treatment)
Solid Foods
Quality of life questionnaire asking "I can eat solid foods". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 8 months after start of treatment
Solid Foods
Quality of life questionnaire asking "I can eat solid foods". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 12 months after start of treatment
Solid Foods
Quality of life questionnaire asking "I can eat solid foods". The Categories were assigned a number. The categories were: Not at all (0), A little bit (1), Somewhat (2), Quite a bit (3), Very much (4). The mean was determined from each statement.
Time frame: 24 months after start of treatment
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