Comparing Two Palliative Schemes of Radiotherapy for Head and Neck Cancer

The Netherlands Cancer Institute36 enrolled

Overview

RCT to compare two radiation schemes for palliative HeadNeck cancer

A substantial proportion of patients with head and neck (HNC) are not suitable for curative treatment with surgery and/or (chemo)radiotherapy (CRT) because of very advanced stage, significant comorbidities, bad general condition, distant metastasis, or a combination of these factors. Although radiotherapy (RT) is a commonly used option to achieve durable disease control and to alleviate troublesome symptoms, the data about the optimal radiation scheme and the impact of these schedules on quality of life (QoL) of these vulnerable patients is extremely scarce. Although different radiation schemes are used worldwide (in the Netherlands, at least 15 different radiation schedules are used), it is currently not possible to identify the best RT scheme, based only on retrospective studies because of the major differences between these studies with regard to patient's demographics, radiation schedules given, the radiation technique used etc. Furthermore, no any information is available on the impact of these schemes on treatment-related toxicity and QoL. This illustrates the urgent need for a multicenter randomized controlled trial (RCT) to identify the most optimal schemes of RT for this group of patients. Therefore, the investigators intend to initiate a prospective RCT comparing the survival, loco-regional control, toxicity, and QoL of two commonly used schemes. This study will be the first of his kind for palliative patients with HNC and will compare a short-course (6 fractions) with a long-course of radiotherapy (16 fractions). Because most of patients with incurable HNC have a poor performance status and major comorbidity and prefer limited number of visits to the hospital, it is quite reasonable to investigate whether a short scheme of radiotherapy with limited number of visits to the clinic as good as a relatively long-course of radiotherapy in terms of outcome, toxicity and QoL. This delicate balance between outcomes, possible toxicity and patient's comfort would justify the initiation of such randomized trial. The results of this study will in the nearby future enable us to indicate the radiation scheme best suits which patient category

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Head and Neck Neoplasms

Interventions

6 x 6 GyRADIATION

radiation in 6 fraction of 6 Gy, twice a week during 3 weeks

16 x 3.125 GyRADIATION

radiation in 16 fraction of 3.125 Gy, 4 times a week during 4 weeks

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: • Newly diagnosed patients with primary non-metastatic carcinoma located in the oral cavity, oropharynx, larynx (except T1 glottic), hypopharynx, nasopharynx, paranasal sinuses and salivary gland and carcinoma of unknown primary in the head and neck region who are not suitable for radical treatment with surgery or (chemo) and, therefore, planned for treatment with radiotherapy in palliative setting. OR * Newly diagnosed patients with primary head and neck carcinoma with limited metastatic disease in a good general condition and few comorbidities (ACE-25 \<3) with life expectancy of at least 6 months are also eligible. * No chemotherapy or surgery is allowed before inclusion. * Age ≥ 18 years * WHO performance status 0-2 * Signed written informed consent Exclusion Criteria: * Patients with previously radiation treatment in the head and neck region, for any reason. \* Chemotherapy or surgery for head and neck tumor before inclusion and no other concomitant anti-cancer therapy is allowed during study treatment. * Patients with head and neck malignancies arising from skin, nose, thyroid gland or esophagus. * Patients with advanced stage sarcoma or lymphoma of the head and neck region. * Expected life expectancy of less than 3 months

Locations (11)

Medisch Spectrum Twente

Enschede, Overijssel, Netherlands

Leids Universitair Medisch Centrum

Leiden, South Holland, Netherlands

Vrije Universiteit Medisch Centrum

Amsterdam, Netherlands

Outcomes

Primary Outcomes

time to loco-regional progression

caculated from date of response until the date of clinical deteriotion; accoriding to RECIST

Time frame: 4 months

impact of both radiation schemes on QoL

this will be measured by the EORTC questionnaires C30 and HN35; analysis will be performed by a random effects regression model

Time frame: 2 years

Secondary Outcomes

overall survival rates

RECIST

Time frame: 4 months

loco-regional control rates

caculated from date of response until the date of clinical deteriotion; according to RECIST

Time frame: 3 months

overall response rates

caculated from date of response until the date of clinical deteriotion; accoriding to RECIST

Time frame: 2 year

compliance to the study treatments as assessed by completed treatment and follow-up visits

number of treatment fractions and follow-up visits

Time frame: 4 months

the incidence of grade ≥ 2 acute and late toxicity

scoring of AE according tot CTC 4.0

Time frame: 2 years

Data from ClinicalTrials.gov

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