The overall purpose of this study is to examine the efficacy of prophylactic low-level laser therapy (LLLT) to reduce the incidence of oral mucositis and adverse events in patients receiving combined modality therapy consisting of chemotherapy and radiation therapy for head and neck cancer.
A phase II, single-arm trial to examine the efficacy of prophylactic low-level laser therapy (LLLT) to reduce the incidence of oral mucositis and adverse events in patients receiving combined modality therapy consisting of chemotherapy and radiation therapy for head and neck cancer. Patients meeting the eligibility criteria will be enrolled to receive prophylactic LLLT in addition to standard of care measures for oral mucositis or other toxicity of therapy. The radiation and chemotherapy dose, schedule, modality, technique, and any required adjustments will not be influenced by this protocol and will follow standard existing institutional practices. Patients will receive LLLT three times per week concurrently with chemoradiotherapy. LLLT may be delivered either immediately prior to or after the patient's daily fraction of radiotherapy. Patients will be treated extra-orally with a THOR® LED cluster for one minute along the buccal mucosa on each side and intraorally for one minute to the tongue and soft palate. During each LLLT treatment session a thorough oral exam will be performed to identify any areas of mucositis. If the patient should develop intraoral lesions they will be targeted directly with the intraoral probe for one minute to each site of mucositis. The laser settings to be used are as follows: frequency 2.5 Hz; wavelength 660 nm; and power 75 mW, for an energy of 4.5 J. Patients will be evaluated prior to therapy, weekly during therapy, two weeks after the completion of therapy, and three months after the completion of therapy. During each assessment, the following toxicities will be assessed: pain, mucositis, dysphagia, xerostomia, dysgeusia, dermatitis, trismus, and quality of life. Previous studies indicate that approximately 40% of patients will experience severe mucositis with radiation and concurrent chemotherapy. The hypothesis in this trial is that the addition of LLLT to this treatment regimen will decrease the rate of severe acute oral mucositis (OM) to 20%. We plan to enroll 25 patients at our institution in 12 months after the trial opens.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
PREVENTION
Masking
NONE
Enrollment
25
Patients will receive LLLT three times per week concurrently with chemoradiotherapy. LLLT may be delivered either immediately prior to or after the patient's daily fraction of radiotherapy. Patients will be treated extra-orally with a THOR® LED cluster for one minute along the buccal mucosa on each side and intraorally for one minute to the tongue and soft palate. During each LLLT treatment session a thorough oral exam will be performed to identify any areas of mucositis. If the patient should develop intraoral lesions they will be targeted directly with the intraoral probe for one minute to each site of mucositis. The laser settings to be used are as follows: frequency 2.5 Hz; wavelength 660 nm; and power 75 mW, for an energy of 4.5 J.
Wayne State University/Karmanos Cancer Institute
Detroit, Michigan, United States
Number of Participants With Severe (Common Terminology Criteria for Adverse Events Version 4.0 [CTCAE v. 4.0] Grade 3-5 Oral Mucositis in Patients Treated to a Cumulative Radiation Dose of at Least 5000 cGy
Time frame: From beginning of therapy up to 3 months after completion of therapy
Number of Participants With Severe World Health Organization [WHO] (Grade 3-4) Oral Mucositis in Patients Treated to a Cumulative Radiation Dose of at Least 5000 cGy
Time frame: From beginning of therapy up to 3 months after completion of therapy
Change in OM-related QOL Assessed Using FACT Questionnaire
The QOL assessment taken at the beginning of therapy is subtracted from the QOL assessment taken at the completion of therapy. The QOL scale is the FACT Questionnaire. Measure on a scale of 0 to 4. 0 = not at all and 4= very much.
Time frame: From beginning of therapy up to completion of therapy
Duration of Oral Mucositis
Survival analysis was used to estimate the duration of oral mucositis. Patients were censored if oral mucositis not resolved by the end of the study.
Time frame: From beginning of therapy up to 3 months after completion of therapy
Number of Participants With Any Grade Oral Mucositis in Patients Treated to a Cumulative Radiation Dose of at Least 5000 cGy
Grade of oral mucositis assessed using the NCI CTCAE version 4.0
Time frame: From beginning of therapy up to 3 months after completion of therapy
Number of Participants With Dysgeusia Assessed by CTCAE v. 4.0
Variable is reported on the 1-5 CTCAE scale: 1. \- Mild 2. \- Moderate 3. \- Severe 4. \- Life-threatening 5. \- Death The maximum recorded severity is reported.
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Time frame: From beginning of therapy up to 3 months after completion of therapy
Number of Participants With Dysphagia Assessed by CTCAE v. 4.0 and Diet Assessment
Variable is reported on the 1-5 CTCAE scale: 1. \- Mild 2. \- Moderate 3. \- Severe 4. \- Life-threatening 5. \- Death The maximum recorded severity is reported.
Time frame: From beginning of therapy up to 3 months after completion of therapy
Number of Participants With Pain as Assessed by the Visual Analogue Scale (VAS)
Variable is reported on the 1-10 scale Higher values represent a worse outcome The maximum recorded severity is reported
Time frame: From beginning of therapy up to 3 months after completion of therapy
Number of Participants With Radiodermatitis Assessed by CTCAE v. 4.0
Variable is reported on the 1-5 CTCAE scale: 1. \- Mild 2. \- Moderate 3. \- Severe 4. \- Life-threatening 5. \- Death The maximum recorded severity is reported.
Time frame: From beginning of therapy up to 3 months after completion of therapy
Number of Participants With Trismus Assessed by Measurement of Interincisal Distance
Trismus is defined as a measurement of interincisal distance less than or equal to 30mm.
Time frame: From beginning of therapy up to 3 months after completion of therapy
Number of Participants With Xerostomia Assessed by CTCAE v. 4.0
Variable is reported on the 1-5 CTCAE scale: 1. \- Mild 2. \- Moderate 3. \- Severe 4. \- Life-threatening 5. \- Death The maximum recorded severity is reported.
Time frame: Up to 3 months after completion of therapy
Mean Cumulative Radiation Dose at Time of Onset of Severe (CTCAE v. 4.0 Grade 3-4) Oral Mucositis
The reported dose is at the first incidence of severe oral mucositis.
Time frame: From beginning of therapy up to 3 months after completion of therapy
Time to Onset of Severe (CTCAE v. 4.0 Grade 3-4) Oral Mucositis Following the Initiation of Radiotherapy
Survival analysis is used to analyze this endpoint
Time frame: From beginning of therapy up to 3 months after completion of therapy