Role of Radiotherapy in T1-T2N0M0 Glottic Carcinoma With Poor Differentiation

Second Affiliated Hospital, Zhejiang University, School of Medicine38 enrolled

Overview

There remains no uniform treatment modality for glottic laryngeal carcinoma. Current clinical guidelines broadly recommend surgery or radiotherapy as single-modality treatment for early-stage glottic laryngeal carcinoma. Surgery is the predominant treatment modality for patients with early-stage glottic carcinoma in China. Patients with poorly-differentiated early-stage glottic carcinoma exhibit inferior local control after surgery compared with those with moderately-to-well-differentiated tumours. Data from our previous retrospective study suggest that definitive radiotherapy/postoperative radiotherapy yields superior local control compared with surgery alone for poorly-differentiated early-stage glottic carcinoma. We hypothesize that definitive radiotherapy and postoperative radiotherapy can improve local control rates in patients with poorly-differentiated early-stage glottic squamous cell carcinoma. This study aims to conduct a multicenter, prospective, single-arm phase II clinical trial using intensity-modulated radiotherapy (IMRT) for patients with poorly-differentiated early-stage glottic laryngeal carcinoma, to preliminarily evaluate the impact of IMRT on local control rates and long-term survival outcomes in this patient population.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Early Stage Glottic Squamous Cell Carcinoma With Poor Differentiation

Interventions

Radiation: intensity modulated radiotherapy (IMRT)RADIATION

Post operative radiotherapy (CTV): CTV1 is routine postoperative laryngeal target covering whole larynx, piriform sinus, glosso epiglottic vallecula, paraglottic space, pre epiglottic space, thyroid cartilage down to inferior border of cricoid cartilage. Given higher lymphatic metastatic risk of poorly differentiated tumours, CTV2 delineates bilateral cervical nodal levels II III. PTV1/PTV2 are 3 mm isotropic expansions of CTV1/CTV2. Prescription: PTV1 60 Gy/30 fractions; PTV2 54 Gy/30 fractions. Definitive radiotherapy targets: Additional GTV denotes macroscopic tumour identified by laryngoscopy and imaging. PGTV/PTV1/PTV2 are 3 mm isotropic expansions of GTV/CTV1/CTV2. Prescription: PGTV 66 Gy/30 fractions; PTV1 60 Gy/30 fractions; PTV2 54 Gy/30 fractions.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Age ≥18 years, any gender 2. Histologically proven glottic squamous cell carcinoma 3. T1 T2N0M0 glottic laryngeal carcinoma with poor differentiation (moderate poor differentiation counted as poor differentiation) 4. Subjects undergoing curative intent surgery must be enrolled 4 8 weeks after operation. 5. No prior chemoradiotherapy or antineoplastic therapy 6. ECOG PS 0 1 7. Written informed consent provided Exclusion Criteria: 1. Moderately or well differentiated tumours 2. Prior chemotherapy or other antineoplastic agents 3. Prior head and neck irradiation 4. Previous participation in another clinical trial 5. Severe allergic history including contrast media allergy 6. Pregnancy or lactation 7. Uncontrolled acute infection 8. Drug/substance abuse, chronic heavy drinking, HIV infection 9. Uncontrolled concomitant malignant disease

Outcomes

Primary Outcomes

3-year local-regional failure-free survival (LRFS)

3-year local-regional failure-free survival (LRFS): defined as the time from the date of enrollment to recurrence of the primary lesion and perilesional tissues. The index date for recurrence is the date when a measurable new lesion is first identified. For patients who die of any other cause prior to documented disease recurrence, LRFS is calculated from the date of enrollment to the date of death. For patients without documented disease recurrence or death at the time of analysis (i.e., recurrence-free survivors), the time of the last efficacy assessment will be used as the endpoint.

Time frame: From the date of enrollment to the date of local recurrence, , assessed up to 3 year.

Secondary Outcomes

5-year local-regional failure-free survival (LRFS)

5-year local-regional failure-free survival (LRFS): defined as the time from the date of enrollment to recurrence of the primary lesion and perilesional tissues. The index date for recurrence is the date when a measurable new lesion is first identified. For patients who die of any other cause prior to documented disease recurrence, LRFS is calculated from the date of enrollment to the date of death. For patients without documented disease recurrence or death at the time of analysis (i.e., recurrence-free survivors), the time of the last efficacy assessment will be used as the endpoint.

Time frame: From the date of enrollment to the date of local recurrence, assessed up to 5 year.

5-year overall survival (OS)

Overall Survival(OS) is defined as the period from the date of enrollment to the date of death due to any cause.

Time frame: From the date of enrollment until the date of death due to any cause, assessed up to 5 year.

5-year disease-free survival (DFS)

5-year disease-free survival (DFS): defined as the time from the date of enrollment during which the patient remains alive without evidence of tumour growth. Recurrence is defined as the emergence of new lesions, including recurrence of the primary lesion and perilesional tissues, cervical lymph-node metastasis, and distant metastasis. The index date for recurrence is the date on which a measurable new lesion is first identified. For patients who die of any other cause prior to documented disease recurrence, DFS is calculated from the date of enrollment to the date of death. For patients with no documented disease recurrence or death at the time of analysis (i.e., disease-free survivors), the time of the last efficacy assessment will serve as the endpoint.

Time frame: Time from the date of enrollment to any evidence of tumour growth or death, assessed up to 5 year.

Adverse events

The incidence, type, and severity of adverse events (AEs), serious AEs, and immune-related AEs (irAEs) were assessed in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE version 5.0).

Time frame: From enrollment to the end of treatment at 5 years.