Phase I Study of IMRT and Molecular-Image Guided Adaptive Radiation Therapy for Advanced HNSCC

NCT ID: NCT01283178

Last Updated: 2016-10-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE1

Total Enrollment

3 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-07-31

Study Completion Date

2016-09-30

Brief Summary

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RATIONALE: Specialized radiation therapy that delivers a high dose of radiation directly to the tumor may kill more tumor cells and cause less damage to normal tissue. CT and PET scans and treatment-planning systems may help in planning radiation therapy. Drugs used in chemotherapy, such as cisplatin, 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 may kill more tumor cells.

PURPOSE: This phase I trial is studying the side effects and best dose of intensity-modulated image guided adaptive radiation therapy when given together with cisplatin in treating patients with locally advanced head and neck squamous cell cancer

Detailed Description

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PRIMARY OBJECTIVES:

I. To determine the feasibility of integrating molecular imaging (PET with FLT tracer) into current state-of-the-art image-guided adaptive radiation therapy (IGART) of head and neck cancer.

II. To determine within a predefined range the maximum tolerated radiation dose for concurrent cisplatin and molecular and anatomic image-based IGART of head and neck cancer.

SECONDARY OBJECTIVES I. To compare gross tumor volumes defined by FDG-PET, FLT-PET, CBCT, and regular FBCT before, during, and following completion of chemo-radiation therapy.

II. To evaluate the impact of escalated doses to tumor sub-volumes with high FLT and FDG uptake prior to and during radiation therapy using post-treatment FDG images as an early surrogate for sub-volume-specific local control.

III. To develop a database consisting of all molecular and anatomic images, including daily CBCT data sets, obtained during chemo-radiation therapy to support further research. Potential applications include determination of optimal adaptive re-planning frequency and the benefits of basing IGART on 4D anatomic data sets derived from deformably registering daily CBCT and FBCT data sets.

IV. Determine patient long-term toxicities and survival. V. To evaluate the impact of daily image-guided setup; off-line every other week adaptive re-planning; and molecular-image based targeting on sparing of tissues and organs responsible for late and early treatment sequelae.

OUTLINE: This a dose-escalation study of intensity-modulated radiotherapy.

Patients undergo intensity-modulated image-guided adaptive radiotherapy once daily 5 days a week for 6 weeks. Patients also receive cisplatin IV on days 1 and 22. Treatment continues in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up at 2 and 4 weeks, 2, 3, 4, 5, 6, 9, and 12 months, every 6 months for 2 years, and then annually for 2 years.

Conditions

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Salivary Gland Squamous Cell Carcinoma Stage II Salivary Gland Cancer Stage II Squamous Cell Carcinoma of the Hypopharynx Stage II Squamous Cell Carcinoma of the Lip and Oral Cavity Stage II Squamous Cell Carcinoma of the Oropharynx Stage II Verrucous Carcinoma of the Oral Cavity Stage III Salivary Gland Cancer Stage III Squamous Cell Carcinoma of the Hypopharynx Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity Stage III Squamous Cell Carcinoma of the Oropharynx Stage III Verrucous Carcinoma of the Oral Cavity Stage IV Salivary Gland Cancer Stage IV Squamous Cell Carcinoma of the Hypopharynx Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity Stage IV Squamous Cell Carcinoma of the Oropharynx Stage IV Verrucous Carcinoma of the Oral Cavity

Keywords

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squamous cell carcinoma of the paranasal sinus and nasal cavity

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Arm I

Patients undergo intensity-modulated image-guided adaptive radiotherapy once daily 5 days a week for 6 weeks. Patients also receive cisplatin IV on days 1 and 22. Treatment continues in the absence of disease progression or unacceptable toxicity.

Group Type EXPERIMENTAL

intensity-modulated radiation therapy

Intervention Type RADIATION

Undergo intensity-modulated image-guided adaptive radiotherapy

cisplatin

Intervention Type DRUG

Given IV

image-guided adaptive radiation therapy

Intervention Type RADIATION

Undergo intensity-modulated image-guided adaptive radiotherapy

3'-deoxy-3'-[18F]fluorothymidine

Intervention Type OTHER

Undergo FLT-PET scans for IMRT/IGART

positron emission tomography/computed tomography

Intervention Type PROCEDURE

Undergo FDG/FLT-PET scans for IMRT/IGARTT

fludeoxyglucose F 18

Intervention Type RADIATION

Undergo FDG-PET scans for IMRT/IGART

Interventions

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intensity-modulated radiation therapy

Undergo intensity-modulated image-guided adaptive radiotherapy

Intervention Type RADIATION

cisplatin

Given IV

Intervention Type DRUG

image-guided adaptive radiation therapy

Undergo intensity-modulated image-guided adaptive radiotherapy

Intervention Type RADIATION

3'-deoxy-3'-[18F]fluorothymidine

Undergo FLT-PET scans for IMRT/IGART

Intervention Type OTHER

positron emission tomography/computed tomography

Undergo FDG/FLT-PET scans for IMRT/IGARTT

Intervention Type PROCEDURE

fludeoxyglucose F 18

Undergo FDG-PET scans for IMRT/IGART

Intervention Type RADIATION

Other Intervention Names

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IMRT CACP CDDP CPDD DDP IGART image-guided adaptive radiotherapy 18F-FLT 18FDG FDG

Eligibility Criteria

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Inclusion Criteria

* Histologic or cytologic confirmation of head and neck malignancy without clinical or radiographic evidence of metastatic disease
* Locally advanced HN SCC, stages III, IV, and bulky (\> 27 cm\^3 volume) stage II, excluding larynx and nasopharynx, of no more than 150 cm\^3 volume base on CT scan
* All patients must be informed of the investigational nature of this study and must give written informed consent in accordance with institutional and federal guidelines
* Candidate for chemotherapy
* Zubrod performance score of 0 or 1
* Absolute granulocyte count (AGC) \>= 2000 cells/mm\^3
* Platelet count \>= 100,000 cells/mm\^3
* Hemoglobin \> 8.0 g/dl based upon CBC/differential obtained within 2 weeks prior to registration on study
* Serum creatinine =\< 1.5 mg/dl or measured or calculated creatinine clearance \>= 50 ml/min
* Negative pregnancy test within 2 weeks prior to registration for women of childbearing potential

Exclusion Criteria

* Prior invasive malignancy except non-melanomatous skin cancers unless patient has been disease free for at least 3 years
* Prior cancer treatment for this cancer, including gross total tumor excision
* Prior radiation treatment to the HN region
* Patients with known syndromes that alter radiosensitivity
* Any medical contraindications for chemotherapy
* Pregnant or lactating women
* Women (of childbearing potential) and men who are sexually active and are not willing/able to use a medically acceptable form of contraception throughout the treatment and 60 days thereafter
Minimum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

Virginia Commonwealth University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Shiyu Song

Role: PRINCIPAL_INVESTIGATOR

Virginia Commonwealth University

Locations

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Virginia Commonwealth University

Richmond, Virginia, United States

Site Status

Countries

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United States

Other Identifiers

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NCI-2010-02340

Identifier Type: REGISTRY

Identifier Source: secondary_id

P30CA016059

Identifier Type: NIH

Identifier Source: secondary_id

View Link

MCC 13222

Identifier Type: -

Identifier Source: org_study_id