Parotid-gland Stem-cell Sparing Intensity-modulated Radiotherapy

NCT ID: NCT01955239

Last Updated: 2017-06-22

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

COMPLETED

Clinical Phase

NA

Total Enrollment

106 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-09-30

Study Completion Date

2017-05-31

Brief Summary

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Rationale:

Radiation-induced parotid gland dysfunction, often leading to xerostomia is the most-frequently occurring side-effect with a major impact on patient-reported quality of life after radiotherapy for head and neck cancer (HNC). Therefore, treatments for HNC are currently optimized to minimize the mean dose to the parotid glands. Though this resulted in a significant reduction of toxicity, 30%-40% of the patients still develop sustained parotid gland dysfunction and xerostomia.

However, in animal studies the investigators found that the dose to the sub-volume of the gland containing the parotid gland stem cells is a better predictor for dysfunction than the mean dose to the whole gland. Subsequently, this finding was confirmed in a retrospective analysis in patients. Therefore, a reduction of dose specifically in this sub-volume of the parotid glands of patients is expected to further reduce the risk of parotid gland dysfunction and xerostomia.

Objective:

To test the hypothesis that parotid gland stem cell sparing intensity modulated radiotherapy in HNC patients reduces the risk of parotid gland dysfunction and xerostomia as compared to conventional parotid gland sparing intensity modulated radiotherapy.

Study design:

Double-blind prospective randomized trial (51 patients per arm). Study population: Patients treated for tumours in the head-and-neck region with curative radiotherapy, with or without the addition of chemotherapy or cetuximab.

Intervention: Patients randomized into the experimental arm will receive a treatment in which the radiation dose to the parotid gland is re-distributed to minimize dose to the sub-volume containing the stem cells, while keeping the same mean dose to the parotid gland as a whole.

Main study parameters/endpoints:

Primary endpoint is parotid gland salivary secretion. Secondary endpoints are patient- and physician-rated xerostomia.

Detailed Description

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Conditions

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Head and Neck Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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Standard IMRT

Standard IMRT in which the mean dose to both whole parotid glands is minimized.

Group Type ACTIVE_COMPARATOR

Intensity-modulated Radiotherapy

Intervention Type RADIATION

Stem-cell Sparing IMRT

Stem-cell Sparing IMRT in which the mean dose to the stem cell containing region of the parotid gland is minimized

Group Type EXPERIMENTAL

Intensity-modulated Radiotherapy

Intervention Type RADIATION

Interventions

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Intensity-modulated Radiotherapy

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

* Squamous cell carcinoma originating from the mucosa of the head and neck area or nasopharyngeal carcinoma originating from the nasopharynx;
* The radiotherapy includes prophylactic or therapeutic irradiation of both sides of the neck (at least level II to IV);
* Age ≥ 18 years;
* WHO performance 0-2;
* To reduce the uncertainty in the assessment of relative flow after treatment, pre-treatment parotid gland saliva production stimulated with 5% citric acid should exceed \>0.1 ml/min

Exclusion Criteria

* Postoperative radiotherapy;
* Previous radiotherapy of the head and neck region (re-irradiation);
* Unilateral radiotherapy;
* Primary salivary gland tumours
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Medical Center Groningen

OTHER

Sponsor Role lead

Responsible Party

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Roel Steenbakkers

M.D., Ph.D.

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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University Medical Center Groningen

Groningen, , Netherlands

Site Status

Countries

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Netherlands

References

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Langendijk JA, Doornaert P, Verdonck-de Leeuw IM, Leemans CR, Aaronson NK, Slotman BJ. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol. 2008 Aug 1;26(22):3770-6. doi: 10.1200/JCO.2007.14.6647.

Reference Type BACKGROUND
PMID: 18669465 (View on PubMed)

Beetz I, Schilstra C, van der Schaaf A, van den Heuvel ER, Doornaert P, van Luijk P, Vissink A, van der Laan BF, Leemans CR, Bijl HP, Christianen ME, Steenbakkers RJ, Langendijk JA. NTCP models for patient-rated xerostomia and sticky saliva after treatment with intensity modulated radiotherapy for head and neck cancer: the role of dosimetric and clinical factors. Radiother Oncol. 2012 Oct;105(1):101-6. doi: 10.1016/j.radonc.2012.03.004. Epub 2012 Apr 18.

Reference Type BACKGROUND
PMID: 22516776 (View on PubMed)

Eisbruch A. Radiotherapy: IMRT reduces xerostomia and potentially improves QoL. Nat Rev Clin Oncol. 2009 Oct;6(10):567-8. doi: 10.1038/nrclinonc.2009.143. No abstract available.

Reference Type BACKGROUND
PMID: 19787001 (View on PubMed)

Konings AW, Cotteleer F, Faber H, van Luijk P, Meertens H, Coppes RP. Volume effects and region-dependent radiosensitivity of the parotid gland. Int J Radiat Oncol Biol Phys. 2005 Jul 15;62(4):1090-5. doi: 10.1016/j.ijrobp.2004.12.035.

Reference Type BACKGROUND
PMID: 15990013 (View on PubMed)

Konings AW, Faber H, Cotteleer F, Vissink A, Coppes RP. Secondary radiation damage as the main cause for unexpected volume effects: a histopathologic study of the parotid gland. Int J Radiat Oncol Biol Phys. 2006 Jan 1;64(1):98-105. doi: 10.1016/j.ijrobp.2005.06.042. Epub 2005 Oct 13.

Reference Type BACKGROUND
PMID: 16226398 (View on PubMed)

Lombaert IM, Brunsting JF, Wierenga PK, Faber H, Stokman MA, Kok T, Visser WH, Kampinga HH, de Haan G, Coppes RP. Rescue of salivary gland function after stem cell transplantation in irradiated glands. PLoS One. 2008 Apr 30;3(4):e2063. doi: 10.1371/journal.pone.0002063.

Reference Type BACKGROUND
PMID: 18446241 (View on PubMed)

Lombaert IM, Brunsting JF, Wierenga PK, Kampinga HH, de Haan G, Coppes RP. Keratinocyte growth factor prevents radiation damage to salivary glands by expansion of the stem/progenitor pool. Stem Cells. 2008 Oct;26(10):2595-601. doi: 10.1634/stemcells.2007-1034. Epub 2008 Jul 31.

Reference Type BACKGROUND
PMID: 18669914 (View on PubMed)

Doornaert P, Dahele M, Ljumanovic R, de Bree R, Slotman BJ, Castelijns JA. Use of diffusion-weighted magnetic resonance imaging (DW-MRI) to investigate the effect of chemoradiotherapy on the salivary glands. Acta Oncol. 2015 Jul;54(7):1068-71. doi: 10.3109/0284186X.2014.987357. Epub 2014 Dec 18. No abstract available.

Reference Type DERIVED
PMID: 25519706 (View on PubMed)

Other Identifiers

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RT2011-04

Identifier Type: -

Identifier Source: org_study_id

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