Adjuvant Radiotherapy in Early Stage Oral Cancers

NCT ID: NCT03853655

Last Updated: 2026-01-16

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

392 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-08-02

Study Completion Date

2025-12-15

Brief Summary

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This study will assess the benefit of postoperative adjuvant radiotherapy in patients with an early oral squamous cell carcinoma (OSCC) having tumor thickness more than or equal to 5mm. The study population will consist of patients who have been treated by surgery for early stage oral tongue cancers. Patients with a close or positive margin (\</= 5mm) and or with metastatic neck node(s) will be excluded. Selected patients will be randomized into two groups. The group I will be observed after surgery and group II will receive adjuvant radiotherapy as per protocol.

Detailed Description

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The aim of this study is to assess the benefit of postoperative adjuvant radiotherapy in patients with an early oral squamous cell carcinoma (OSCC) having a tumor depth of invasion more than or equal to 5mm.

Primary objective:

To determine the impact of postoperative adjuvant radiotherapy on locoregional recurrence-free survival in patients with early-stage oral tongue cancer with tumor thickness ≥ 5 mm.

Secondary objectives:

1. To compare disease-free survival and overall survival between the two groups.
2. To assess and compare the quality of life changes between the two groups.
3. To assess the acute and long-term radiation toxicity.

We will be conducting a Phase III Open-Label Prospective Randomized Controlled Trial using stratified randomization. Patients will be randomized into two groups:

Group I: Control arm (Observation only) Group II: Study arm (Postoperative adjuvant radiotherapy)

Patients will be stratified on the following factors

1. Presence of Perineural Invasion (PNI)/Lympho-Vascular Emboli (LVE)
2. Histological grade (well-differentiated/moderately differentiated vs poorly differentiated)
3. Tongue/Floor of Mouth vs Buccal Mucosa.

Study procedures:

The study population will consist of patients who have been treated by surgery for early-stage oral cancers. Patients satisfying the inclusion-exclusion criteria will be included in the study after obtaining a valid, written and informed consent. The depth of invasion will be assessed microscopically by measuring the maximum vertical bulk of the tumor from the normal mucosal surface to the deepest point of invasion. After reviewing the histopathological report, patients will be randomized to one of the 2 arms. Patients belonging to study arm (Group II) will receive adjuvant radiotherapy 60 Gray, 30 fractions for 30 days over 6 weeks as routinely prescribed at Tata Memorial Center (TMC) and will receive the treatment within or by 6 weeks after surgery.

Both the groups (Group I and Group II) will be under regular follow-up with 3 monthly intervals for the first 2 years and 6 monthly for the next 3 years and once a year thereafter. At each follow-up, patients will be evaluated clinically for evidence of locoregional tumor recurrence. The locoregional recurrence-free survival will be calculated based on the difference between the date of randomization and the date of biopsy-proven recurrence. We will also record the overall survival in both groups. The quality of life will be assessed at each follow-up regular intervals using the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ H\&N-35 ) and EORTC QLQ-C 30. The radiation toxicity will be assessed using Common Terminology Criteria for Adverse Events (CTCAE) v4.0.

Conditions

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Cancer of Mouth Cancer of the Tongue Cancer of the Head and Neck Buccal Mucosa Cancer Floor of Mouth Carcinoma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Control arm

Patients in this arm will be observed and kept under active follow-up after surgery for the primary.

Group Type NO_INTERVENTION

No interventions assigned to this group

Study arm

Intervention in the study arm will be in the form of post-operative adjuvant radiotherapy starting within 6-weeks after primary surgery.

Group Type EXPERIMENTAL

Post-operative adjuvant radiotherapy

Intervention Type RADIATION

Conventional treatment planning, as well as intensity-modulated radiation therapy (IMRT) planning, would be allowed on the study with patients being stratified on the RT technique.

Treatment would be delivered on telecobalt unit (gamma-rays/linear accelerator (6MV photons). All fields would be treated daily.

Phase I: 46 Gray(Gy) in 23 fractions over 4.5 weeks Phase II: 14Gray in 7 fractions over 1.5 weeks

For IMRT, inverse planning would be done on a commercial TPS configured to deliver IMRT using 6MV photons. Patients shall be treated using the simultaneous integrated boost (SIB) technique with 5 fractions being delivered every week.

Interventions

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Post-operative adjuvant radiotherapy

Conventional treatment planning, as well as intensity-modulated radiation therapy (IMRT) planning, would be allowed on the study with patients being stratified on the RT technique.

Treatment would be delivered on telecobalt unit (gamma-rays/linear accelerator (6MV photons). All fields would be treated daily.

Phase I: 46 Gray(Gy) in 23 fractions over 4.5 weeks Phase II: 14Gray in 7 fractions over 1.5 weeks

For IMRT, inverse planning would be done on a commercial TPS configured to deliver IMRT using 6MV photons. Patients shall be treated using the simultaneous integrated boost (SIB) technique with 5 fractions being delivered every week.

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

1. Post-operative early stage squamous cell carcinoma of the oral cavity (Oral Tongue, Buccal Mucosa, Floor of mouth). (pT1, pT2, N0 as defined in the AJCC Classification 8th edition.
2. Adequate surgery (Defined as wide local excision of the primary tumor with tumor-free margin ≥ 5mm and ipsilateral selective neck dissection addressing levels I-III at minimum.)
3. Written informed consent.
4. Age ≥18 years
5. Eastern Co-operative Oncology Group (ECOG) Performance Status 0-2
6. The depth of invasion (DOI) ≥ 5 mm.
7. Compliance to therapy and follow-up
8. The interval from surgery to adjuvant radiotherapy ≤ 6 weeks

Exclusion Criteria

1. pT3/pT4 (as specified in the AJCC 8th edition).
2. Depth of invasion \< 5mm.
3. Any neck nodal metastasis with or without extra nodal extension
4. Tumor-free margin \< 5 mm
5. Non-squamous histology
6. Pregnant woman
7. Prior h/o any other malignancy in the last five years
8. Prior therapeutic irradiation of the head and neck.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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NATIONAL CANCER GRID

UNKNOWN

Sponsor Role collaborator

Tata Memorial Hospital

OTHER_GOV

Sponsor Role lead

Responsible Party

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Dr. Sudhir Nair

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sudhir V Nair, MS, MCh

Role: PRINCIPAL_INVESTIGATOR

Associate Professor

Locations

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Dr. B Barooah Cancer Institute

Guwahati, Assam, India

Site Status

HCG Hospital

Ahmedabad, Gujarat, India

Site Status

Kailash Cancer Hospital and Research Centre

Goraj, Gujarat, India

Site Status

Sree Sankara Cancer Hospital

Bangalore, Karnataka, India

Site Status

Mazumdar Shaw Medical Centre

Bangalore, Karnataka, India

Site Status

Malabar Cancer Centre

Kannur, Kerala, India

Site Status

Amrita Institute of Medical Sciences

Kochi, Kerala, India

Site Status

Tata Memorial Centre

Mumbai, Maharashtra, India

Site Status

Countries

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India

References

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Caramello P, Giacobbi D, Savoia D. [Identification of Pneumocystis carinii in a patient dying of AIDS]. G Batteriol Virol Immunol. 1985 Jul-Dec;78(7-12):171-7. Italian.

Reference Type BACKGROUND
PMID: 3879892 (View on PubMed)

Thiagarajan S, Nair S, Nair D, Chaturvedi P, Kane SV, Agarwal JP, D'Cruz AK. Predictors of prognosis for squamous cell carcinoma of oral tongue. J Surg Oncol. 2014 Jun;109(7):639-44. doi: 10.1002/jso.23583. Epub 2014 Mar 12.

Reference Type BACKGROUND
PMID: 24619660 (View on PubMed)

Dequanter D, Saint-Aubin N, Paesmans M, Badr-El-Din A, Lothaire P, Andry G. [Prognostic factors in epidermoid carcinoma of the mobile tongue classified as T1-T2]. Ann Otolaryngol Chir Cervicofac. 2001 Oct;118(5):315-22. French.

Reference Type BACKGROUND
PMID: 11845040 (View on PubMed)

Kokemueller H, Rana M, Rublack J, Eckardt A, Tavassol F, Schumann P, Lindhorst D, Ruecker M, Gellrich NC. The Hannover experience: surgical treatment of tongue cancer--a clinical retrospective evaluation over a 30 years period. Head Neck Oncol. 2011 May 21;3:27. doi: 10.1186/1758-3284-3-27.

Reference Type BACKGROUND
PMID: 21600000 (View on PubMed)

Ganly I, Patel S, Shah J. Early stage squamous cell cancer of the oral tongue--clinicopathologic features affecting outcome. Cancer. 2012 Jan 1;118(1):101-11. doi: 10.1002/cncr.26229. Epub 2011 Jun 29.

Reference Type BACKGROUND
PMID: 21717431 (View on PubMed)

Gonzalez-Moles MA, Esteban F, Rodriguez-Archilla A, Ruiz-Avila I, Gonzalez-Moles S. Importance of tumour thickness measurement in prognosis of tongue cancer. Oral Oncol. 2002 Jun;38(4):394-7. doi: 10.1016/s1368-8375(01)00081-1.

Reference Type BACKGROUND
PMID: 12076706 (View on PubMed)

Huang SF, Kang CJ, Lin CY, Fan KH, Yen TC, Wang HM, Chen IH, Liao CT, Cheng AJ, Chang JT. Neck treatment of patients with early stage oral tongue cancer: comparison between observation, supraomohyoid dissection, and extended dissection. Cancer. 2008 Mar 1;112(5):1066-75. doi: 10.1002/cncr.23278.

Reference Type BACKGROUND
PMID: 18246535 (View on PubMed)

Shim SJ, Cha J, Koom WS, Kim GE, Lee CG, Choi EC, Keum KC. Clinical outcomes for T1-2N0-1 oral tongue cancer patients underwent surgery with and without postoperative radiotherapy. Radiat Oncol. 2010 May 27;5:43. doi: 10.1186/1748-717X-5-43.

Reference Type BACKGROUND
PMID: 20504371 (View on PubMed)

Related Links

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https://seer.cancer.gov/archive/csr/1975_2010/

SEER Cancer statistics review 1975-2010. National cancer institute

Other Identifiers

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1713

Identifier Type: -

Identifier Source: org_study_id

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