Phase 3 Trial Comparing IMRT or IMPT Plus CIRT for Patients With NPC

NCT ID: NCT06846450

Last Updated: 2025-12-02

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

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

470 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-04-01

Study Completion Date

2031-01-31

Brief Summary

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The goal of this phase 3 non-inferiority trial is to compare the efficacy and toxicity of proton or photon radiation therapy plus carbon ion radiation therapy for newly diagnosed nasopharyngeal carcinoma. The main question it aims to answer is that if proton radiation therapy plus carbon ion radiation therapy is non-inferior to photon radiation therapy plus carbon ion radiation therapy in terms of therapeutic efficacy. Participants will be randomized to receive either proton radiation therapy (arm 1) or photon radiation therapy (arm 2), in addition to carbon ion radiation therapy (for both arms).

Detailed Description

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This is a phase 3 randomized non-inferiority trial. The primary objective of the trial is to compare progression-free survival between proton plus carbon ion radiation therapy (arm 1) and photon plus carbon ion radiation therapy (arm 2) for patients with newly diagnosed nasopharyngeal carcinoma (NPC). The secondary objectives includes overall survival, locoregional progression-free survival, distant metastasis-free survival, physician-graded toxicities according to the CTCAE, and patients-reported outcomes. This study adopts a web-based central randomization system. The randomization method uses minimization, with two balancing factors: Stage (AJCC Staging System, 9th edition): Stage I vs. Stages II/III; Response to induction chemotherapy: No induction chemotherapy vs. sensitive (CR + PR) vs. resistant (SD + PD). Eligible patients will be randomized in a 1:1 ratio into either the experimental group or the control group. This is an open-label study, meaning both patients and investigators are aware of the treatment allocation.

Participants randomized to arm 1 will receive proton therapy with a dose of 56 GyRBE in 28 fractions, in addition to a boost delivered using carbon ion radiation therapy with a dose of 17.5 GyRBE in 5 fractions. Participants randomized to arm 2 will receive photon therapy with a dose of 56 Gy in 28 fractions, plus carbon ion radiation therapy with a dose of 17.5 GyRBE in 5 fractions. The treatment response will be evaluated according to the RECIST criteria.

Induction chemotherapy and concurrent chemotherapy will be prescribed according to disease stage.

Conditions

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Nasopharyngeal Cancinoma (NPC)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This study adopts a web-based central randomization system. The randomization method uses minimization, with two balancing factors:

Stage (AJCC Staging System, 9th edition): Stage I vs. Stages II/III; Response to induction chemotherapy: No induction chemotherapy vs. sensitive (CR + PR) vs. resistant (SD + PD).

Eligible patients will be randomized in a 1:1 ratio into either the experimental group or the control group. This is an open-label study, meaning both patients and investigators are aware of the treatment allocation.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Arm 1

Group Type EXPERIMENTAL

Intensity-modulated proton radiation therapy

Intervention Type RADIATION

Intensity-modulated proton therapy, will be delivered to the high risk area with a dose of 56 GyRBE in 28 fractions, and if applicable, to the low risk area with a dose of 50.4 GyRBE in 28 fractions.

Intensity-modulated carbon ion radiation therapy

Intervention Type RADIATION

Intensity-modulated carbon ion radiation therapy will be delivered as a boost with a dose of 17.5 GyRBE in 5 fractions to gross tumor.

Concurrent chemotherapy

Intervention Type DRUG

Concurrent chemotherapy will be administered on a weekly basis.

Induction chemotherapy

Intervention Type DRUG

Cisplatin-based induction chemotherapy will be administered every three weekly.

Arm 2

Group Type ACTIVE_COMPARATOR

Intensity-modulated photon radiation therapy

Intervention Type RADIATION

Intensity-modulated photon therapy, will be delivered to the high risk area with a dose of 56 Gy in 28 fractions, and if applicable, to the low risk area with a dose of 50.4 Gy in 28 fractions.

Intensity-modulated carbon ion radiation therapy

Intervention Type RADIATION

Intensity-modulated carbon ion radiation therapy will be delivered as a boost with a dose of 17.5 GyRBE in 5 fractions to gross tumor.

Concurrent chemotherapy

Intervention Type DRUG

Concurrent chemotherapy will be administered on a weekly basis.

Induction chemotherapy

Intervention Type DRUG

Cisplatin-based induction chemotherapy will be administered every three weekly.

Interventions

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Intensity-modulated proton radiation therapy

Intensity-modulated proton therapy, will be delivered to the high risk area with a dose of 56 GyRBE in 28 fractions, and if applicable, to the low risk area with a dose of 50.4 GyRBE in 28 fractions.

Intervention Type RADIATION

Intensity-modulated photon radiation therapy

Intensity-modulated photon therapy, will be delivered to the high risk area with a dose of 56 Gy in 28 fractions, and if applicable, to the low risk area with a dose of 50.4 Gy in 28 fractions.

Intervention Type RADIATION

Intensity-modulated carbon ion radiation therapy

Intensity-modulated carbon ion radiation therapy will be delivered as a boost with a dose of 17.5 GyRBE in 5 fractions to gross tumor.

Intervention Type RADIATION

Concurrent chemotherapy

Concurrent chemotherapy will be administered on a weekly basis.

Intervention Type DRUG

Induction chemotherapy

Cisplatin-based induction chemotherapy will be administered every three weekly.

Intervention Type DRUG

Other Intervention Names

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IMPT IMRT IMCT

Eligibility Criteria

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Inclusion Criteria

* Willingness to sign the written informed consent.
* Pathologically confirmed Nasopharyngeal carcinoma.
* Patients with any stage of disease except distant metastasis.
* Age: ≥ 18 and ≤ 70 years old.
* Eastern Cooperative Oncology Group score: 0-1.
* Adequate laboratory test results.
* Willingness to accept adequate contraception.

Exclusion Criteria

* Presence of distant metastasis.
* Previous radiotherapy to head and neck region.
* Previous surgery (except for biopsy) for the primary lesion or cervical lymph nodes.
* History of malignant tumor within the past 5 years.
* Presence of multiple primary tumors.
* Presence of diseases that may interfere with the evaluation of study endpoints.
* Presence of severe major organ dysfunction.
* Mental illness that may affect the understanding of informed consent.
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Lin Kong, MD

OTHER

Sponsor Role lead

Responsible Party

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Lin Kong, MD

Chief physician

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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Shanghai Proton and Heavy Ion Center

Shanghai, Shanghai Municipality, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Lin Kong

Role: CONTACT

86-38296666

Jiyi Hu

Role: CONTACT

86-38296666

Facility Contacts

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Lin Kong

Role: primary

86-38296666

Jiyi Hu

Role: backup

86-38296666

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Other Identifiers

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SPHIC-TR-HNCNS-2024-70

Identifier Type: -

Identifier Source: org_study_id

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