Post-Operative Adjuvant Concurrent Chemoradiotherapy For High Risk Oral Cavity Squamous Cell Carcinoma Patients

September 13, 2005 updated by: National Health Research Institutes, Taiwan

Phase III Study Of Post-Operative Adjuvant Concurrent Chemoradiotherapy For High Risk Oral Cavity Squamous Cell Carcinoma Patients

The purpose of this study is to confirm the value of concurrent chemoradiotherapy in improving the locoregional control and survival of patients with resected locally advanced HNSCC, a phase III randomized study is proposed. The population studied in this trial is limited to patients of oral cavity cancer; this could reduce the confounding factor of varying prognosis in patients of different primary sites of HNSCC.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Potentially resectable Stage III or IV squamous cell carcinomas of the head and neck (HNSCC) are treated by operation and adjuvant radiotherapy. The 5-year survival rate is approximating 30%. Recurrence typically occurs within 3 years, 60-80% in locoregional sites, and 20-30% systemically. Patients who are found to have tumors at the margins of surgical specimens far particularly poorly.

Chemotherapy has been added in the hope to improve this situation. Induction and adjuvant chemotherapy has resulted in a decrease in the appearance of systemic metastases in most trials, but has not improved locoregional control and survival.

For cases with unresectable head and neck cancers, concurrent chemoradiotherapy appears to have improved locoregional control, disease-free survival, and possibly overall survival, as compared to radiotherapy alone. Bachaud et al. reported a randomized trial of postoperative cisplatin and radiotherapy vs. radiotherapy alone for patients with Stage III or IV head and neck cancer. Cisplatin was administered 50 mg weekly during radiotherapy. There was a significant improvement in locoregional control (70% vs. 55%) as well as overall survival (median 36m vs. 20m) in patients who received concurrent chemoradiotherapy. Al-Sarraf et al. also reported a phase II concurrent chemoradiotherapy trial, using cisplatin 100 mg/m2 every three weeks. Based on comparison with similar patients treated in a prior RTOG trial, they conclude that postoperative radiotherapy with concurrent cisplatin may improve locoregional control rates10. The superiority of adjuvant concurrent chemoradiotherapy (CCRT) to RT alone or sequential adjuvant RT and chemotherapy has been further confirmed in an analysis of data of RTOG 85-03 and RTOG 88-24. Comparing high-risk patients of RTOG 85-03 with prognostically similar patients from RTOG 88-24, the data suggest that sequential surgery, RT, and chemotherapy produced better locoregional control than surgery plus RT, but that surgery followed by CCRT produced even higher locoregional control. Independent of the differences in the amount of RT delivered, the Cox proportional hazards model suggests that the addition of CCRT resulted in a 50% decrease in locoregional relapse rates compared with surgery plus postoperative RT with no chemotherapy. The reduction in mortality was 18%.

Although CCRT may be better than RT alone or sequential treatment, the 3 year survival in both adjuvant CCRT studies were only around 50%. Is more aggressive treatment warranted? Tolerance to CCRT is a major concern. In the French study, severe acute toxicity occurred in 18% of RT only patients and 41% of patients received CCRT. In the RTOG 88-24 trial, severe and life-threatening toxicities occurred in 20% and 12% of patients, respectively; the most common drug-related toxicities were leukopenia, anemia, nausea, and vomiting . Theoretically, to optimize CCRT, continuous presence of chemotherapeutic drug or drug effect is necessary to maximize the effect of radiosensitization. For radiosensitization purpose, daily chemotherapy may be better than weekly and weekly may be better than tri-weekly. French study used weekly cisplatin with a dose of 30 mg/m2. RTOG 88-24 used different treatment dose and schedule 100 mg/m2 of cisplatin on radiotherapy days 1, 23 and 43. We choose weekly for convenience and hope this can increase the recruitment of patients. In the pilot study, we observed a remarkable toxicity with this treatment schedule. Considering the remarkable toxicity reported and our preliminary experience, more drugs, higher dosage, or extended schedule may not be justified.

Study Type

Interventional

Enrollment

161

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Taiwan
      • Taipei, Taiwan, 100
        • National Taiwan University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

Clinically free of disease after having undergone surgery for histologically confirmed primary keratinizing SCC of the oral cavity.

buccal mucosa upper lip (140.3) lower lip (140.4) cheek (145.0) retromolar area (145.6) bucco-alveolar sulci upper and lower (145.1) oral tongue dorsum (141.1) lateral border (141.2) inferior surface (141.3)

With any one of the risk factors of recurrence listed below:

Nodal extracapsular spread of disease (ECS) Number of positive node > 2 Perineural involvement Lymphovascular emboli/permeation in resected surgical specimen Histologically positive surgical margin

Exclusion Criteria:

Karnofsky performance status of <50 Concurrent or previous second primary cancer (excluding non-melanoma skin cancer) Gross residual disease following surgery Distant metastasis before or at the time of adjuvant treatment Serum creatinine > 1.4 mg/dl, WBC <3500/mm3, platelet <100,000/mm3

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Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
RT versus RT plus CT in effect on local control and survival of patients of oral cavity cancer after curative operation.

Secondary Outcome Measures

Outcome Measure
the acute and chronic toxicity of RT versus RT plus CT in patients of oral cavity cancer after curative operation.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

National Health Research Institutes, Taiwan

Collaborators

National Taiwan University Hospital
Mackay Memorial Hospital
China Medical University Hospital
Buddhist Tzu Chi General Hospital
Changhua Christian Hospital
Kaohsiung Veterans General Hospital.
Chi Mei Medical Hospital
Koo Foundation Sun Yat-Sen Cancer Center

Investigators

  • Study Chair: Mow-Ming Hsu, MD, National Taiwan University Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

October 1, 1999

Study Completion

August 1, 2009

Study Registration Dates

First Submitted

September 13, 2005

First Submitted That Met QC Criteria

September 13, 2005

First Posted (Estimate)

September 20, 2005

Study Record Updates

Last Update Posted (Estimate)

September 20, 2005

Last Update Submitted That Met QC Criteria

September 13, 2005

Last Verified

January 1, 2005

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • T2399

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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