Reduced vs Conventional Dosage Intensity-modulated Radiotherapy for Chemotherapy-sensitive Stage II-III Nasopharyngeal Carcinoma

September 24, 2020 updated by: Ming-Yuan Chen, Sun Yat-sen University

A Multicenter Randomized Controlled Trial Comparing Reduced Dose With Regular Dose Intensity-modulated Radiotherapy for Chemotherapy Sensitive Stage II-III Nasopharyngeal Carcinoma

Through multicenter, open-label, randomised clinical trials, we intend to demonstrate that radiotherapy with reduced dose could significantly reduce the incidence of radiotherapy toxicities, improve the quality of life of patients while ensuring the tumor control rates for NPC patients staged as II-III who are sensitive to induction chemotherapy (imaging evaluation of CR/PR and EBV DNA copy number decreased to 0 copies/mL after induction chemotherapy)

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Through multicenter, open-label, randomised clinical trials, patients with NPC staged as II-III with CR/PR according to RECIST criteria and EBV DNA decreased to 0 copies/mL after 3 cycles of GP induction chemotherapy will be randomized into experimental group to receive IMRT of reduced dose (prescribed dose, 63.6 Gy, 2.12 Gy per fractions, 30 fractions) and control group to receive IMRT of conventional dose (prescribed dose, 69.96 Gy, 2.13 Gy per time, 33 fractions). Two cycles of cisplatin chemotherapy will be performed during IMRT. The efficacy, toxicity, and quality of life of patients between the two groups will be compared.

Study Type

Interventional

Enrollment (Anticipated)

508

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

  • China
    • Guangdong
      • Guangzhou, Guangdong, China, 510060
        • Recruiting
        • Sun Yat-sen University Cancer Center
      • Guangzhou, Guangdong, China, 510095
        • Not yet recruiting
        • Cancer Center of Guangzhou Medical University
        • Contact:
        • Principal Investigator:
          • Dong-Ping Chen, MD
        • Contact:
      • Shaoguan, Guangdong, China, 512025
        • Not yet recruiting
        • Yuebei People's Hospital
        • Contact:
          • Su-Ming Pan, MD
          • Phone Number: 86-13826331948
        • Principal Investigator:
          • Su-Ming Pan, MD
        • Contact:
      • Zhongshan, Guangdong, China, 528403
        • Recruiting
        • Zhongshan People's Hospital
        • Principal Investigator:
          • Feng Lei, MD
        • Contact:
          • Feng Lei, MD
          • Phone Number: 86-18933345382
    • Guangxi
      • Wuzhou, Guangxi, China, 543002
        • Not yet recruiting
        • Wuzhou Red Cross Hospital
        • Contact:
          • Jin-Hui Liang, MD
          • Phone Number: 86-13878480806
        • Principal Investigator:
          • Jin-Hui Liang, MD
  • Singapore
      • Singapore, Singapore, 169610
        • Not yet recruiting
        • National Cancer Centre Singapore
        • Contact:
        • Principal Investigator:
          • Melvin Lee Kiang Chua, PhD

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

18 years to 70 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Histologically confirmed non-keratinizing nasopharyngeal carcinoma (differentiated or undifferentiated type, i.e., WHO type II or type III).
  2. Staged as T1-3N1-2M0, T2-3N0M0 (stage II-III) at diagnosis (according to the 8th AJCC edition).
  3. Aged between 18-70 years.
  4. Karnofsky scale (KPS)≥70.
  5. Normal bone marrow function.
  6. Evaluated as PR or CR after 3 cycles of GP induction chemotherapy.
  7. EBV DNA copy number decreased to 0 copies/mL after 3 cycles of GP induction chemotherapy.

  8. Normal liver and kidney function:

    1. total bilirubin, AST and ALT levels of no more than 2.5 times the upper normal limit;
    2. creatinine clearance rate of at least 60 mL/min or creatinine of no more than 1.5 times the upper normal limit.
  9. Given written informed consent.

Exclusion Criteria:

  1. Histologically confirmed keratinized squamous cell carcinoma (WHO type I) or basal squamous cell carcinoma.
  2. Recurrent or metastatic nasopharyngeal carcinoma.
  3. Evaluated as SD or PD after 3 cycles of GP induction chemotherapy.
  4. EBV DNA copy number of more than 0 copies/mL after 3 cycles of GP induction chemotherapy.
  5. Pregnancy or lactation (Pregnancy tests should be considered for women in childbearing age, and effective contraception should be emphasized during treatment.)
  6. Other invasive malignant diseases in the past, other than cured basal cell skin carcinoma, squamous cell carcinoma, cervical carcinoma in situ.
  7. Primary and regional lesions have been treated with chemotherapy or surgery (except diagnostic purpose)
  8. Any severe disease, which may cause unacceptable risk factors or affect compliance with the trial, for example, unstable heart disease requiring treatment, kidney disease, chronic hepatitis, poorly controlled diabetes (fasting blood glucose > 1.5×ULN), and mental illness.

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)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Reduced dosage IMRT group
3 cycles of gemcitabin and cisplatin induction chemotherapy plus concurrent cheomtherapy with IMRT dosage of 63.6 Gy
Radiation: reduced dosage IMRT
  1. Gemcitabine plus cisplatin induction chemotherapy: gemcitabine is injected intravenously at the dose of 1000 mg/m2 on the 1st and 8th day (within 30 minutes) for 3 cycles; cisplatin is injected intravenously at the dose of 80 mg/m2 on the 1st day, for 3 cycles. 1 cycles per 3 weeks.
  2. Concurrent cisplatin chemotherapy: cisplatin is given at a dose of 100 mg/m2 via a continuous intravenous infusion during radiotherapy and starts on the 1st day of radiotherapy for 2 cycles. 1 cycles per 3 weeks.
  3. IMRT: PTVnx：63.6Gy/30Fr/2.12Gy; PTVnd：63.6Gy/30Fr/2.12Gy; PTV1：54Gy/30Fr/1.8Gy; PTV2：49.2Gy/30Fr/1.64Gy
Active Comparator: Conventional dosage IMRT group
3 cycles of gemcitabin and cisplatin induction chemotherapy plus concurrent cheomtherapy with IMRT dosage of 69.96 Gy
Radiation: conventional dosage IMRT
  1. Gemcitabine plus cisplatin induction chemotherapy: gemcitabine is injected intravenously at the dose of 1000 mg/m2 on the 1st and 8th day (within 30 minutes) for 3 cycles; cisplatin is injected intravenously at the dose of 80 mg/m2 on the 1st day, for 3 cycles. 1 cycles per 3 weeks.
  2. Concurrent cisplatin chemotherapy: cisplatin is given at a dose of 100 mg/m2 via a continuous intravenous infusion during radiotherapy and starts on the 1st day of radiotherapy for 2 cycles. 1 cycles per 3 weeks.
  3. IMRT: PTVnx：69.96Gy/33Fr/2.12Gy; PTVnd：69.96Gy/33Fr/2.12Gy; PTV1：59.4Gy/33Fr/1.8Gy; PTV2：54Gy/33Fr/1.64Gy

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Progress-free survival (PFS)
Time Frame: 3 years
Defined as time from randomization to locoregional or distant metastasis relapse or death from any cause, whichever occurred first.
3 years

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Overall Survival (OS)
Time Frame: 3 years
Defined as the time interval from randomization to death due to any cause.
3 years
Distant Metastasis-Free Survival (DMFS)
Time Frame: 3 years
Defined as the time interval from randomisation to the date of first distant metastases.
3 years
Locoregional Relapse-Free Survival (LRRFS)
Time Frame: 3 years
Defined as the time from randomisation to the date of first locoregional relapse.
3 years
Incidence of treatment related acute complications
Time Frame: up to 1 years
The proportion of patients with treatment related acute complications according to NCI-CTC5.0 criteria and RTOG criteria.
up to 1 years
Incidence of treatment related late complications
Time Frame: up to 3 years
The proportion of patients with treatment related late complications according to NCI-CTC5.0 criteria and RTOG criteria.
up to 3 years
Score of survival quality according to the EORTC Quality of Life Questionnaire (QLQ)-C30 (V3.0)
Time Frame: up to 3 years
Score of survival quality according to the EORTC Quality of Life Questionnaire (QLQ)-C30 (V3.0) before treatment, during treatment, after treatment.
up to 3 years
Score of survival quality according to the EORTC Quality of Life Questionnaire Head and Neck (The QLQ-H&N35)
Time Frame: up to 3 years
Score of survival quality according to the EORTC Quality of Life Questionnaire Head and Neck (The QLQ-H&N35) before treatment, during treatment, after treatment.
up to 3 years

Collaborators and Investigators

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

Sponsor

Sun Yat-sen University

Collaborators

Wuzhou Red Cross Hospital
Affiliated Cancer Hospital & Institute of Guangzhou Medical University
National Cancer Centre, Singapore
Zhongshan People's Hospital, Guangdong, China
Yuebei People's Hospital

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 (Actual)

August 18, 2020

Primary Completion (Anticipated)

August 1, 2026

Study Completion (Anticipated)

August 1, 2028

Study Registration Dates

First Submitted

June 24, 2020

First Submitted That Met QC Criteria

June 24, 2020

First Posted (Actual)

June 26, 2020

Study Record Updates

Last Update Posted (Actual)

September 28, 2020

Last Update Submitted That Met QC Criteria

September 24, 2020

Last Verified

September 1, 2020

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • SYSUCC-MYC-2020-1201

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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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