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Combination Chemotherapy Plus Radiation Therapy To Preserve the Larynx in Patients With Cancer of the Hypopharynx or Larynx

6. juli 2018 opdateret af: European Organisation for Research and Treatment of Cancer - EORTC

PHASE II STUDY ON LARYNX PRESERVATION COMPARING INDUCTION CHEMOTHERAPY AND RADIOTHERAPY VERSUS ALTERNATING CHEMO-RADIOTHERAPY IN RESECTABLE HYPOPHARYNX AND LARYNX CANCERS

RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining chemotherapy with radiation therapy may kill more tumor cells and allow doctors to preserve the part of the body where the cancer started. It is not yet known which regimen of cisplatin and fluorouracil combined with radiation therapy is more effective in treating resectable cancer of the hypopharynx or larynx.

PURPOSE: Randomized phase III trial to compare the effectiveness of two regimens of cisplatin and fluorouracil combined with radiation therapy in preserving the larynx in patients who have resectable cancer of the hypopharynx or larynx.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

OBJECTIVES:

  • Compare relapse-free survival and larynx preservation in patients with resectable hypopharyngeal or laryngeal cancer treated with sequential vs alternating cisplatin and fluorouracil and radiotherapy.
  • Compare the health-related quality of life in patients treated with these regimens.
  • Compare the cost-effectiveness of these regimens.

OUTLINE: This is a randomized, multicenter study. Patients are stratified by performance status, disease site, tumor stage, node stage, and center.

Patients are randomized to one of two treatment arms. Both groups may receive either conventional radiotherapy in single daily fractions, 5 days per week, for 7 weeks (option 1) or hyperfractionated radiotherapy in 2 daily fractions, 5 days per week, for 4-5 weeks (option 2), according to institutional policy.

  • Arm I: Patients receive cisplatin and fluorouracil every 3 weeks. Patients with a complete or partial response on day 42 receive 2 additional courses of chemotherapy followed by 7 weeks of radiotherapy beginning on day 80. After radiotherapy, patients with a complete remission enter follow-up; those with a partial remission proceed to surgery. Patients with stable or progressive disease proceed immediately to surgery with or without postoperative radiotherapy.
  • Arm II: Patients receive cisplatin and fluorouracil every 3 weeks for 4 courses. Patients treated on radiotherapy option 1 are evaluated 2 months after completion of radiotherapy; those with a complete remission enter follow-up while all others proceed to surgery. Patients treated on option 2 are evaluated on day 42; those with a partial or complete response complete chemoradiotherapy and are then evaluated and treated like option 1 patients. Patients with stable or progressive disease on day 42 proceed to surgery with or without a third course of chemotherapy on week 7.

Patients are followed every 3 months for 3 years and at least every 6 months thereafter.

PROJECTED ACCRUAL: A total of 564 patients will be accrued for this study within 4 years.

Undersøgelsestype

Interventionel

Tilmelding (Forventet)

564

Fase

  • Fase 3

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Belgien
      • Antwerp, Belgien, 2020
        • Algemeen Ziekenhuis Middelheim
      • Edegem, Belgien, B-2650
        • Universitair Ziekenhuis Antwerpen
  • Frankrig
      • Besancon, Frankrig, 25030
        • CHR de Besancon - Hopital Jean Minjoz
      • Caen, Frankrig, 14076
        • Centre Regional Francois Baclesse
      • Dijon, Frankrig, 21033
        • Centre Hospitalier Universitaire De Dijon
      • Dijon, Frankrig, 21079
        • Centre de Lutte Contre le Cancer, Georges-Francois Leclerc
      • Lille, Frankrig, 59020
        • Centre Oscar Lambret
      • Lille, Frankrig, 59037
        • Centre Hospitalier Regional et Universitaire de Lille
      • Nantes-Saint Herblain, Frankrig, 44805
        • CRLCC Nantes - Atlantique
      • Nice, Frankrig, 06189
        • Centre Antoine Lacassagne
      • Rouen, Frankrig, 76031
        • Hôpital Charles Nicolle
      • Vandoeuvre-les-Nancy, Frankrig, 54511
        • Centre Alexis Vautrin
  • Holland
      • Amsterdam, Holland, 1007 MB
        • Vrije Universiteit Medisch Centrum
      • Leiden, Holland, 2300 CA
        • Leiden University Medical Center
      • Maastricht, Holland, 6202 AZ
        • Academisch Ziekenhuis Maastricht
  • Israel
      • Haifa, Israel, 31096
        • Rambam Medical Center
  • Italien
      • Milano (Milan), Italien, 20133
        • Istituto Nazionale per lo Studio e la Cura dei Tumori
      • Monselice, Padova, Italien, 35043
        • Ospedale Civile Monselice
      • Pordenone, Italien, 33170
        • Azienda Ospedaliera "Santa Maria Degli Angeli"
  • Schweiz
      • Lausanne, Schweiz, CH-1011
        • Centre Hospitalier Universitaire Vaudois

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 120 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

DISEASE CHARACTERISTICS:

  • Histologically proven squamous cell carcinoma of the head and neck, including:

    • Stage III/IV cancer of the glottic or supraglottic larynx

      • Eligible T4 tumor defined as:

        • Bulging the valleculae
        • Bulging the hyothyroid membrane
        • Minimal thyroid cartilage invasion or suspicion of invasion on imaging

    • Stage II/III/IV cancer of the pyriform sinus or of the hypopharyngeal aspect of the aryepiglottic fold (with or without extension to postcricoid area)

      • No massive destruction of the thyroid cartilage
      • No continuity between primary tumor and a lymph node

  • Operable on first attempt (as assessed by head and neck surgeon) by classical total laryngectomy with or without partial pharyngectomy

    • No requirement for extended surgery (circumferential pharyngolaryngectomy)
    • No tumor suitable for partial (functional) surgery or requiring extended surgery that necessitates any kind of flap for closure
    • No N2c tumor unless no requirement for bilateral resection of internal jugular veins

  • Measurable or evaluable disease by panendoscopy and CT scan or MRI

    • Esophagoscopy required
    • Bronchofiberscopy recommended
  • No requirement for tracheotomy

PATIENT CHARACTERISTICS:

Age:

  • 18 and over

Performance status:

  • ECOG 0-2 OR
  • WHO 0-2

Hematopoietic:

  • WBC at least 4,000/mm^3

Hepatic:

  • Bilirubin no greater than 2.0 times normal

Renal:

  • Creatinine no greater than 1.5 mg/dL OR
  • Creatinine clearance at least 60 mL/min

Other:

  • No medical, psychological, or geographical condition that precludes study compliance
  • No serious nonmalignant systemic disease

  • No second malignancy except:

    • Carcinoma in situ of the cervix
    • Adequately treated nonmelanomatous skin cancer
  • No poor nutritional status unlikely to be restored to fair status within 3 weeks
  • No contraindication to CT scan or general anesthesia

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • No prior anticancer biologic therapy

Chemotherapy

  • No prior anticancer chemotherapy

Endocrine therapy

  • No prior anticancer endocrine therapy

Radiotherapy

  • No prior anticancer radiotherapy

Surgery

  • See Disease Characteristics

Other

  • No other prior anticancer therapy

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

European Organisation for Research and Treatment of Cancer - EORTC

Efterforskere

  • Studiestol: Jean-Louis Lefebvre, MD, Centre Oscar Lambret
  • Studiestol: Jean-Claude Horiot, MD, PhD, Centre Georges Francois Leclerc

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. juli 1996

Primær færdiggørelse (Faktiske)

1. maj 2004

Studieafslutning

7. december 2022

Datoer for studieregistrering

Først indsendt

1. november 1999

Først indsendt, der opfyldte QC-kriterier

26. januar 2003

Først opslået (Skøn)

27. januar 2003

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

9. juli 2018

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

6. juli 2018

Sidst verificeret

1. juli 2018

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • EORTC-24954

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

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Ingen

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Ingen

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Betingelser

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Placeringer

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