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Impacted Tooth Management and Osteoradionecrosis Risk in NPC

2026年8月10日 更新者：min kang、First Affiliated Hospital of Guangxi Medical University

Omission of Prophylactic Impacted Tooth Extraction and Risk of Jaw Osteoradionecrosis in Nasopharyngeal Carcinoma: A Multicenter, Noninferiority, Open-Label, Randomized Controlled Trial

This multicenter, randomized controlled trial is designed to determine whether omitting prophylactic extraction of impacted teeth before radiotherapy leads to an unacceptably higher risk of jaw osteoradionecrosis (JORN) compared with conventional prophylactic extraction in patients with non-metastatic nasopharyngeal carcinoma (NPC). JORN is a condition in which jawbone tissue is damaged and fails to heal properly after radiotherapy.

A total of 536 eligible participants with at least one impacted tooth will be randomly assigned to either omit prophylactic extraction of impacted teeth before radiotherapy or undergo conventional prophylactic extraction before radiotherapy. All participants will receive standard curative-intent intensity-modulated radiotherapy (IMRT), with chemotherapy administered when indicated according to the study protocol.

Participants will be followed for up to 5 years. The primary outcome is the incidence of JORN within 2 years after completion of radiotherapy. Secondary outcomes include longer-term incidence of JORN, overall survival, locoregional relapse-free survival, distant metastasis-free survival, quality of life, and treatment-related toxicities.

調査の概要

状態

まだ募集していません

条件

介入・治療

詳細な説明

Prophylactic extraction of impacted teeth before radiotherapy is performed to reduce the potential risk of dental complications and jaw osteoradionecrosis after treatment. However, whether prophylactic extraction is necessary for impacted teeth without indications for therapeutic extraction remains uncertain.

This study is designed to evaluate whether omission of prophylactic impacted tooth extraction is noninferior to conventional prophylactic extraction with respect to the risk of jaw osteoradionecrosis in patients with non-metastatic nasopharyngeal carcinoma undergoing curative-intent radiotherapy. The study will also assess the long-term clinical outcomes and safety of this tooth-management strategy.

研究の種類

介入

入学 (推定)

536

段階

  • 適用できない

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究連絡先

研究連絡先のバックアップ

研究場所

  • 中国
    • Guangxi
      • Baise City、Guangxi、中国、533000
        • Affiliated Hospital of Youjiang Medical University for Nationalities
        • コンタクト：
      • Beihai、Guangxi、中国、536000
        • Beihai People's Hospital
        • コンタクト：
      • Guigang、Guangxi、中国、537100
        • Guigang People's Hospital
        • コンタクト：
      • Guilin、Guangxi、中国、541001
        • The Affiliated Hospital of Guilin Medical University
        • コンタクト：
      • Liuzhou、Guangxi、中国、545006
        • Liuzhou People's Hospital
        • コンタクト：
      • Liuzhou、Guangxi、中国、545007
        • Liuzhou Workers' Hospital
        • コンタクト：
      • Nanning、Guangxi、中国、530021
        • The First Affiliated Hospital of Guangxi Medical University
        • コンタクト：
      • Nanning、Guangxi、中国、530000
        • The People's Hospital of Guangxi Zhuang Autonomous Region
        • コンタクト：
      • Nanning、Guangxi、中国、530199
        • Wuming Hospital Affiliated to Guangxi Medical University
        • コンタクト：
      • Wuzhou、Guangxi、中国、543002
        • Wuzhou Red Cross Hospital
        • コンタクト：
      • Yulin、Guangxi、中国、537000
        • The First People's Hospital of Yulin
        • コンタクト：
          • Leifeng Liang, MD

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

  • 大人
  • 高齢者

健康ボランティアの受け入れ

いいえ

説明

Inclusion Criteria:

  • Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.
  • Age 18-75 years, regardless of sex.
  • Histologically confirmed non-keratinizing nasopharyngeal carcinoma, including differentiated or undifferentiated subtype (WHO type II or III).
  • Newly diagnosed, previously untreated nasopharyngeal carcinoma with stage T1-4N0-3M0 according to the 9th edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system.
  • Presence of permanent dentition with at least one impacted third molar.
  • Adequate bone marrow function, defined as white blood cell count ≥4.0 × 10⁹/L, platelet count ≥100 × 10⁹/L, and hemoglobin ≥90 g/L.
  • Adequate hepatic function, defined as alanine aminotransferase and aspartate aminotransferase ≤2.5 × the upper limit of normal (ULN), and total bilirubin ≤1.5 × ULN.
  • Adequate renal function, defined as blood urea nitrogen and serum creatinine ≤1.5 × ULN, or creatinine clearance ≥60 mL/min.
  • Coagulation function within normal limits.
  • Written informed consent provided, with willingness and ability to comply with study visits, treatment plans, laboratory assessments, and other study procedures.

Exclusion Criteria:

  • Histopathological diagnosis other than WHO type II or III nasopharyngeal carcinoma.
  • Impacted third molars with recurrent pericoronitis or inflammation due to incomplete eruption.
  • Fully erupted third molars with dental caries involving the pulp.
  • Impacted third molars with radiographic evidence of periapical or periodontal inflammation.
  • Third molars completely impacted within the jawbone.
  • History of active malignancy or other malignant tumors diagnosed within the previous 5 years, except for adequately treated non-melanoma skin cancer or carcinoma in situ.
  • Previous chemotherapy, surgery (except diagnostic procedures), radiotherapy, or other antitumor treatment for nasopharyngeal carcinoma or cervical lesions.
  • Patients receiving palliative treatment.
  • Pregnant or breastfeeding women.
  • Severe uncontrolled cardiovascular or cerebrovascular diseases.
  • Severe hepatic or renal dysfunction.
  • Uncontrolled diabetes mellitus.
  • Severe osteoporosis, medication-related osteonecrosis/osteomyelitis, or chronic diseases requiring long-term systemic corticosteroid therapy.
  • Other severe chronic debilitating diseases that may increase study risk or affect study compliance.
  • History of drug abuse or alcohol dependence.
  • Uncontrolled psychiatric disorders or inability to provide legally valid informed consent.
  • Positive hepatitis B surface antigen (HBsAg) with hepatitis B virus DNA >1,000 copies/mL.
  • Active hepatitis C virus infection (positive HCV RNA).
  • Human immunodeficiency virus (HIV) infection or diagnosis of acquired immunodeficiency syndrome (AIDS).
  • Active tuberculosis within the previous 1 year.
  • History of active tuberculosis more than 1 year previously without documented completion of standard anti-tuberculosis treatment.
  • Any other medical, psychological, social, or laboratory condition that, in the investigator's judgment, may compromise participant safety, interfere with study procedures, affect protocol compliance, or result in premature withdrawal from the study.
  • Refusal or inability to provide written informed consent.

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか？

デザインの詳細

  • 主な目的：防止
  • 割り当て：ランダム化
  • 介入モデル：並列代入
  • マスキング：なし（オープンラベル）

武器と介入

参加者グループ / アーム
介入・治療
実験的：Omission of Prophylactic Extraction Group
Participants assigned to this group will not undergo prophylactic extraction of impacted teeth before radiotherapy.
他の：Omission of Prophylactic Impacted Tooth Extraction
Participants will not undergo prophylactic extraction of eligible impacted teeth before radiotherapy.
アクティブコンパレータ：Conventional Prophylactic Extraction Group
Participants assigned to this group will undergo conventional prophylactic extraction of impacted teeth before radiotherapy.
手順：Prophylactic Impacted Tooth Extraction
Participants will undergo prophylactic extraction of eligible impacted teeth before radiotherapy according to the study protocol.

この研究は何を測定していますか？

主要な結果の測定

結果測定
メジャーの説明
時間枠
2-Year Cumulative Incidence of Jaw Osteoradionecrosis
時間枠：Within 24 months after completion of radiotherapy
The cumulative incidence of jaw osteoradionecrosis (JORN) within 24 months after completion of radiotherapy will be estimated and compared between the two treatment groups.
Within 24 months after completion of radiotherapy

二次結果の測定

結果測定
メジャーの説明
時間枠
2-Year Overall Survival
時間枠：24 months after randomization
The 2-year overall survival rate will be estimated as the probability of remaining alive at 24 months after randomization and compared between the two treatment groups.
24 months after randomization
2-Year Event-Free Survival
時間枠：24 months after randomization
The 2-year event-free survival rate will be estimated as the probability of remaining free from local recurrence, regional recurrence, distant metastasis, or death from any cause at 24 months after randomization and compared between the two treatment groups.
24 months after randomization
2-Year Local Relapse-Free Survival
時間枠：24 months after randomization
The 2-year local relapse-free survival rate will be estimated as the probability of remaining free from local recurrence or death at 24 months after randomization and compared between the two treatment groups.
24 months after randomization
2-Year Regional Relapse-Free Survival
時間枠：24 months after randomization
The 2-year regional relapse-free survival rate will be estimated as the probability of remaining free from regional recurrence or death at 24 months after randomization and compared between the two treatment groups.
24 months after randomization
2-Year Distant Metastasis-Free Survival
時間枠：24 months after randomization
The 2-year distant metastasis-free survival rate will be estimated as the probability of remaining free from distant metastasis or death from any cause at 24 months after randomization and compared between the two treatment groups.
24 months after randomization
Quality of Life Assessed by the EORTC QLQ-C30
時間枠：Baseline and 3, 6, 12, and 24 months after completion of radiotherapy
Quality of life will be assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Scores are transformed to a 0-100 scale. Higher scores on the functional scales and global health status/quality-of-life scale indicate better functioning or quality of life, whereas higher scores on the symptom scales indicate greater symptom burden.
Baseline and 3, 6, 12, and 24 months after completion of radiotherapy
Head and Neck Cancer-Specific Quality of Life Assessed by the EORTC QLQ-H&N35
時間枠：Baseline and 3, 6, 12, and 24 months after completion of radiotherapy
Head and neck cancer-specific symptoms and quality-of-life problems will be assessed using the EORTC QLQ-H&N35 questionnaire. Scores are transformed to a 0-100 scale, with higher scores indicating greater symptom burden or more severe problems.
Baseline and 3, 6, 12, and 24 months after completion of radiotherapy
Acute Treatment-Related Toxicities
時間枠：From initiation of treatment through 90 days after completion of radiotherapy
The incidence and severity of acute treatment-related toxicities will be assessed and compared between the two treatment groups. Toxicities will be graded according to the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0, as applicable.
From initiation of treatment through 90 days after completion of radiotherapy
5-Year Cumulative Incidence of Jaw Osteoradionecrosis
時間枠：Within 60 months after completion of radiotherapy
The cumulative incidence of jaw osteoradionecrosis (JORN) within 60 months after completion of radiotherapy will be estimated and compared between the two treatment groups.
Within 60 months after completion of radiotherapy
5-Year Overall Survival
時間枠：60 months after randomization
The 5-year overall survival rate will be estimated as the probability of remaining alive at 60 months after randomization and compared between the two treatment groups.
60 months after randomization
5-Year Event-Free Survival
時間枠：60 months after randomization
The 5-year event-free survival rate will be estimated as the probability of remaining free from local recurrence, regional recurrence, distant metastasis, or death from any cause at 60 months after randomization and compared between the two treatment groups.
60 months after randomization
5-Year Local Relapse-Free Survival
時間枠：60 months after randomization
The 5-year local relapse-free survival rate will be estimated as the probability of remaining free from local recurrence or death from any cause at 60 months after randomization and compared between the two treatment groups.
60 months after randomization
5-Year Regional Relapse-Free Survival
時間枠：60 months after randomization
The 5-year regional relapse-free survival rate will be estimated as the probability of remaining free from regional recurrence or death from any cause at 60 months after randomization and compared between the two treatment groups.
60 months after randomization
5-Year Distant Metastasis-Free Survival
時間枠：60 months after randomization
The 5-year distant metastasis-free survival rate will be estimated as the probability of remaining free from distant metastasis or death from any cause at 60 months after randomization and compared between the two treatment groups.
60 months after randomization
Late Treatment-Related Toxicities
時間枠：From more than 90 days through 60 months after completion of radiotherapy
The incidence and severity of late treatment-related toxicities will be assessed and compared between the two treatment groups using the RTOG/EORTC late radiation morbidity scoring criteria and CTCAE version 5.0, as applicable.
From more than 90 days through 60 months after completion of radiotherapy

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

First Affiliated Hospital of Guangxi Medical University

協力者

Wuzhou Red Cross Hospital
LiuZhou People's Hospital
First People's Hospital of Yulin
Guigang People's Hospital
Affiliated Hospital of Guilin University
People's Hospital of Guangxi Zhuang Autonomous Region
Youjiang Medical College for Nationalities
Liuzhou Workers' Hospital

捜査官

  • 主任研究者：Min Kang, MD、First Affiliated Hospital of Guangxi Medical University

出版物と役立つリンク

研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。

一般刊行物

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (推定)

2026年8月30日

一次修了 (推定)

2029年11月30日

研究の完了 (推定)

2032年11月30日

試験登録日

最初に提出

2026年3月26日

QC基準を満たした最初の提出物

2026年8月10日

最初の投稿 (実際)

2026年8月14日

学習記録の更新

投稿された最後の更新 (実際)

2026年8月14日

QC基準を満たした最後の更新が送信されました

2026年8月10日

最終確認日

2026年8月1日

詳しくは

本研究に関する用語

キーワード

追加の関連 MeSH 用語

その他の研究ID番号

  • FirstGuangxiMU02

個々の参加者データ (IPD) の計画

個々の参加者データ (IPD) を共有する予定はありますか?

いいえ

IPD プランの説明

Individual participant data (IPD) will not be shared because the study data are subject to institutional, ethical, and participant confidentiality requirements.

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