PET/CT Scan-Guided Watchful Waiting or Neck Dissection of Locally Advanced Lymph Node Metastases in Treating Patients Undergoing Chemotherapy and Radiation Therapy for Primary Head And Neck Cancer
A Multi-centre Randomised Phase III Trial Comparing PET-CT Guided Watch and Wait Policy Versus Planned Neck Dissection for the Management of Locally Advanced (N2/N3) Nodal Metastases in Patients With Head and Neck Squamous Cancer
RATIONALE: Imaging procedures, such as PET/CT scan, produce pictures of areas inside the body and may help doctors detect residual disease and plan the best treatment. Neck dissection is surgery to remove lymph nodes and other tissues in the neck. It is not yet known whether a neck dissection should always be performed in treating patients with head and neck cancer.
PURPOSE: This randomized phase III trial is studying PET/CT scan-guided watchful waiting compared with neck dissection of locally advanced lymph node metastases in treating patients who are undergoing chemotherapy and radiation therapy for primary head and neck cancer.
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
OBJECTIVES:
- To compare the efficacy, in terms of overall survival, disease-specific survival, recurrence, quality of life, and cost-effectiveness, of a PET/CT scan-guided watch and wait policy with the current practice of planned neck dissection in the management of advanced (N2 or N3) nodal metastases in patients with primary head and neck squamous cell carcinoma undergoing chemoradiotherapy.
- To assess the predictive value of PET/CT scanning in detecting persistent or residual disease in the primary site.
OUTLINE: This is a multicenter study. Patients are stratified according to center, chemotherapy schedule (concurrent platinum vs concurrent cetuximab vs neoadjuvant and concurrent platinum vs neoadjuvant docetaxel, platinum, and fluorouracil with concurrent platinum), T stage (T1-T2 vs T3-T4), and N stage (N2a-N2b vs N2c-N3). Patients are randomized to 1 of 2 treatment arms.
- Arm I: Patients receive standard concurrent chemoradiotherapy (CRT). Patients undergo PET/CT scan at 9-13 weeks after completion of CRT. Patients with complete response of primary site undergo neck dissection within 4 weeks.
- Arm II: Patients undergo neck dissection and then receive standard CRT. Patients undergo PET/CT scan at 9-13 weeks after completion of CRT.
Patients are assessed periodically for quality-of-life. Tissue and blood samples collected periodically are stored for future research.
After completion of study treatment, patients are followed monthly for 1 year and then bimonthly for 1 year.
Studietype
Inschrijving (Verwacht)
Fase
- Fase 3
Contacten en locaties
Studie Locaties
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England
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Coventry, England, Verenigd Koninkrijk, CV4 7AL
- Werving
- Warwick Medical School Clinical Trials Unit
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Contact:
- Hisham Mehanna, MD
- Telefoonnummer: 44-247-696-5606
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
DISEASE CHARACTERISTICS:
Histologically confirmed head and neck squamous cell carcinoma (HNSCC), including any of the following subtypes:
- Oropharyngeal
- Laryngeal
- Oral
- Hypopharyngeal
- No primary nasopharyngeal carcinoma
Must have clinical and CT/MRI evidence of nodal metastases staged N2 (a, b, or c) or N3
- No occult nodal metastasis (i.e., large nodal metastasis but no proven primary site on clinical assessment)
- No N1 nodal metastasis
Planning to receive curative radical concurrent chemoradiotherapy (approved by study) for primary disease
- Patients undergoing neoadjuvant chemotherapy followed by concurrent chemoradiotherapy are eligible
- Able to undergo neck dissection surgery
- No current resection for primary tumor planned (e.g., resection of tonsil or base of tongue with flap reconstruction [diagnostic tonsillectomy allowed])
- No distant metastases to chest, liver, bones, or other sites
PATIENT CHARACTERISTICS:
- Not pregnant
- No other cancer diagnosis within the past 5 years except basal cell carcinoma or cervical carcinoma in situ
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- No prior treatment for HNSCC
- No concurrent neoadjuvant chemoradiotherapy without concurrent chemotherapy
- No concurrent adjuvant chemotherapy
- No concurrent chemoradiotherapy for palliative purposes
- No concurrent radiotherapy alone
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Diagnostisch
- Toewijzing: Gerandomiseerd
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
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Experimenteel: Arm I
Patients receive standard concurrent chemoradiotherapy (CRT).
Patients undergo PET/CT scan at 9-13 weeks after completion of CRT.
Patients with complete response of primary site undergo neck dissection within 4 weeks.
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Patients undergo PET/CT scan
Patients undergo neck dissection
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Actieve vergelijker: Arm II
Patients undergo neck dissection and receive standard concurrent CRT.
Patients undergo PET/CT scan at 9-13 weeks after completion of CRT.
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Patients undergo PET/CT scan
Patients undergo neck dissection
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
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Totale overleving na 2 jaar
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Health economics using quality adjusted life years
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Secundaire uitkomstmaten
Uitkomstmaat |
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Kwaliteit van het leven
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Complicatie tarieven
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Ziektespecifieke overleving
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Recurrence and local control in neck
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Utility cost
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Accuracy of PET-CT scanning for assessing primary tumor
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Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Hoofdonderzoeker: Hisham Mehanna, MD, Warwick Medical School
Studie record data
Bestudeer belangrijke data
Studie start
Primaire voltooiing (Verwacht)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
Updates van studierecords
Laatste update geplaatst (Schatting)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
- stadium III plaveiselcelcarcinoom van de lip en mondholte
- stadium III verrukeus carcinoom van de mondholte
- stadium III plaveiselcelcarcinoom van de orofarynx
- stadium III plaveiselcelcarcinoom van de hypofarynx
- stadium III plaveiselcelcarcinoom van het strottenhoofd
- stadium III verrukeus carcinoom van het strottenhoofd
- stadium I plaveiselcelcarcinoom van de lip en mondholte
- stadium II plaveiselcelcarcinoom van de lip en mondholte
- stadium I plaveiselcelcarcinoom van de hypofarynx
- stadium I plaveiselcelcarcinoom van het strottenhoofd
- stadium I plaveiselcelcarcinoom van de orofarynx
- stadium II plaveiselcelcarcinoom van de hypofarynx
- stadium II plaveiselcelcarcinoom van het strottenhoofd
- stadium II plaveiselcelcarcinoom van de orofarynx
- tong kanker
- stadium I verrukeus carcinoom van de mondholte
- stadium II verrukeus carcinoom van de mondholte
- stadium I verrukeus carcinoom van het strottenhoofd
- stadium II verrukeus carcinoom van het strottenhoofd
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- CDR0000597895
- WMS-PET-NECK
- ISRCTN13735240
- EU-20856
- MREC-07/Q1604/35
- UKCRN ID: 3799
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