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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 oppdatert av: 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.

Studieoversikt

Status

Fullført

Forhold

Intervensjon / Behandling

Detaljert 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.

Studietype

Intervensjonell

Registrering (Forventet)

564

Fase

  • Fase 3

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

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

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år til 120 år (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

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

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Behandling
  • Tildeling: Randomisert

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

European Organisation for Research and Treatment of Cancer - EORTC

Etterforskere

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

Publikasjoner og nyttige lenker

Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.

Generelle publikasjoner

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart

1. juli 1996

Primær fullføring (Faktiske)

1. mai 2004

Studiet fullført

7. desember 2022

Datoer for studieregistrering

Først innsendt

1. november 1999

Først innsendt som oppfylte QC-kriteriene

26. januar 2003

Først lagt ut (Anslag)

27. januar 2003

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

9. juli 2018

Siste oppdatering sendt inn som oppfylte QC-kriteriene

6. juli 2018

Sist bekreftet

1. juli 2018

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • EORTC-24954

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Nei

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

produkt produsert i og eksportert fra USA

Nei

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