Salivary Gland Surgery Before Radiation Therapy in Preventing Radiation-Caused Xerostomia in Patients With Head and Neck Cancer
2019年2月1日 更新者：Radiation Therapy Oncology Group
A Phase II Study Of Submandibular Salivary Gland Transfer To The Submental Space Prior To Start Of Radiation Treatment For Prevention Of Radiation-Induced Xerostomia In Head And Neck Cancer Patients
RATIONALE: Moving a salivary gland out of the area that will undergo radiation therapy may protect the gland from side effects of radiation therapy and may prevent xerostomia (dry mouth).
PURPOSE: Phase II trial to study the effectiveness of salivary gland surgery in preventing xerostomia in patients who are undergoing radiation therapy for head and neck cancer.
研究概览
详细说明
OBJECTIVES:
- Determine the reproducibility of the surgical technique of submandibular salivary gland transfer in patients with head and neck cancer.
- Determine the rate and severity of radiation-induced xerostomia after this surgery in these patients.
- Determine the pattern of recurrence, disease-free survival, and overall survival of patients treated with this surgery followed by radiotherapy.
- Determine the quality of life of patients treated with this regimen.
OUTLINE: This is a multicenter study.
Patients undergo surgical transfer of the submandibular salivary gland to the submental space.
Within 4-6 weeks after surgery, patients undergo radiotherapy once daily, 5 days a week for 5 ½ to 7 weeks in the absence of disease progression or unacceptable toxicity.
Salivary scans are performed before surgery, at 2-3 weeks after surgery, and then at 6 months from the start of radiotherapy.
Quality of life is assessed at baseline and at 3, 6, and 12 months from the start of radiotherapy.
Patients are followed every 3 months for 2 years and then every 6 months for 3 years and then annually.
PROJECTED ACCRUAL: A total of 11-48 patients will be accrued for this study within 1.6 years.
研究类型
介入性
注册 (实际的)
49
阶段
- 阶段2
联系人和位置
本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。
学习地点
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Alberta
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Edmonton、Alberta、加拿大、T6G 1Z2
- Cross Cancer Institute at University of Alberta
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Newfoundland and Labrador
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St. John's、Newfoundland and Labrador、加拿大、A1B 3V6
- Doctor H. Bliss Murphy Cancer Centre
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Quebec
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Quebec City、Quebec、加拿大、G1R 2J6
- Centre Hospitalier Universitaire de Quebec
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Florida
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Gainesville、Florida、美国、32610-0232
- University of Florida Shands Cancer Center
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Miami、Florida、美国、33136
- University of Miami Sylvester Comprehensive Cancer Center - Miami
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Illinois
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Springfield、Illinois、美国、62702
- Cancer Institute at St. John's Hospital
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Michigan
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Detroit、Michigan、美国、48202
- Josephine Ford Cancer Center at Henry Ford Hospital
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Ohio
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Columbus、Ohio、美国、43210-1240
- Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center
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South Carolina
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Charleston、South Carolina、美国、29425
- Hollings Cancer Center at Medical University of South Carolina
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Texas
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Houston、Texas、美国、77030-4009
- M. D. Anderson Cancer Center at University of Texas
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Wisconsin
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Milwaukee、Wisconsin、美国、53226
- Medical College of Wisconsin Cancer Center
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Milwaukee、Wisconsin、美国、53295
- Veterans Affairs Medical Center - Milwaukee
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参与标准
研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
适合学习的年龄
18年 及以上 (成人、年长者)
接受健康志愿者
不
有资格学习的性别
全部
描述
DISEASE CHARACTERISTICS:
One of the following diagnoses:
- Histologically confirmed, previously untreated squamous cell carcinoma of the oropharynx, hypopharynx, or larynx
- Head and neck cancer of unknown primary with unilateral metastases to the neck nodes
- No N3 disease
- No carcinoma of the oral cavity or nasopharynx
- No bilateral neck node involvement
- No suspicious neck node on the contralateral neck or the side chosen for salivary gland transfer by CT scan or MRI
- No pre-epiglottic space involvement
- No involvement of level 1 nodes on either side of the neck
- No salivary gland malignancy
- No recurrent disease
PATIENT CHARACTERISTICS:
Age
- At least 18 years old
Performance status
- Zubrod 0-1
Life expectancy
- Not specified
Hematopoietic
- Hemoglobin at least 10 g/dL
Hepatic
- Not specified
Renal
- Not specified
Other
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- No salivary gland disease (e.g., Sjögren's syndrome)
- No other malignancy within the past 3 years except basal cell or squamous cell skin cancer
PRIOR CONCURRENT THERAPY:
Biologic therapy
- Not specified
Chemotherapy
- More than 3 years since prior chemotherapy
- No prior or concurrent neoadjuvant chemotherapy
- Concurrent adjuvant chemoradiotherapy (in addition to study radiotherapy) allowed
Endocrine therapy
- Not specified
Radiotherapy
- See Chemotherapy
- No prior radiotherapy to the head and neck
- No concurrent intensity-modulated radiotherapy
Surgery
- Not specified
Other
- No concurrent cholinergic drugs
- No concurrent anti-cholinergic drugs
- No concurrent tricyclic drugs
- No concurrent prophylactic amifostine or pilocarpine during and for at least 3 months after completion of study radiotherapy
学习计划
本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。
研究是如何设计的？
设计细节
- 主要用途：支持治疗
- 分配：不适用
- 介入模型：单组作业
- 屏蔽：无（打开标签）
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
|
实验性的：Surgery + Transfer + Radiation
Submandibular salivary gland transfer at the time of surgery for the primary tumor and neck nodes followed by post-operative radiation therapy.
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Seikaly and Jha method of submandibular salivary gland transfer at the time of surgery for the primary tumor and neck nodes on Day 1
Dose ranging from 54-70 Gy over 5.5-7 weeks, at 2.0 Gy/fraction.
Starts within 4-6 weeks of surgery.
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研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Number of Patients Scored as Having the Surgical Technique of Submandibular Salivary Gland Transfer Performed "Per Protocol"
大体时间：At the time of the submandibular salivary gland transfer
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Surgery will be scored as "per protocol prescription" if scored as such by both central reviewers- the Study Chair and the Radiation Therapy Oncology Group Head and Neck Committee Surgical Chair.
If 21 or more of 43 subjects are scored as having surgery "per protocol prescription", then the technique will be considered reproducible with 80% power and 5% type I error using Simon's two stage design with unacceptable/acceptable rates set at 60%/80%.
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At the time of the submandibular salivary gland transfer
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Percentage of Patients With Acute Xerostomia
大体时间：From start of treatment to 90 days
|
The proportion of patients who experience grade 2 or higher xerostomia or start amifostine and/or pilocarpine within 90 days of the start of radiation therapy.
A proportion less than or equal to 51% would be considered acceptable based on the results of the U.S. Bioscience phase III amifostine trial (this trial preceded FDAAA requirements).
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From start of treatment to 90 days
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Percentage of Patients With Normal Functioning Transferred Submandibular Gland
大体时间：Pre-surgery, post-surgery (4-6 weeks), post radiation therapy (10-13 weeks)
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Salivary gland functioning classified as "Non-functioning", "Minimal function", "Well-functioning but some impairment", "Normal functioning", or "Other" is determined by central review of scintigraphy scans using sodium pertechnetate (Na-99mTcO4-) with a sialagogue (lemon juice) administered halfway through the study to determine if secretory function is maintained.
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Pre-surgery, post-surgery (4-6 weeks), post radiation therapy (10-13 weeks)
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Change From Baseline to One Year in Total Score on the Modified University of Washington Head and Neck Symptom Questionnaire
大体时间：Baseline and one year
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The University of Washington Head and Neck Symptom Questionnaire, also referred to as the University of Washington Health Related Quality of Life tool (UW-QOL) was modified for use by the Radiation Therapy Oncology Group (RTOG).
The resulting UW-QOL-RTOG modification is a valid tool that can be used to assess symptom burden of head and neck cancer patients receiving radiation therapy or those who have recently completed radiation.
The UW-QOL-RTOG modification consists of 15 items with response options ranging from 10-50, in multiples of 10.
That is, the lowest symptom burden is rated as 10, while the highest symptom burden is rated as 50.
The individual item scores are averaged to obtain the final score which also ranges from 10 to 50.
This scoring results in a lower score indicating greater HR-QOL; and conversely, higher scores indicating lower health-related quality of life (HR-QOL).
Change = baseline score - one year score, such that a positive change score indicates improvement.
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Baseline and one year
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Percentage of Patients Experiencing Facial Edema Following Surgery
大体时间：From surgery to 30 days after surgery
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Facial edema was noted as present or absent following surgery.
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From surgery to 30 days after surgery
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Percentage of Patients Experiencing Acute Grade 3-4 Toxicity Definitely, Probably, or Possibly Related to Radiation Therapy or Chemotherapy
大体时间：From start of radiation therapy to 90 days
|
Adverse events are graded using the National Cancer Institute (NCI) Common Toxicity Criteria (CTC) v2.0.
Grade refers to the severity of the toxicity by assigning Grades 1 through 5 with unique clinical descriptions of severity for each toxicity based on this general guideline: Grade 1 Mild, Grade 2 Moderate, Grade 3 Severe, Grade 4 Life-threatening or disabling, Grade 5 Death related to toxicity.
"Acute" refers to toxicities occurring less than or equal to 90 days from the start of radiation therapy.
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From start of radiation therapy to 90 days
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Percentage of Patients Experiencing Late Grade 3-4 Toxicity Definitely, Probably, or Possibly Related to Radiation Therapy
大体时间：From 91 days from start of radiation therapy to last follow-up. Maximum follow-up at time of analysis was 5.6 years.
|
Adverse events are graded using the National Cancer Institute (NCI) Common Toxicity Criteria (CTC) v2.0.
Grade refers to the severity of the toxicity by assigning Grades 1 through 5 with unique clinical descriptions of severity for each toxicity based on this general guideline: Grade 1 Mild, Grade 2 Moderate, Grade 3 Severe, Grade 4 Life-threatening or disabling, Grade 5 Death related to toxicity.
"Late" refers to toxicities occurring at least 91 days from the start of radiation therapy.
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From 91 days from start of radiation therapy to last follow-up. Maximum follow-up at time of analysis was 5.6 years.
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Disease-free Survival Rate at 2 Years
大体时间：From registration to two years
|
Failure was defined as local, regional, or distant recurrence/progression, second primary tumor, or death due to any cause.
Disease-free survival time is defined as time from registration to the the date of failure or last known follow-up (censored).
Disease-free survival rate is estimated using the kaplan-meier method.
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From registration to two years
|
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Overall Survival Rate at 2 Years
大体时间：From registration to two years
|
Failure was defined as death due to any cause.
Survival time is defined as time from registration to the the date of failure or last known follow-up (censored).
Survival rate is estimated using the kaplan-meier method.
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From registration to two years
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合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
调查人员
- 学习椅：Naresh Jha, MBBS、Cross Cancer Institute at University of Alberta
出版物和有用的链接
负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。
研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始
2003年8月1日
初级完成 (实际的)
2008年1月1日
研究完成 (实际的)
2016年12月1日
研究注册日期
首次提交
2003年9月10日
首先提交符合 QC 标准的
2003年9月10日
首次发布 (估计)
2003年9月11日
研究记录更新
最后更新发布 (实际的)
2019年2月5日
上次提交的符合 QC 标准的更新
2019年2月1日
最后验证
2019年1月1日
更多信息
与本研究相关的术语
关键字
其他研究编号
- RTOG-0244
- CDR0000287213
此信息直接从 clinicaltrials.gov 网站检索，没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求，请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改，我们的网站上也会自动更新.