Comparison of Elective Lymph Node Treatment Versus Clinical Observation in the Absence of Palpable Lymph Nodes for High Risk Skin Squamous Cell Carcinoma (SCC)
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| ClinicalTrials.gov Identifier: NCT01252329 |
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Recruitment Status :
Terminated
(insufficient recruitment)
First Posted : December 2, 2010
Last Update Posted : October 24, 2017
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Sponsor:
University of Pittsburgh
Information provided by (Responsible Party):
John Zitelli, University of Pittsburgh
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Brief Summary:
This study will evaluate if there is a difference in survival between elective treatment of draining lymph nodes vs. clinical nodal observation in patients undergoing Mohs surgery for high risk skin squamous cell carcinoma of the head and neck who have a normal lymph node exam. Each treatment arm is accepted as a current standard of care, and the objective is to compare outcomes between the two arms.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| High Risk Cutaneous Squamous Cell Carcinoma | Procedure: elective lymph node dissection | Not Applicable |
This is a prospective, randomized, non-blinded, controlled trial of high risk head and neck cutaneous squamous cell carcinomas which will compare specific outcomes between two treatment arms. Subjects are eligible patients who are sent to Zitelli & Brodland PC for Mohs micrographic surgery of tumors that meet our high risk criteria. These patients with clinically-negative lymph node exams will either enter into the arm of nodal observation or the arm of elective management of the neck, which is currently the standard protocol per the UPMC ENT department. The patients in the observation arm will have evaluation and treatment of their lymph nodes if an abnormality is detected clinically. The primary endpoint is disease-specific survival. Secondary endpoints will include overall and disease-free survival, complications, and quality of life measures for each arm.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 29 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | High Risk Cutaneous Squamous Cell Carcinoma Treated With Mohs Surgery Randomized to Elective Management of the Draining Lymph Nodes vs. Periodic Clinical Nodal Observation |
| Study Start Date : | April 2011 |
| Actual Primary Completion Date : | July 14, 2014 |
| Actual Study Completion Date : | July 14, 2014 |
| Arm | Intervention/treatment |
|---|---|
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Active Comparator: Elective lymph node treatment arm
Patients entering this arm will undergo selective nodal dissection of the draining lymph nodes with subsequent radiation and/or chemotherapy if indicated.
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Procedure: elective lymph node dissection
This entails selective lymph node dissection in patients with negative lymph node exams. The nodes dissected are those that drain from the high risk cutaneous squamous cell cancer. Subsequent radiation and/or chemotherapy may be administered in a small percentage of subjects, depending on the result of the neck dissection. |
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No Intervention: Clinical observation arm
Patients who enter into this arm will undergo regular, periodic clinical nodal observation with subsequent evaluation and treatment if indicated upon discovery of a palpable lymph node.
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Primary Outcome Measures :
- Disease-specific survival [ Time Frame: 5 years ]
Secondary Outcome Measures :
- Overall survival [ Time Frame: 5 years ]
- Disease-free survival [ Time Frame: 5 years ]
- Complications [ Time Frame: 5 years ]This refers to any adverse event or side effect related to any of the study interventions.
- quality of life [ Time Frame: 5 years ]This refers to quality of life measured with a standard questionnaire. The two arms will be compared with respect to their differences (if any) in quality of life.
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Criteria
Inclusion Criteria: Major criterion and at least one minor criteria
- Major criterion: > 6 mm depth of invasion
- Minor criteria (one or more):
- Greater than 2cm diameter
- Recurrent (prior Mohs, wide local excision, electrodesiccation and curettage, topical imiquimod or 5 fluorouracil, cryotherapy or photodynamic therapy)
- High risk location: any portion of cutaneous lip, ear, temple, scalp
- Immunosuppressed host (organ transplant recipient or chronic lymphocytic leukemia)
- Perineural invasion (yes/no; nerve involved must be greater than 0.1mm)
- Direct involvement of subcutaneous tissue (Clark's V), muscle, cartilage,or bone
Exclusion Criteria:
- Satellite metastases
- Clinically abnormal lymph node exam
- Location other than head or neck
- Exclusively mucosal squamous cell carcinoma
- Previous head and neck radiation
- In situ disease, keratoacanthoma subtypes, metatypical or collision tumors
- Inability of subject to give written informed consent
- Pregnancy
Information from the National Library of Medicine
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01252329
Locations
| United States, Pennsylvania | |
| UPMC Department of Otolaryngology | |
| Pittsburgh, Pennsylvania, United States, 15213 | |
| Zitelli & Brodland PC | |
| Pittsburgh, Pennsylvania, United States, 15232 | |
Sponsors and Collaborators
University of Pittsburgh
Investigators
| Principal Investigator: | John A Zitelli, MD | Zitelli & Brodland PC; UPMC Departments of Dermatology and Otolaryngology | |
| Principal Investigator: | David G Brodland, MD | Zitelli & Brodland PC; UPMC Departments of Dermatology and Otolaryngology | |
| Principal Investigator: | Uma Duvvuri, MD,PhD | UPMC Department of Otolaryngology | |
| Principal Investigator: | Christine H Weinberger, MD | Zitelli & Brodland PC |
| Responsible Party: | John Zitelli, John A Zitelli, MD, University of Pittsburgh |
| ClinicalTrials.gov Identifier: | NCT01252329 History of Changes |
| Other Study ID Numbers: |
PRO10030462 |
| First Posted: | December 2, 2010 Key Record Dates |
| Last Update Posted: | October 24, 2017 |
| Last Verified: | October 2017 |
Keywords provided by John Zitelli, University of Pittsburgh:
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high risk cutaneous squamous cell carcinoma selective neck dissection elective lymph node management clinical nodal observation |
Additional relevant MeSH terms:
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Carcinoma Carcinoma, Squamous Cell Neoplasms, Glandular and Epithelial |
Neoplasms by Histologic Type Neoplasms Neoplasms, Squamous Cell |