To Study the Impact of Radiation Treatment After Surgery in Patient With Locally Advanced Thyroid Cancer. (THYRO-RT)

• ClinicalTrials.gov Identifier: NCT03669432
• Recruitment Status: Unknown
• First Posted: September 13, 2018
• Last Update Posted: March 16, 2020
• Sponsor: Tata Memorial Hospital
• Collaborator: Department of Atomic Energy
• Information provided by (Responsible Party): Dr. Gouri Pantvaidya, Tata Memorial Hospital

Study Description

Brief Summary:

This trial deals with cancers of the thyroid gland which are advanced at the local site of thyroid. These cancers are treated with surgery and complete removal of the thyroid gland. But due to advanced nature, there is risk of re-occurrence. Radiotherapy can be used to prevent this re-occurrence. This study attempt to see the effect of radiotherapy in preventing re-occurrence and its side effects in advanced thyroid cancer.

Condition or disease	Intervention/treatment	Phase
Thyroid Cancer Stage IV; Radiation Toxicity	Radiation: Intensity Modulated Radiotherapy; Procedure: Surgery alone	Not Applicable

Detailed Description:

Surgery, when possible offers the best chance of cure for cancer of the thyroid gland. Surgery for thyroid cancer involves removal of the thyroid gland along with removal of the lymph nodes which drain the gland. After surgery most patients will receive radio-iodine treatment to diagnose and treat any spread of the cancer in the body. Most thyroid cancers will have good outcomes with the above mentioned treatment. However, in advanced thyroid cancer there is a higher chance of recurrence even with surgery and radio iodine. Surgery for recurrence of these cancers is very morbid This may entail surgeries which may also involve removing portions of the voice box and food pipe. You may therefore develop and discomfort or inability to eat or speak.

Radiation therapy can be given to the neck along with radio-iodine therapy to decrease these re occurrences of the cancer. A number of studies have shown a benefit with the use of radiation therapy in advanced cases of thyroid cancer. However, the side effects of radiation, if any, have not been well documented. This study is being done to assess the impact of radiation on the outcome of cancer and the exact side effects of radiation therapy. If the side effects are not too many, then radiation therapy can be used to decrease the chances of recurrence in the neck after thyroid.

In this study, patients undergoing total thyroidectomy for thyroid cancer will be assessed for high risk features on the histopathology report and the intra operative findings. Those with advanced thyroid cancer as per the eligibility criteria will be counselled and consented for the study. Those patients willing to participate in the study will be randomised to either receive only surgery and radio-iodine or surgery, radio-iodine and external beam radiation.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 72 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Phase II Randomized Controlled Trial Of Postoperative Intensity Modulated Radiotherapy (IMRT) in Locally Advanced Thyroid Cancers.
• Study Start Date: July 2013
• Estimated Primary Completion Date: July 2021
• Estimated Study Completion Date: July 2021

Arms and Interventions

Arm	Intervention/treatment
Experimental: Intensity Modulated radiotherapy; In this Arm, after surgery, patient will receive radio-iodine treatment as per guidelines, 6-8 weeks after surgery. The patient will receive adjuvant radiation therapy about 8-10 weeks after completion of initial surgery. The duration of this radiation therapy will be approximately 45 days. : The goal of the treatment plan would be to encompass the PTV subclinical disease with a dose of 54-60 Gy and the PTV of the gross disease with 70-74 Gy while sparing as much of the aforesaid critical structures as possible. The maximum permissible point doses to the spinal cord will be limited to 46 Gy. IMRT planning and delivery will be carried out on the Tomotherapy Hi Art System.	Radiation: Intensity Modulated Radiotherapy; The patient will receive adjuvant radiation therapy about 8-10 weeks after completion of initial surgery. The duration of this radiation therapy will be approximately 45 days. : The goal of the treatment plan would be to encompass the PTV subclinical disease with a dose of 54-60 Gy and the planned target volume (PTV) of the gross disease with 70-74 Gy while sparing as much of the aforesaid critical structures as possible. The maximum permissible point doses to the spinal cord will be limited to 46 Gy. IMRT planning and delivery will be carried out on the Tomotherapy Hi Art System.; Procedure: Surgery alone; This intervention is of no interest
Surgery alone; In this Arm, after surgery patient will receive radio-iodine treatment as per guidelines, 6-8 weeks after surgery. Patient under surgery arm will receive no further treatment after surgery and radio-iodine therapy and will be kept on a routine follow up	Procedure: Surgery alone; This intervention is of no interest

Outcome Measures

Primary Outcome Measures :

1. locoregional recurrence [ Time Frame: after completion of treatment- till 5 years ]
   locoregional recurrence is defined as occurrence of pathology proven recurrence in the neck

Secondary Outcome Measures :

1. acute toxicity [ Time Frame: during treatment- till 23 months ]
   Acute toxicity will be measured during and after completion of radiation (3 months).
2. late toxicity [ Time Frame: at 2 years after treatment completion ]
   Late toxicity will be measured using the LENT-SOMA scale

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 70 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

A) All patients of differentiated thyroid cancer (papillary/follicular/poorly differentiated/) who have undergone total/completion thyroidectomy at our institute and having at least two of the following features (listed below) intra-operatively and/or on histopathology

1. Gross extrathyroidal spread into soft tissues of the neck, trachea, esophagus, recurrent laryngeal nerve (constituting stage T4a)
2. R1/ shave resections (minimal residual disease)
3. R2 resections (gross residual disease)
4. Multiple lymph nodes positive(>2) with perinodal extension at level VI B) Normal baseline haematological and biochemical parameters.

Exclusion Criteria:

1. Anaplastic or medullary thyroid cancer
2. Previous history of radiation
3. Pregnancy
4. < 18 years Patient unwilling to participate in the study.

Contacts and Locations

Contacts

Contact: Gouri H Pantvaidya, MS; +919833971155; docgouri@gmail.com

Contact: Sarbani Ghosh-Laskar, MD; 9820834386; sarbanilaskar@gmail.com

Locations

India

Gouri Pantvaidya; Recruiting

Mumbai, Maharashtra, India, 400012

Contact: Gouri Pantvaidya, MS +919833971155 docgouri@gmail.com

Principal Investigator: Gouri Pantvaidya, MS

Principal Investigator: Sarbani GhoshLaskar, MD

Sub-Investigator: Sandeep Basu, MD

Sub-Investigator: Anil D'Cruz, MS

Sponsors and Collaborators

Tata Memorial Hospital

Department of Atomic Energy

  Study Documents (Full-Text)

Documents provided by Dr. Gouri Pantvaidya, Tata Memorial Hospital:

Informed Consent Form  [PDF] May 21, 2015

Study Protocol and Statistical Analysis Plan  [PDF] February 13, 2014

More Information

• Responsible Party: Dr. Gouri Pantvaidya, Associate Professor & Assistant surgeon E, Tata Memorial Hospital
• ClinicalTrials.gov Identifier: NCT03669432
• Other Study ID Numbers: 1076
• First Posted: September 13, 2018
• Last Update Posted: March 16, 2020
• Last Verified: March 2020

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Undecided

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No
• Product Manufactured in and Exported from the U.S.: No

Keywords provided by Dr. Gouri Pantvaidya, Tata Memorial Hospital:

locally advanced thyroid cancers, IMRT, toxicity

Additional relevant MeSH terms:

Thyroid Neoplasms; Thyroid Diseases; Endocrine System Diseases; Endocrine Gland Neoplasms; Neoplasms by Site; Neoplasms; Head and Neck Neoplasms