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Stereotactic Body Radiation Therapy in Treating Patients With High Risk Locally Advanced Head and Neck Cancer

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ClinicalTrials.gov Identifier: NCT02388932
Recruitment Status : Terminated (Slow Accrual)
First Posted : March 17, 2015
Results First Posted : November 16, 2018
Last Update Posted : January 24, 2019
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Case Comprehensive Cancer Center

Brief Summary:
This phase I trial studies the side effects and best dose of stereotactic body radiation therapy (SBRT) in treating participants with head and neck cancer that has spread from where it started to nearby tissue or lymph nodes and is at high risk for continuing to spread because the participant cannot undergo standard chemotherapy. Stereotactic body radiation therapy is a specialized radiation therapy that delivers radiation directly to the tumor in smaller doses over several days, which may kill more tumor cells and cause less damage to normal tissue.

Condition or disease Intervention/treatment Phase
Recurrent Hypopharyngeal Squamous Cell Carcinoma Recurrent Laryngeal Squamous Cell Carcinoma Recurrent Nasal Cavity and Paranasal Sinus Squamous Cell Carcinoma Recurrent Nasopharyngeal Keratinizing Squamous Cell Carcinoma Recurrent Oral Cavity Squamous Cell Carcinoma Recurrent Oropharyngeal Squamous Cell Carcinoma Stage II Nasopharyngeal Keratinizing Squamous Cell Carcinoma Stage III Hypopharyngeal Squamous Cell Carcinoma Stage III Laryngeal Squamous Cell Carcinoma Stage III Nasal Cavity and Paranasal Sinus Squamous Cell Carcinoma Stage III Nasopharyngeal Keratinizing Squamous Cell Carcinoma Stage III Oral Cavity Squamous Cell Carcinoma Stage III Oropharyngeal Squamous Cell Carcinoma Stage IVA Hypopharyngeal Squamous Cell Carcinoma Stage IVA Laryngeal Squamous Cell Carcinoma Stage IVA Nasopharyngeal Keratinizing Squamous Cell Carcinoma Stage IVA Oral Cavity Squamous Cell Carcinoma Stage IVA Oropharyngeal Squamous Cell Carcinoma Stage IVB Hypopharyngeal Squamous Cell Carcinoma Stage IVB Laryngeal Squamous Cell Carcinoma Stage IVB Nasopharyngeal Keratinizing Squamous Cell Carcinoma Stage IVB Oral Cavity Squamous Cell Carcinoma Stage IVB Oropharyngeal Squamous Cell Carcinoma Stage IVC Hypopharyngeal Squamous Cell Carcinoma Stage IVC Laryngeal Squamous Cell Carcinoma Stage IVC Nasopharyngeal Keratinizing Squamous Cell Carcinoma Stage IVC Oral Cavity Squamous Cell Carcinoma Stage IVC Oropharyngeal Squamous Cell Carcinoma Radiation: Stereotactic Body Radiation Therapy Device: Positron Emission Tomography Device: Computed Tomography Other: Quality-of-Life Assessment Not Applicable

Detailed Description:

PRIMARY OBJECTIVES:

I. To explore the maximum tolerated dose of head and neck stereotactic body radiation therapy (SBRT) in a high risk participant population ineligible for standard chemoradiotherapy.

SECONDARY OBJECTIVES:

I. Assess profiles of SBRT toxicity and examine participant (including co-morbidities), tumor and treatment related factors that are associated with SBRT related toxicity.

II. Identify any dose volume parameters that are associated with SBRT related toxicity.

III. Explore potential dose response relationships between higher SBRT dosing and radiographic response.

IV. Assess impact of SBRT on participants' quality of life.

OUTLINE: This is a dose-escalation study.

Participants undergo SBRT in 5 fractions at least 40 hours apart over 10-18 days.

After completion of study treatment, participants are followed up at 0.5, 3, 6, 9, and 12 months.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 3 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I Dose Escalation Study of Stereotactic Body Radiotherapy for Carcinoma of the Head and Neck in High Risk Patients Who Are Ineligible/Refuse Standard of Care Therapy
Actual Study Start Date : March 3, 2015
Actual Primary Completion Date : February 6, 2017
Actual Study Completion Date : February 6, 2017

Arm Intervention/treatment
Experimental: Treatment (SBRT)

Participants undergo Stereotactic Body Radiation Therapy in 5 fractions at least 40 hours apart over 10-18 days.

Three dose levels: 40Gy and 45Gy all in 5 fractions. Each initial dose level will have 6 participants allocated to them. All participants are assessed at their 3 month post SBRT visit for Dose-Limiting Toxicities (DLTs). If ≤1 participant experiences a DLT, participants will be enrolled at the next dose level. If ≥3 participants experience a DLT, further accrual will be permanently halted and the study stopped. If 2 participants experience a DLT, then an additional 6 participants will be enrolled at the same dose level. In this setting, if ≤ 3/12 participants have a DLT, participants will be enrolled at the next dose level. If ≥ 4/12 participants have a DLT, further accrual will be permanently halted and the study stopped and 35 Gy will not be recommended as safe.

The dosing strategy for the 2nd (45Gy) cohort will be identical to the first.

Radiation: Stereotactic Body Radiation Therapy
Undergo SBRT
Other Name: SBRT

Device: Positron Emission Tomography
Undergo PET/CT
Other Names:
  • Medical Imaging, Positron Emission Tomography
  • PET
  • PET Scan
  • Positron Emission Tomography Scan

Device: Computed Tomography
Undergo PET/CT
Other Names:
  • CAT
  • CAT Scan
  • CT

Other: Quality-of-Life Assessment
Ancillary studies
Other Name: Quality of Life Assessment




Primary Outcome Measures :
  1. Maximum Tolerated Dose (MTD) of Head and Neck SBRT [ Time Frame: 3 months ]
    Maximum tolerated dose of SBRT in this patient population determined by the dose escalation design with doses '40Gy' and '45Gy all in 5 fractions'.

  2. Incidence of Dose Limiting Toxicities (DLTs) [ Time Frame: 3 months from start of treatment ]
    Number of patients with dose limiting toxicity events graded according to CTCAE Version 4.0


Secondary Outcome Measures :
  1. Overall Survival [ Time Frame: Up to 12 months ]
    Kaplan-Meier estimates will be used to plot overall survival - the number of patients alive at 12 months followup

  2. Local Progression Free Survival [ Time Frame: Up to 12 months ]
    Kaplan-Meier estimates will be used to plot local progression free survival.

  3. Response Measured According to Standard Response Evaluation Criteria in Solid Tumors [ Time Frame: Up to 12 months ]
    Trend tests will be used to investigate the relationship between SBRT dose and response.

  4. Incidence of SBRT Related Morbidity [ Time Frame: Up to 12 months ]
    Number of patients who experiences SBRT-related morbidity according to NCI CTCAE v 4.0

  5. Quality of Life Assessed by Functional Assessment of Cancer Therapy-Head and Neck Questionnaire [ Time Frame: Up to 12 months ]
    Repeated analysis of variance measures will be used to analyze the quality of life data.



Information from the National Library of Medicine

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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:

  • The participant must have squamous cell carcinoma proven by histologic diagnosis; for cancers of the oropharynx, p16 staining by immunohistochemistry must be negative; for cancers of the larynx, hypopharynx, oral cavity, nasopharynx, paranasal sinuses, p16 staining is not required
  • The participant must have clinical stage T1-4, N0-3, M0-1, stage II-IVC carcinoma as per the 7th edition of the American Joint Committee on Cancer (AJCC) staging manual; participants with T1N0M0 will be ineligible; participants with metastatic disease with a limited metastatic burden are eligible if obtaining local control is determined by their treating oncologist to be an important therapeutic goal
  • The participant must have imaging documenting a primary tumor, or involved lymph node, ≥ 2.5 cm in greatest dimension
  • PET/CT is required for all participants, unless contraindicated; this may be acquired prior to study entry or after enrollment prior to SBRT planning
  • The participant must have a history and physical documented within four weeks of registration and be deemed by a medical oncologist to be ineligible for standard continuous course chemoradiotherapy with cisplatin
  • Karnofsky performance status (PS) ≥ 40
  • Female participants cannot be of childbearing age, or if they are, must have a negative pregnancy test prior to enrollment and be willing to use contraceptives during treatment and continue for 6 additional months
  • Participants must have the ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

  • Participants with T1N0M0 stage I disease
  • Participants who are receiving any other investigational agents
  • Participants with non-squamous cell histology
  • Participants with life expectancy < 6 months
  • Participants who cannot lie flat for 20 minutes
  • Participants with prior history of head and neck radiotherapy (> 40 Gy) with significant areas of anticipated overlap

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): NCT02388932


Locations
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United States, Ohio
University Hospitals Cleveland Medical Center, Seidman Cancer Center, Case Comprehensive Cancer Center
Cleveland, Ohio, United States, 44106
Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center
Cleveland, Ohio, United States, 44195
Sponsors and Collaborators
Case Comprehensive Cancer Center
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Shlomo Koyfman Case Comprehensive Cancer Center
  Study Documents (Full-Text)

Documents provided by Case Comprehensive Cancer Center:

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Responsible Party: Case Comprehensive Cancer Center
ClinicalTrials.gov Identifier: NCT02388932     History of Changes
Other Study ID Numbers: CASE8314
NCI-2014-02279 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
CASE8314
CASE 8314 ( Other Identifier: Case Comprehensive Cancer Center )
P30CA043703 ( U.S. NIH Grant/Contract )
First Posted: March 17, 2015    Key Record Dates
Results First Posted: November 16, 2018
Last Update Posted: January 24, 2019
Last Verified: January 2019

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Device Product Not Approved or Cleared by U.S. FDA: No
Pediatric Postmarket Surveillance of a Device Product: No
Product Manufactured in and Exported from the U.S.: No

Additional relevant MeSH terms:
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Carcinoma
Carcinoma, Squamous Cell
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Squamous Cell