Reduced Target Delineation and Radiation Doses Chemoradiotherapy for Patients With Locoregionally Advanced Nasopharyngeal Carcinoma
- Conditions
- Nasopharyngeal Carcinoma
- Interventions
- Radiation: Reduced Target Delineation and Radiation Doses
- Registration Number
- NCT03389295
- Lead Sponsor
- Xiayun He, MD
- Brief Summary
To determine the efficacy and safety of sequential chemoradiotherapy with regimen of docetaxel, cisplatin and fluorouracil and reduced target delineation and radiation doses IMRT for patients with locoregionally advanced nasopharyngeal carcinoma
- Detailed Description
Although concurrent chemoradiation is the standard treatment modality for locally advanced nasopharyngeal carcinoma (NPC), high incidences of distant metastases and severe treatment related toxicities have become an obstacle to be overcome. Besides, a common problem in locally advanced NPC is the narrow gap between the tumor and critical normal structures, which makes dose optimization difficult. Considering that significant tumor shrinkage may occur during induction chemotherapy, and incidences of distant metastases may be reduced by adjuvant chemotherapy, this study was designed to explore the efficacy and safety of sequential chemoradiotherapy with regimen of docetaxel, cisplatin and fluorouracil and reduced target delineation and radiation doses IMRT for patients with locoregionally advanced NPC.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 118
- Histopathologically proven nasopharyngeal carcinoma (WHO type 2 or 3)
- Stage Ⅲ-ⅣB disease (AJCC/UICC 2010)
- KPS more than 70
- Life expectancy of more than 6 months
- Signed written informed consent
- Adequate organ function including the following:
Absolute neutrophil count (ANC) >= 1.5 * 109/l Platelets count >= 100 * 109/l Hemoglobin >= 10 g/dl AST and ALT <= 2.5 times institutional upper limit of normal (ULN) Total bilirubin <= 1.5 times institutional ULN Creatinine clearance >= 50 ml/min Serum creatine <= 1 times ULN
- Evidence of distant metastasis
- Prior chemotherapy or anti-cancer biologic therapy for any type of cancer, or prior radiotherapy to the head and neck region
- Other previous or concomitant cancer, except for in situ cervical cancer and cutaneous basal cell carcinoma
- Pregnant or breast-feeding females, or females and males of childbearing potential not taking adequate contraceptive measures
- Presence of an uncontrolled concomitant illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Reduced Target Delineation and Radiation Doses Reduced Target Delineation and Radiation Doses All patients were assigned to receive induction chemotherapy (IC) followed by IMRT with adjuvant chemotherapy (AC). IMRT was administered 2 weeks after IC, and AC was administered 1 month after IMRT. IC or AC (TPF regimen) comprised docetaxel (60 mg/m2/day, day 1), cisplatin (25 mg/m2/day, days 1-3), and 5-fluorouracil (500 mg/m2/day with a 120-h infusion) administered once every 3 weeks for two cycles. During radiotherapy, involved retropharyngeal lymph nodes and intracavity lesions of the primary tumor were delineated according to the post-IC volume, whereas the remainder of the involved tissues (eg, pterygopalatine fossa) of the primary tumor were delineated according to the pre-IC volume of the primary tumor as shown by MRI. Post-IC volumes of involved neck lymph nodes were used for delineation. The prescribed dose was 66 Gy to tumors above the slices of skull base or below the orapharynx with less than 5 mm retropharyngeal lymph nodes, or 70.4 Gy to tumors in other slices.
- Primary Outcome Measures
Name Time Method Progression-free survival up to 5 years The time from date of treatment until date of first documented disease progression or death from any cause, assessed up to 5 years.
- Secondary Outcome Measures
Name Time Method Changes of tumor volume 2 weeks after completion of induction chemotherapy Changes of tumor volume before and after induction chemotherapy
Distant metastasis-free survival up to 5 years The time from date of treatment until date of first documented distant metastasis, assessed up to 5 years.
Regional recurrence-free survival up to 5 years The time from date of treatment until date of first documented disease recurrence at a regional site, assessed up to 5 years.
Local recurrence-free survival up to 5 years The time from date of treatment until date of first documented disease recurrence at a local site, assessed up to 5 years.
Locoregional failure patterns up to 5 years The failures were categorized as occurring inside or outside the high dose target volume, depending on the location of Vrecur: "in field" if 95% of Vrecur was within the 95% isodose; "marginal" if 20% to 95% of Vrecur was within the 95% isodose, or "outside" if less than 20% of Vrecur was inside the 95% isodose.
Number of participants with acute toxicities during treatment Number of participants with acute toxicities occurred during the chemoradiotherapy according to CTCAE4.0
Relationship between treatment failure and dose received by target up to 5 years Relationship between treatment failure and dose received by target
Overall survival up to 5 years The time from date of treatment until date of death due to any cause, assessed up to 5 years.
Number of participants with late toxicities up to 5 years Number of participants with late toxicities occurred from 3 months after completion of radiotherapy to last follow-up visit according to Radiation Therapy Oncology Group radiation morbidity scoring criteria.
Trial Locations
- Locations (1)
Fudan University Shanghai Cancer Center
🇨🇳Shanghai, Shanghai, China