A Pilot Study Using Intraoperative Placement of Cesium-131 Permanent Interstitial Brachytherapy in Resectable High Risk Recurrent Head and Neck Cancer
Overview
- Phase
- Early Phase 1
- Intervention
- Cesium 131
- Conditions
- Head and Neck Cancer
- Sponsor
- Case Comprehensive Cancer Center
- Enrollment
- 15
- Locations
- 1
- Primary Endpoint
- Median disease free survival (DFS)
- Status
- Completed
- Last Updated
- 5 years ago
Overview
Brief Summary
The purpose of this study is to explore the use of a treatment called interstitial brachytherapy for patients who have a high risk resectable (able to be treated with surgery) recurrent head and neck cancer.
Brachytherapy is a form of radiation therapy that uses radioactive seeds and implants them into a specific place on your body. This study is using Cesium-131 permanent interstitial brachytherapy.
Cesium-131 is FDA approve for brachytherapy use, however, there are currently no research studies to show how effective it is for head and neck cancer. The goal of this study is determine the effect that the placement of Cesium-131 brachytherapy seeds has on overall survival as well as to assess possible side effects.
Detailed Description
Primary Objective: To assess the effect of Cesium 131 brachytherapy in subjects with resectable recurrent cancer of the head and neck by evaluating disease free survival (DFS) and comparing to a previous cohort. Potential effects on locoregional control rate and overall survival will be explored. Secondary Objective: To assess toxicity associated with cesium 131 brachytherapy treatment. Study Design Patients with a head and neck recurrent cancer who are planned to undergo definitive tumor resection surgery that meet our inclusion and exclusion criteria will be offered participation in this clinical trial. Participant's Follow-up. The participant's medical records will be reviewed every 3 months for 24 months to assess: loco-regional control, distant metastasis free survival, disease free survival, and overall survival. This will allow us to assess the potential treatment effect of cesium 131.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Subjects must have histologically or cytologically confirmed recurrent head and neck cancer.
- •Based on clinical and radiographic evidence the tumor needs to be deemed resectable preoperatively by the surgeon and when necessary (determined by the surgeon) tumor board review.
- •Patients must have potentially curable disease
- •Karnofsky Performance status ≥ 60% (ECOG/Zubrod 0,1,or 2)
- •Subjects must have normal organ and marrow function as defined below:
- •Hemoglobin ≥ 7.0 g/dl
- •Absolute neutrophil count (ANC) \> 500/mcL
- •Platelet count ≥ 75,000/mcL
- •Patients with recurrent/previous treated head and neck squamous cell carcinoma that is deemed surgically resectable by the treating physician but at high risk for recurrence due to concerns regarding close and/or margins due to locations on or near critical structures such as internal or common carotid, skull base, deep cervical musculature, and other areas that may limit the possibility of an enbloc resection. This group otherwise would be considered for retreatment with radiation and/or chemoradiation.
- •Subjects must have the ability to understand and the willingness to sign a written informed consent document.
Exclusion Criteria
- •Patients deemed to have un-resectable disease by the treating surgeon or upon tumor board review.
- •Patients with exposed carotid artery preoperatively requiring sacrifice or bypass intra-operatively
- •Patients with active pharyngocutaneous fistula
- •Patients may have had a recent previous hospital admission (within 30 days) or be admitted preoperatively but not for the following conditions
- •Unstable angina
- •Congestive heart failure
- •Severe hypothyroidism TSH \>10
- •--- Endocrine consult and intervention may allow participation at the discretion of the principal investigator for a thyroid-stimulating hormone (TSH) \>
- •Patients deemed to be "High Risk" by pre admission testing (CPM) or by a preoperative risk assessment by the hospitalist for perioperative complications
- •Subjects with more than one site of distant metastatic disease (beyond the head and neck) as evidenced by computerized tomography (CT) scan or positron emission tomography/CT (PET/CT) or biopsy ---- A subject with a single lung nodule (deemed cancerous by PET/CT or Biopsy) will not be excluded.
Arms & Interventions
Cesium 131 brachytherapy
Cesium 131 is the radioactive isotope in the protocol. The prescribed dose will range from 50-80 Gy at maximal delivery. It comes in 0.5 cm seeds that will be placed in the tumor resection bed at 1cm intervals. They are implantable seeds that do not require removal.
Intervention: Cesium 131
Outcomes
Primary Outcomes
Median disease free survival (DFS)
Time Frame: Up to two years
DFS defined as the time of diagnosis with no evidence of disease through death by any cause or relapse of disease.