Sequential or Concurrent Chemoradiotherapy in Patients With Locoregionally Advanced NPC
- Conditions
- Nasopharyngeal Carcinoma
- Interventions
- Radiation: IMRTRadiation: IMRT and concurrent cisplatin
- Registration Number
- NCT03366415
- Lead Sponsor
- Chaosu Hu
- Brief Summary
The purpose of this study is to compare the efficacy and safety of sequential chemoradiotherapy (induction chemotherapy + intensity-modulated radiotherapy +adjuvant chemotherapy) with induction chemotherapy plus concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma (NPC), in order to confirm the value of sequential chemoradiotherapy in NPC patients.
- Detailed Description
Patients with non-keratinizing NPC III-IVA (UICC/AJCC 8th edition) are randomly assigned to receive sequential chemoradiotherapy (induction chemotherapy + intensity-modulated radiotherapy + adjuvant chemotherapy) or induction chemotherapy plus concurrent chemoradiotherapy. Intensity-modulated radiotherapy (IMRT) is given as 2.2 Gy per fraction with five daily fractions per week for 6-7 weeks to a total dose of 66 or 70.4 Gy to the primary tumor. The induction or adjuvant chemotherapy is given gemcitabine (1000 mg/m² d1,8) and cisplatin (25mg/m² d1-3) every 3 weeks for two cycles. The concurrent chemotherapy is given cisplatin 30 mg/m² every week concurrently with IMRT. Our primary endpoint is failure-free survival(FFS) and grade III mucositis during radiation. Secondary end points include overall survival (OS), locoregional failure-free survival (LR-FFS), distant failure-free survival (D-FFS) rates and toxic effects. All efficacy analyses are conducted in the intention-to-treat population, and the safety population include only patients who receive their randomly assigned treatment.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 420
- Patients with newly histologically confirmed non-keratinizing (according to WHO histologically type)
- Tumor staged as III-IVA (according to the 8th AJCC edition).
- Satisfactory performance status: Karnofsky scale (KPS) ≥ 70.
- Age between 18 and 65 years old.
- Adequate marrow: Neutrophil count ≥2000/μL, hemoglobin ≥90g/L and platelet count ≥100000/μL.
- Normal liver function test: Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST) ≤ 1.5×upper limit of normal (ULN) concomitant with alkaline phosphatase (ALP) ≤ 2.5×ULN, and bilirubin ≤ 1.5ULN.
- Adequate renal function: creatinine clearance ≥60 ml/min.
- Patients must be informed of the investigational nature of this study and give written informed consent.
- Evidence of distant metastasis
- Prior chemotherapy, radiotherapy or surgery (except diagnostic) to primary tumor or nodes.
- Other previous or concomitant cancer.
- Pregnancy or lactation.
- Presence of an uncontrolled concomitant illness including, but not limited to, ongoing or active infection, immune deficiency, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia or emotional disturbance.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Induction chemotherapy+IMRT+adjuvant chemotherapy gemcitabine and cisplatin (Induction and adjuvant chemotherapy) Patients receive gemcitabine (1000 mg/m² d1,8) and cisplatin (25 mg/m² d1-3) every 3 weeks for 2 cycles before radiotherapy, and then receive intensity modulated-radiotherapy (IMRT), followed by gemcitabine (1000 mg/m² d1,8) and cisplatin (25 mg/m² d1-3) every 3 weeks for 2 cycles. Induction chemotherapy+IMRT+adjuvant chemotherapy IMRT Patients receive gemcitabine (1000 mg/m² d1,8) and cisplatin (25 mg/m² d1-3) every 3 weeks for 2 cycles before radiotherapy, and then receive intensity modulated-radiotherapy (IMRT), followed by gemcitabine (1000 mg/m² d1,8) and cisplatin (25 mg/m² d1-3) every 3 weeks for 2 cycles. Induction chemotherapy+IMRT and concurrent cisplatin gemcitabine and cisplatin (Induction chemotherapy) Patients receive gemcitabine (1000 mg/m² d1,8) and cisplatin (25 mg/m² d1-3) every 3 weeks for 2 cycles before radiotherapy, and then receive intensity modulated-radiotherapy (IMRT), concurrently with cisplatin 30 mg/m² every week. Induction chemotherapy+IMRT and concurrent cisplatin IMRT and concurrent cisplatin Patients receive gemcitabine (1000 mg/m² d1,8) and cisplatin (25 mg/m² d1-3) every 3 weeks for 2 cycles before radiotherapy, and then receive intensity modulated-radiotherapy (IMRT), concurrently with cisplatin 30 mg/m² every week.
- Primary Outcome Measures
Name Time Method Failure-free survival 3-year Failure-free survival is calculated from the date of randomisation to the date of treatment failure or death from any cause, whichever is first.
Grade III or more mucositis From the start of radiotherapy to 30 days after radiotherapy Grade III or more mucositis during radiotherapy
- Secondary Outcome Measures
Name Time Method Overall survival 3-year Overall survival is calculated from randomization to death from any cause.
Distant failure-free survival 3-year Distant failure-free survival is calculated from randomization to the first remote failure.
Locoregional failure-free survival 3-year Locoregional failure-free survival is calculated from randomization to the first locoregional failure.
Short-term treatment response Two weeks after completion of induction chemotherapy. Three months after completion of the radiotherapy. Treatment response after induction chemotherapy, IMRT and completion of treatment.
Number of participants with adverse events up to 3 years Incidence of acute and late toxicity
Quality of Life up to 3 years Use EORTC QLQ-HN35.
Trial Locations
- Locations (1)
Fudan University Shanghai Cancer Center
🇨🇳Shanghai, Shanghai, China