Hypofractionated Radiotherapy in Elderly Patients With Head & Neck Squamous Cell Carcinoma

STATUS

Recruiting
participants needed

40
sponsor

Icahn School of Medicine at Mount Sinai

Updated on 19 February 2024

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Summary

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The purpose of this research study is to investigate a shorter radiation treatment schedule for head and neck cancers in patients 70 years of age and older.

Standard radiation treatment for head and neck patients normally requires that the patient travel to the hospital daily for 6-7 weeks to receive radiation treatment 5 days per week. This long course of radiation can lead to significant side effects resulting in some people being unable to complete the course of treatment. If this happens, and there are gaps in the radiation treatment, this can lead to worse outcomes.

Description

This is a non-randomized pilot study examining the objective response rate and tolerability of short-course radiotherapy (RT) in elderly patients who are unfit for standard conventional fractionation treatment with head and neck squamous cell carcinoma (HNSCC). There will be two unrelated cohorts in this study: definitive RT and adjuvant RT. Patients will be assigned to the cohorts based on their surgical or non-surgical candidacy. The primary study measure is the locoregional control (LRC) rate of patients at 6 months post RT treated with short-course RT. Locoregional control at one year will be determined by radiographic (PET/CT) and clinical assessment of disease. For the definitive cohort, LRC will be defined as regression in size or disappearance of primary tumor and/or lymph nodes on imaging or clinical examination; and for the adjuvant cohort, LRC will be defined as absence of disease on imaging or no clinical evidence of disease.

To further investigate the treatment regimen, the study team will assess the safety of short-course RT and determine the incidence of serious complications, overall survival (OS), disease-free survival (DFS) within 1 year, and the change in quality of life (QoL) in these patients who are unfit for standard conventional fractionation treatment with head and neck squamous cell carcinoma (HNSCC) as secondary objectives. Secondary endpoints will include 1- year overall survival (OS), 1-year disease-free survival (DFS), and the total score of the Functional Assessment of Cancer Therapy-Head and Neck questionnaire (FACT-H&N). DFS will be defined from the completion of treatment until disease recurrence locally, regionally and/or distantly or until death from disease. OS will be defined from the RT to death or to last follow-up.

As a safety endpoint, the study team will calculate number and proportion of patients developing reportable AEs and SAEs according to relatedness to the treatment and stratified by severity.

Details

Condition	Head and Neck Squamous Cell Carcinoma
Age	70years - 100years
Treatment	Adjuvant hypofractionation, Definitive Hypofractionation
Clinical Study Identifier	NCT04284540
Sponsor	Icahn School of Medicine at Mount Sinai
Last Modified on	19 February 2024

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Eligibility		Yes	No	Not Sure
Inclusion Criteria
	Age 70 years
	No previous RT or chemotherapy for HNSCC is allowed at time of study entry
	Life expectancy > 12 weeks
	Participants must have histologically or cytologically confirmed diagnosis of HNSCC: oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, cervical nodes (unknown primary)
	All stages (according to National Comprehensive Cancer Network 8th edition for head and neck cancers), except stage IVC5
	Non-concurrent chemotherapy
	First line treatment
	Anyone eligible for definitive or adjuvant based RT therapy
	Adjuvant therapy when histopathological factors (advanced T category, nodal disease, lymphovascular or perineural invasion, high-grade, or positive margins)
	Anyone being treated with curative intent
	Unfit as determined by the treating physician and ECOG performance 1, 2, or 3 (Appendix 2)
	Ability to understand and the willingness to sign a written informed consent
Exclusion Criteria
	Patients < 70
	Metastatic disease outside of the head and neck
	Pregnancy
	Previous or current malignancies at other sites, with the exception of adequately treated in situ carcinoma of the cervix, basal or squamous cell carcinoma of the skin, thyroid cancer, or other cancer curatively treated by surgery and with no current evidence of disease for at least 5 years
	Prior RT of head and neck area
	Concurrent chemotherapy or immunotherapy or hormonotherapy
	Any comorbid connective tissue disorder which could aggravate RT associated toxicities (e.g. Scleroderma)
	In cases where patients cannot consent on their own due to underlying dementia, we can consent the patient's healthcare proxy

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Hypofractionated Radiotherapy in Elderly Patients With Head & Neck Squamous Cell Carcinoma

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Hypofractionated Radiotherapy in Elderly Patients With Head & Neck Squamous Cell Carcinoma

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