Squamous Cell Carcinoma of Head and Neck
Conditions
Keywords
Elderly, Vulnerable, Radiotherapy, Non-elective Radiotherapy
Brief summary
To evaluate whether patients defined non-fit for curative non-surgical radio-chemotherapy and therefore treated with RT alone addressed only to non-elective sites of disease, could obtain a non-inferior loco-regional control compared to similar historical cohorts.
Detailed description
The current standard approach for head and neck malignancies cannot be considered the gold standard for elderly patients, except in carefully selected cases. Given the relevance of this population, scientific societies also suggest to propose prospective studies for this subset of frail patients (European Organization for Research and treatment of cancer (EORTC), European Society for Medical oncology (ESMO)). In addition, it is necessary to collect data on specific categories, which are as homogeneous as possible. Therefore, the purpose of this study is to evaluate efficacy and safety of a tailored RT approach administered with a curative intent in a subset of frails elderly patients not candidates neither to standard concurrent RT-CT / RT-cetuximab nor to palliative treatment/best supportive care.
Interventions
RADIATIONNon elective radiotherapy
Simultaneous integrated boost on CTV volumes, delineated as per guidelines, with the exception of intermediate-low risk, where the CTVs are experimental.
Sponsors
Azienda Ospedaliero Universitaria Policlinico Modena
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
70 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* locally advanced non-metastatic HNSCC patients older than 70 years * Primary tumor clinically and radiologically detectable and measurable (staging according to ed. TNM VII and also VIII. * patients defined by the tumor board (ENT, Oncologist, Radiotherapist, Nutritionist) as 1) not eligibles for RTCT / RT-cetuximab treatment 2) not amenable to radical surgery and 3) not candidates for treatments with palliative intent/best supportive care * Availability of staging with CT/PET for distant metastasis and CT/MRI for primary tumor * Karnofsky performance status (KPS) ≥60/100 * Oropharynx , Hypopharynx and Larynx, Oral cavity: stage III and IV and Unknown primitive P16-POSITIVE
Exclusion criteria
* Age less than 70 years * Staging exams done 45 days before the date of the beginning of the treatment * Subsites: nasopharynx, salivary glands, paranasal sinuses. Metastatic disease * Gross total excision * All subsites concerned if N3. * Squamous cell neoplasms of the glottic larynx T1-T2 N0. * Unknown primary HPV negative or EBV positive. * Presence of distant metastases or sub-clavicular lymphadenopathies. * Previous surgery on T and/or N except diagnostic tonsillectomy. * 3D-conformational radiotherapy technique
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Loco-regional control | 24 months after the start of treatment | clinical or radiological (RECIST 1.1) disease progression from end of treatment with tumor present, or to the date of salvage surgery of primary tumor with tumor present performed for clinical or radiological (RECIST 1.1) disease progression, whichever comes first. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| rate of severe sub-acute or late toxicity | at 6 and 12 months after the completion of radiotherapy | assessment of toxicity according to CTCAE v5.0 scale |
| Cause-specific mortality rates | within 3 months after start of treatment | Patients who died from cancer/total amount |
| progression free survival | 12 and 24 months | per modified Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1 |
| G8 role | 6 and 12 months | correlation between G8 pre-screening evaluation and toxicity |
| overall survival | 5 years | defined as the time from the date of randomization to the date of death for any cause |
Other
| Measure | Time frame | Description |
|---|---|---|
| radiomics | through study completion, an average of 5 year | evaluation of radiomics features in study population: using an automated high-throughput extraction of large amounts of quantitative features |
Countries
Italy
Contacts
Primary ContactPasquale Mighali, MD
Backup ContactElisa D'Angelo, MD
Outcome results
None listed