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CyberKnife Accelerated Hemilarynx Stereotactic Radiotherapy Study for Early-stage Glottic Larynx Cancer

Primary Purpose

Early-stage Glottic Larynx Cancer

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
CyberKnife Accelerated Hemilarynx Stereotactic Radiotherapy
Sponsored by
University of Texas Southwestern Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Early-stage Glottic Larynx Cancer focused on measuring Larynx Cancer

Eligibility Criteria

18 Years - 99 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

3.1.1 Stage Tis, T1, or T2 laryngeal squamous cancer as defined by American Joint Commission on Cancer (AJCC) 2007 staging system

3.1.2 Biopsy proven squamous cell carcinoma histology or squamous cell variants (sarcomatoid, verrucous, basaloid, and papillary subtypes) involving the true vocal cord

3.1.3 Direct laryngoscopy showing no evidence of greater than Stage II true glottic larynx cancer

3.1.4 PET/CT, X-ray, CT-scan of the chest showing no evidence of metastatic disease

3.1.5 PET/CT or CT-scan of the neck showing no evidence of nodal involvement

3.1.6 Age ≥ 18 years.

3.1.7 Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 90 days following completion of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.

3.1.7.1 A female of child-bearing potential is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:

  • Has not undergone a hysterectomy or bilateral oophorectomy; or
  • Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months).

3.1.8 Ability to understand and the willingness to sign a written informed consent

3.1.9 Eastern Cooperative Oncology Group (ECOG) performance status 0-1

3.1.10 Negative Urine β-HCG or negative serum quantitative β-HCG or within 2 weeks prior to registration for women of childbearing potential

Exclusion Criteria:

3.2.1 Evidence of fixed vocal cord (Stage cT3)

3.2.2 Evidence of thyroid or soft tissue invasion (Stage cT4)

3.2.3 Evidence of positive nodal disease (Stage N1)

3.2.4 Evidence of metastatic disease (Stage M1)

3.2.5 Subjects may not be receiving any other investigational agents.

3.2.6 Non-squamous histology including lymphoma, neuroendocrine carcinoma, adenocarcinoma, or other histology.

3.2.7 Previous laryngeal surgery.

3.2.8 Previous laser therapy within one year prior to protocol treatment.

3.2.9 Previous head and neck radiation therapy involving the glottic larynx

3.2.10 Patients with collagen vascular disease, specifically dermatomyositis with a CPK level above normal or active skin rash, systemic lupus erythematosis, or scleroderma.

3.2.11 Any prior treatment with radiation therapy or chemotherapy for the currently diagnosed larynx cancer prior to registration.

3.2.12 History of another active uncontrolled malignancy at the time of study enrollment

3.2.13 Subjects must not be pregnant due to the potential for congenital abnormalities.

3.2.14 Patients smoking in excess of 2 packs of cigarettes per day.

3.2.15 ECOG performance status ≥ 2

3.2.16 Life expectancy < 3 years

Sites / Locations

  • University Of Texas Southwestern Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Radiation

Arm Description

CyberKnife Accelerated Hemilarynx Stereotactic Radiotherapy

Outcomes

Primary Outcome Measures

Fraction
To determine the feasibility of fraction reduction for early-stage laryngeal cancer without exceeding the maximum tolerated dose.

Secondary Outcome Measures

overall survival
To determine overall survival at 5 years
loco-regional control
To determine loco-regional control at 5 years as determined by physical exam, visualization of tumor by layngoscopy, and CT-scan of the neck to determine if the primary tumor is controlled. A tissue biopsy or recurrent or persistent disease will be required to be considered a loco-regional failure.
functional voice quality
To characterize functional voice quality of patients treated on this protocol.
Quality of Life
To characterize the HR-QoL and PRO of patients treated on this protocol.
cost-effectiveness
To determine cost-effectiveness of hypofractionated larynx irradiation
late toxicity
To determine late toxicity as defined as treatment-related toxicity occurring ≥ 18 months from completion of radiation therapy.

Full Information

First Posted
November 7, 2013
Last Updated
June 27, 2022
Sponsor
University of Texas Southwestern Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT01984502
Brief Title
CyberKnife Accelerated Hemilarynx Stereotactic Radiotherapy Study for Early-stage Glottic Larynx Cancer
Official Title
A Phase I CyberKnife Accelerated Hemilarynx Stereotactic Radiotherapy Study for Early-stage Glottic Larynx Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
June 2022
Overall Recruitment Status
Completed
Study Start Date
November 18, 2013 (Actual)
Primary Completion Date
May 31, 2022 (Actual)
Study Completion Date
May 31, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Texas Southwestern Medical Center

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The feasibility of reducing fractions in early-stage laryngeal cancer has not previously been prospectively studied, and we will therefore conduct a careful phase I bio-equivalent dose fraction reduction study.
Detailed Description
Patients enrolled at each dose level will undergo routine evaluations to identify potential toxicities as well functional voice analyses. Adequate waiting periods will be used to ensure that fraction reduction does not proceed prior to observing toxicity. The purpose of the study will be either to determine the maximal fraction reduction possible until a dose is reached where a dose-limiting toxicity occurs. The initial dose and fractionation will be 50 Gy in 15 fractions with the goal to reduce number of fractions to a dose of 42.5 Gy in 5 fractions. The rationale for using 5 fractions is that it is tolerated in centrally located lung tumors at a dose of 50 Gy in 5 fractions, and thus, is likely to be tolerated in large calliber airways.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Early-stage Glottic Larynx Cancer
Keywords
Larynx Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Radiation
Arm Type
Experimental
Arm Description
CyberKnife Accelerated Hemilarynx Stereotactic Radiotherapy
Intervention Type
Radiation
Intervention Name(s)
CyberKnife Accelerated Hemilarynx Stereotactic Radiotherapy
Intervention Description
CyberKnife Accelerated Hemilarynx Stereotactic Radiotherapy
Primary Outcome Measure Information:
Title
Fraction
Description
To determine the feasibility of fraction reduction for early-stage laryngeal cancer without exceeding the maximum tolerated dose.
Time Frame
90 days
Secondary Outcome Measure Information:
Title
overall survival
Description
To determine overall survival at 5 years
Time Frame
5 years
Title
loco-regional control
Description
To determine loco-regional control at 5 years as determined by physical exam, visualization of tumor by layngoscopy, and CT-scan of the neck to determine if the primary tumor is controlled. A tissue biopsy or recurrent or persistent disease will be required to be considered a loco-regional failure.
Time Frame
5 years
Title
functional voice quality
Description
To characterize functional voice quality of patients treated on this protocol.
Time Frame
18 months
Title
Quality of Life
Description
To characterize the HR-QoL and PRO of patients treated on this protocol.
Time Frame
18 months
Title
cost-effectiveness
Description
To determine cost-effectiveness of hypofractionated larynx irradiation
Time Frame
18 months
Title
late toxicity
Description
To determine late toxicity as defined as treatment-related toxicity occurring ≥ 18 months from completion of radiation therapy.
Time Frame
18 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
99 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 3.1.1 Stage Tis, T1, or T2 laryngeal squamous cancer as defined by American Joint Commission on Cancer (AJCC) 2007 staging system 3.1.2 Biopsy proven squamous cell carcinoma histology or squamous cell variants (sarcomatoid, verrucous, basaloid, and papillary subtypes) involving the true vocal cord 3.1.3 Direct laryngoscopy showing no evidence of greater than Stage II true glottic larynx cancer 3.1.4 PET/CT, X-ray, CT-scan of the chest showing no evidence of metastatic disease 3.1.5 PET/CT or CT-scan of the neck showing no evidence of nodal involvement 3.1.6 Age ≥ 18 years. 3.1.7 Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 90 days following completion of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. 3.1.7.1 A female of child-bearing potential is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria: Has not undergone a hysterectomy or bilateral oophorectomy; or Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months). 3.1.8 Ability to understand and the willingness to sign a written informed consent 3.1.9 Eastern Cooperative Oncology Group (ECOG) performance status 0-1 3.1.10 Negative Urine β-HCG or negative serum quantitative β-HCG or within 2 weeks prior to registration for women of childbearing potential Exclusion Criteria: 3.2.1 Evidence of fixed vocal cord (Stage cT3) 3.2.2 Evidence of thyroid or soft tissue invasion (Stage cT4) 3.2.3 Evidence of positive nodal disease (Stage N1) 3.2.4 Evidence of metastatic disease (Stage M1) 3.2.5 Subjects may not be receiving any other investigational agents. 3.2.6 Non-squamous histology including lymphoma, neuroendocrine carcinoma, adenocarcinoma, or other histology. 3.2.7 Previous laryngeal surgery. 3.2.8 Previous laser therapy within one year prior to protocol treatment. 3.2.9 Previous head and neck radiation therapy involving the glottic larynx 3.2.10 Patients with collagen vascular disease, specifically dermatomyositis with a CPK level above normal or active skin rash, systemic lupus erythematosis, or scleroderma. 3.2.11 Any prior treatment with radiation therapy or chemotherapy for the currently diagnosed larynx cancer prior to registration. 3.2.12 History of another active uncontrolled malignancy at the time of study enrollment 3.2.13 Subjects must not be pregnant due to the potential for congenital abnormalities. 3.2.14 Patients smoking in excess of 2 packs of cigarettes per day. 3.2.15 ECOG performance status ≥ 2 3.2.16 Life expectancy < 3 years
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Baran Sumer, MD
Organizational Affiliation
UTSW
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Of Texas Southwestern Medical Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75239
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
31684993
Citation
Zhang Y, Chiu T, Dubas J, Tian Z, Lee P, Gu X, Yan Y, Sher D, Timmerman R, Zhao B. Benchmarking techniques for stereotactic body radiotherapy for early-stage glottic laryngeal cancer: LINAC-based non-coplanar VMAT vs. Cyberknife planning. Radiat Oncol. 2019 Nov 4;14(1):193. doi: 10.1186/s13014-019-1404-z.
Results Reference
derived
PubMed Identifier
28253270
Citation
Schwartz DL, Sosa A, Chun SG, Ding C, Xie XJ, Nedzi LA, Timmerman RD, Sumer BD. SBRT for early-stage glottic larynx cancer-Initial clinical outcomes from a phase I clinical trial. PLoS One. 2017 Mar 2;12(3):e0172055. doi: 10.1371/journal.pone.0172055. eCollection 2017.
Results Reference
derived

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CyberKnife Accelerated Hemilarynx Stereotactic Radiotherapy Study for Early-stage Glottic Larynx Cancer

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