Optimising Radiation Therapy in Head and Neck Cancers Using Functional Image-Guided Radiotherapy and Novel Biomarkers (INSIGHT-2)
Head and Neck Cancer
About this trial
This is an interventional treatment trial for Head and Neck Cancer focused on measuring Cancer, Oropharynx, HPV, Base of Skull
Eligibility Criteria
Inclusion Criteria:
Feasibility study and Main Study:
- Participants with stage III/IV ((American Joint Committee (AJC) Tumour, Nodes, Metastasis (TMN) on Cancer Version 7)) head and neck cancer planned for primary radical chemo-radiotherapy OR induction chemotherapy followed by chemoradiotherapy with concomitant platinum-based chemotherapy.
- Age between 18 and 70 years.
- Participant can provide informed consent.
- World Health Organisation (WHO) performance status 0 - 1.
- Creatinine Clearance >50ml/minute
- Absolute Neutrophil Count ≥1.5 x10^9/L
- Platelets ≥100 x10^9/L
- Haemoglobin ≥90g/L
Feasibility Study:
- Participants with either HPV associated OPC, HPV negative OPC or Base of Skull HNC.
Low Risk HPV associated OPC:
- T1-3, N0-2c (AJCC 7th Edition, stage III and above)
- Participants with histologically proven squamous cell carcinoma of the head and neck
- p16 positive (defined as >70% cells staining positive)
- <10 year pack smoking history
HPV Associated OPC:
- Patients with histologically proven squamous cell carcinoma of the head and neck
- T1-3,N0-2c (AJCC 7th Edition, stage III and above) with ≥10 pack/ year smoking history
- p16 positive
- Any T4 and/or N3 regardless of smoking history
- Primary tumour size </=5cm
HPV negative OPC, hypopharyngeal or laryngeal cancer:
- Patients with histologically proven squamous cell carcinoma of the head and neck
- T1-4,N0-3 (AJCC 7th edition, stage III and above)
- p16 negative (if OPC)
- Primary tumour size </=5cm
Base of skull Head and Neck Cancer:
- Participants with histologically proven squamous cell carcinoma or undifferentiated carcinoma of the head and neck (sinonasal and nasopharynx)
Exclusion Criteria:
- WHO performance status >=2.
- Participants with any previous malignancy except non-melanoma skin cancer.
- Participants with prior radiotherapy to the head and neck region
- Participants with contraindications to MRI scan.
- Participants with contraindications to IV contrast agents.
- Participants with renal failure
Sites / Locations
- Head and Neck Unit, Royal Marsden HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
No Intervention
Experimental
Experimental
Experimental
Feasibility Study
HPV associated OPC Participants
HPV negative OPC Participants - Radiotherapy dose escalation
Base of Skull HNC Participants
This is a radiotherapy planning study to evaluate the feasibility to acquire longitudinal MRI scans during radiotherapy (prior to the main study) thus, participants will receive standard-of-care chemoradiation therapy (CRT) as per departmental protocol without any treatment adaptation.
Participants will be treated initially with the standard radiotherapy dose of: 65 grays (Gy) in 30 fractions (2.17Gy per fraction) over 6 weeks to the primary and nodal tumour. 54Gy in 30 fractions (1.8Gy per fraction) over 6 weeks to the nodal areas at risk of harbouring microscopic disease In the 2nd week and 4th week of treatment, the participants will undergo Adaptive Radiotherapy to account for anatomical changes.
Participants will be treated initially with the standard radiotherapy dose of: 65Gy in 30 fractions (2.17Gy per fraction) over 6 weeks to the primary and nodal tumour. 54Gy in 30 fractions (1.8Gy per fraction) over 6 weeks to the nodal areas at risk of harbouring microscopic disease After 10 fractions the participants will be stratified into either "responders" or "non-responders" categories based on Apparent Diffusion Coefficients (ADC) response at week 2 of CRT. Participants classified as "responders" will complete treatment without any radiotherapy dose changes. Their radiotherapy treatment target volumes will be adapted at weeks 2 and 4 of CRT to account for volume changes to the tumour. The "non-responders" will undergo an increase in dose per fraction to Clinical Target Volume-1 (CTV-1) primary for fractions 11 to 30.
Participants will be treated initially with the standard radiotherapy dose of: 65Gy in 30 fractions (2.17Gy per fraction) over 6 weeks to the primary and nodal tumour. 54Gy in 30 fractions (1.8Gy per fraction) over 6 weeks to the nodal areas at risk of harbouring microscopic disease Participants will undergo standard treatment with 3 cycles of induction chemotherapy followed by chemo-radiotherapy dose. Their radiotherapy treatment will be adapted at weeks 2 and 4 of CRT to account for volume changes to the tumour.