appaconitine patch for oral mucositis pain caused by chemoradiotherapy in patients with nasopharyngeal cancer

Conditions: Radiation Induced Oral Mucositis

Summary: the purpose of this clinical study is to evaluate the efficacy of lappaconitine adhesive patch in alleviation radiation induced mucositis pain and the improvements in qol of patients with nasopharyngeal carcinoma . to determine if lappaconitine administered prior to radiation therapy reduces the severity of radiation induced oral mucositis pain in patients who have been diagnosed with nasopharyngeal carcinoma.

this is a randomized, single -center study conducted in china to evaluate lappaconitine adhesive patch in the reduction severity of radiation induced oral mucositis pain in patients receiving solo radiation therapy or chemoradiation therapy for nasopharyngeal carcinoma. patients will reveive daily fractions of imrt (2.0 - 2.2 gy) to a total of 60 - 72 gy over approximately 7 weeks, plus cisplatin administered 80 - 100 mg/m2 once every three weeks for 3 doses or 30 - 40 mg/m2 once weekly for 6-7 doses (investigator's choice). patients in both arms received intensity modulated radiation therapy(imrt) :all target volumes were outlined slice by slice on the axial contrast-enhanced ct with mr fusion images in the treatment planning system. the target volumes were defined in accordance with the international commission on radiation units and measurements reports 50 and 62. the prescribed dose is 68-72 gy to ptvnx (planning target volume of the primary tumor), 64-68 gy to gtvnd (gross tumor volume of the cervical lymph node), 60- 64gy to ptvnd and ptv1 (planning target volume 1), and 54-58 gy to ptv2 (planning target volume 2) in 30-32 fractions. patients will be randomized equally to 1 of 2 treatment arms: arm a: lappaconitine adhesive patch per day, concurrent with stardard care for oral mucositis arm b: stardard care for oral mucositis all patients will be assessed weekly for oral mucositis per who grading criteria until the completion of imrt, and once weekly thereafter (if necessary) for 7 weeks, or until oral mucositis resolves to ≤ grade 1. approximately 200 patients will be enrolled to ensure that roughly 80 patients per arm complete treatments for primary endpoint analysis.

Eligibility criteria:
inclusion criteria: * newly histologic diagnosis of nasopharyngeal carcinoma without distant metastasis * clinical stage iii\~iva( uicc (union international against cancer) /ajcc (american joint committee on cancer) tnm staging system 8th edition) * karnofsky performance status scale between 60-100 * wbc count ≥ 4×109/l，neutrophil differential count≥ 1.5×109/l,hemoglobin ≥ 90g/l， platelet count ≥ 100×109/l * alt or ast ≤2.5×uln,bilirubin ≤2.5×uln,serum creatinine ≤1.5×uln or serum creatinine clearance≥60ml/min * sign the informed consent. exclusion criteria: * younger than 18 years old or older than 70 years old * pregnancy or lactation * severe cerebrovascular disease/canker/psychosis/uncontrolled diabetes * have suffered from other tumor or now suffering from other tumor * have suffered from oral diseases or salivary gland diseases or mow suffering from oral diseases or salivary gland diseases * refuse to give up smoking/drinking/betel chewing * suffering from other active infection diseases and in need of treatment.