sargramostim in decreasing mucositis in patients receiving radiation therapy for head and neck cancer

Conditions: Head and Neck Cancer; Oral Complications; Radiation Toxicity

Summary: rationale: sargramostim may lessen symptoms of mucositis in patients receiving radiation therapy for head and neck cancer. it is not yet known if sargramostim is more effective than no treatment in reducing mucositis caused by radiation therapy. purpose: randomized phase iii trial to determine the effectiveness of sargramostim in decreasing mucositis in patients who are receiving radiation therapy for head and neck cancer.

objectives: * determine the efficacy of sargramostim (gm-csf) in terms of reducing the severity and expected duration of radiotherapy-induced oral mucositis in patients with head and neck cancer receiving radiotherapy. * determine the correlation between reduced mucosal injury and quality of life improvement in patients treated with this drug. outline: this is a randomized, double-blind, placebo-controlled study. patients are stratified according to concurrent cisplatin chemotherapy (yes vs no). patients are randomized to 1 of 2 treatment arms. * arm i: patients receive radiotherapy once daily five days a week for 6-7 weeks. patients also receive sargramostim (gm-csf) subcutaneously (sc) three times a week (except on days if receiving concurrent cisplatin) beginning 1 week prior to radiotherapy and continuing until 2 weeks after completion of radiotherapy for a total of approximately 9 weeks. * arm ii: patients receive radiotherapy as in arm i. patients also receive placebo sc on the same schedule as gm-csf in arm i. quality of life is assessed at baseline, and then at 3, 6, and 12 months. patients are followed at 3, 6 and 11 months. projected accrual: a total of 126 patients (63 per arm) will be accrued within 1.2-1.4 years.

Eligibility criteria:
disease characteristics: * histologically confirmed head and neck carcinoma with planned external beam radiotherapy to include 50% of oropharynx, oral cavity, or both\] * planned external beam radiotherapy of 60-70 gy total dose to the primary tumor or standard ports for an unknown primary tumor * neck metastases from an unknown primary allowed if radiotherapy planned to at least 50% of the salivary gland at a dose of at least 50 gy * no t1-t2 glottic tumors * no residual oral/oropharyngeal injury from prior chemotherapy patient characteristics: age: * not specified performance status: * karnofsky 60-100% life expectancy: * not specified hematopoietic: * not specified hepatic: * not specified renal: * not specified other: * not pregnant or nursing * negative pregnancy test * fertile patients must use effective contraception * no allergy or idiosyncratic response to sargramostim (gm-csf) * hiv negative prior concurrent therapy: biologic therapy: * not specified chemotherapy: * see disease characteristics * no concurrent chemotherapy other than cisplatin endocrine therapy: * not specified radiotherapy: * see disease characteristics * no prior radiotherapy to the head and neck surgery: * not specified other: * no concurrent enrollment on other rtog head and neck studies * no concurrent oral care medications (e.g., amifostine, chlorhexidrine gluconate, sucralfate, or benzydamine hcl) during study radiotherapy * no concurrent selective oral cavity decontamination (e.g., ib-367) during study radiotherapy

Keywords: stage i nasopharyngeal cancer stage ii nasopharyngeal cancer stage iii nasopharyngeal cancer stage iv nasopharyngeal cancer recurrent nasopharyngeal cancer stage 0 paranasal sinus and nasal cavity cancer stage 0 nasopharyngeal cancer stage 0 oropharyngeal cancer stage 0 laryngeal cancer stage 0 hypopharyngeal cancer untreated metastatic squamous neck cancer with occult primary recurrent metastatic squamous neck cancer with occult primary stage 0 lip and oral cavity cancer stage i lip and oral cavity cancer stage ii lip and oral cavity cancer stage iii lip and oral cavity cancer stage iv lip and oral cavity cancer recurrent lip and oral cavity cancer stage i hypopharyngeal cancer stage ii hypopharyngeal cancer stage iii hypopharyngeal cancer stage iv hypopharyngeal cancer recurrent hypopharyngeal cancer stage i paranasal sinus and nasal cavity cancer stage ii paranasal sinus and nasal cavity cancer stage iii paranasal sinus and nasal cavity cancer stage iv paranasal sinus and nasal cavity cancer recurrent paranasal sinus and nasal cavity cancer stage i oropharyngeal cancer stage ii oropharyngeal cancer stage iii oropharyngeal cancer stage iv oropharyngeal cancer recurrent oropharyngeal cancer oral complications radiation toxicity