Intensity-Modulated Radiation Therapy or 3-Dimensional Conformal Radiation Therapy in Decreasing Hearing Loss in Patients Who Have Undergone Surgery for Parotid Tumors

Study Overview
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Brief Summary
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RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Specialized radiation therapy that delivers a high dose of radiation directly to the tumor may kill more tumor cells and cause less damage to normal tissue. Giving radiation therapy after surgery may kill any tumor cells that remain after surgery. It is not yet known whether intensity-modulated radiation therapy or 3-dimensional conformal radiation therapy is more effective in decreasing hearing loss in patients undergoing radiation therapy for parotid gland cancer. PURPOSE: This randomized phase III trial is studying intensity-modulated radiation therapy to see how well it works compared with 3-dimensional conformal radiation therapy in decreasing hearing loss in patients who have undergone surgery for parotid tumors.

Detailed Description
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OBJECTIVES: Primary To determine the potential of cochlear-sparing intensity-modulated radiotherapy (IMRT) versus conventional radiotherapy comprising 3-dimensional conformal radiotherapy in reducing the incidence of sensory-neural hearing loss in patients with parotid tumors undergoing radiotherapy to the parotid region. Secondary To describe and compare the impact of both IMRT and conventional radiotherapy on physical, social and emotional well-being including generic functional and symptom aspects as well as disease-specific issues relevant to audiometry. OUTLINE: This is a multicenter study. Patients are stratified according to center and radiotherapy dose. Patients are randomized to 1 of 2 treatment arms after surgical resection. Arm I (cochlear-sparing intensity-modulated radiotherapy [IMRT]): Patients undergo cochlear-sparing IMRT using the local planning system once daily, 5 days per week, for 6 weeks (total of 30 fractions) at a total dose of 60 Gy (65 Gy if macroscopic residual disease). Patients may undergo elective neck irradiation of the uninvolved lymph node areas once daily, 5 days per week, for 6 weeks. Arm II (conventional radiotherapy): Patients undergo conventional radiotherapy comprising 3-dimensional conformal radiotherapy once daily, 5 days per week, for 6 weeks (total of 30 fractions) at a total dose of 60 Gy (65 Gy if macroscopic residual disease). Patients may undergo elective neck irradiation of the uninvolved lymph node areas once daily, 5 days a week, for 5 weeks. Patients complete quality-of-life questionnaires (EORTC QLQC30 v.3.0, the head and neck module H&N35, and a modified version of the Glasgow Hearing Aid Benefit profile) at baseline and at 6,12, 24, 36, 48, and 60 months after completion of study therapy. Patients also undergo audiological and vestibular assessment at 6 and 12 months following radiotherapy and then annually thereafter for up to 5 years. After completion of study treatment, patients are followed up at 3, 6, 12, 18, and 24 months and then annually thereafter for up to 5 years (annually for recurrence for at least 10 years). Peer Reviewed and Funded or Endorsed by Cancer Research UK.

Official Title
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A Multicenter Randomized Study of Cochlear Sparing Intensity Modulated Radiotherapy Versus Conventional Radiotherapy in Patients With Parotid Tumors

Conditions
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Head and Neck Cancer, Ototoxicity, Radiation Toxicity

Intervention / Treatment
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* Procedure: adjuvant therapy
* Procedure: assessment of therapy complications
* Procedure: quality-of-life assessment
* Radiation: 3-dimensional conformal radiation therapy
* Radiation: intensity-modulated radiation therapy


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Histologically confirmed malignant tumors of the parotid glands Adjuvant radiotherapy planned post-surgery No parotid tumors requiring primary radiotherapy No benign tumors requiring postoperative radiotherapy No metastases from squamous cell carcinoma of the head and neck to the parotid gland At high-risk of radiation-induced sensory-neural hearing loss with conventional radiotherapy due to the irradiation of the parotid bed to a dose equivalent of 60 Gy in 2 Gy/fraction with photon beams, using the wedge-pair technique PATIENT CHARACTERISTICS: WHO performance status 0-1 No hearing loss > 60 dB No previous or concurrent illness that, in the investigator's opinion, would interfere with either completion of therapy or follow-up Suitable to attend regular follow-up and undergo audiograms and toxicity monitoring and be available for long term follow-up PRIOR CONCURRENT THERAPY: See Disease Characteristics No prior radiotherapy to the head and neck region No concurrent chemotherapy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized


Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: adjuvant therapy|nan|
|Procedure: assessment of therapy complications|nan|
|Procedure: quality-of-life assessment|nan|
|Radiation: 3-dimensional conformal radiation therapy|nan|
|Radiation: intensity-modulated radiation therapy|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients developing sensory-neural hearing loss of at least 10 dB at bone conduction as assessed by audiograms at 4000 Hz one year after treatment |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Auditory assessment at 6 and 12 months following radiotherapy (RT) and then annually thereafter for up to 5 years |  |  | 
| Vestibular assessment at baseline, at 6 and 12 months following RT, and then annually thereafter for up to 5 years |  |  | 
| Quality of life at 6 and 12 months following RT and then annually thereafter for 5 years |  |  | 
| Local and regional tumor control |  |  | 
| Time to tumor progression |  |  | 
| Overall survival |  |  | 
| Acute and late side effects of RT as assessed by NCI CTCAE v 3.0 and the LENT SOMA and late RT scoring systems |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ototoxicity, radiation toxicity, stage I salivary gland cancer, stage II salivary gland cancer, stage III salivary gland cancer