Clinical Trial: Intensity-Modulated or Proton Radiation Therapy for Sinonasal Malignancy

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: A Phase II Study of Intensity-Modulated or Proton Radiation Therapy for Locally Advanced Sinonasal Malignancy

Brief Summary:

The purpose of this study is to test the hypothesis that 1)intensity-modulated radiotherapy (IMRT) or proton radiation therapy would result in improved local control rate and lowered toxicity compared to conventional radiotherapy, and 2) proton radiation therapy would result in equivalent or improved local control rate with similar or lower toxicity compared to IMRT, in the treatment of locally advanced sinonasal malignancy.

Data from retrospective studies suggest that IMRT or proton radiation therapy resulted in promising outcome in patients with sinonasal malignancy. To this date, no prospective study has been conducted to evaluate the outcome of sinonasal cancer treated with IMRT or proton radiation therapy. This Phase II trial is the first prospective study conducted to determine the treatment outcome and toxicity of IMRT or proton in the treatment of sinonasal cancer.

IMRT and proton radiation therapy are the two most established and most commonly employed advanced radiotherapy techniques for the treatment of sinonasal cancer. It is highly controversial whether one is superior to the other in terms of local control and toxicity outcome. It is also not clear if a subset of patients would benefit more from one treatment technology versus the other.

Due to the rarity and heterogeneity of sinonasal malignancies and the fact that proton beam is only available at a few centers in the United States, it is not feasible at present to do a Phase III study randomizing patients between IMRT and proton radiation therapy. In this study, a planned secondary analysis will be performed, comparing the treatment and toxicity outcome between IMRT and proton. The data on the IMRT and proton comparison from this trial will be used to design future multi-center prospective trials and to dete

Detailed Summary:

Subjects will receive daily proton radiation treatment as outpatients at the Francis H. Burr Proton Center at Massachusetts General Hospital. The subjects may also receive concurrent standard chemotherapy every week during their radiation therapy. This chemotherapy is considered standard treatment for their cancer and is not being done for research purposes.

In addition to daily radiation treatments, subjects will have the following tests every week: review of side effects; physical exam, including weight, height, neurological exam and vital signs; and blood tests, only for those subjects also receiving chemotherapy.

Subjects will be followed for 5 years after the completion of study treatment. The first follow-up visit will be 6-8 weeks after completion of study treatment. Additional follow-up visits will be performed every 3 months during the first 2 years following completion of radiation then every 6 month during years 3-5. At each follow-up visit, subjects will receive a physical exam, chest CT scan (at 1st follow-up visit then at least every 6 months), a CT or MRI tumor assessment (at 1st follow-up visit then at least every 6 months), quality-of-life questionnaire, hearing test, neuro-ophthalmology test, and neurocognitive test.


Sponsor: Massachusetts General Hospital

Current Primary Outcome: Local Control Rates [ Time Frame: 2 years ]

To determine the local control rates with IMRT or proton radiation therapy at 2 years.


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Vision preservation [ Time Frame: 5 years ]
    To determine the late visual-orbital late effects of IMRT or proton beam
  • Regional control [ Time Frame: 2 years ]
    To determine the regional control at 2 years after IMRT or proton
  • Survival [ Time Frame: 5 years ]
    To determine the long-term survival at 5 years after IMRT or proton
  • QOL [ Time Frame: 5 years ]
    To assess quality-of-life (QOL) outcomes after IMRT or proton
  • Patterns of Tumor Relapse [ Time Frame: 5 years ]
    To determine the patterns of tumor relapse after IMRT or proton
  • Local control [ Time Frame: 5 years ]
    To determine long-term local control after IMRT or proton
  • Neurocognitive function [ Time Frame: 5 years ]
    To determine long-term neurocognitive function after IMRT or proton


Original Secondary Outcome: Same as current

Information By: Massachusetts General Hospital

Dates:
Date Received: October 21, 2011
Date Started: July 2011
Date Completion: July 2017
Last Updated: January 26, 2017
Last Verified: January 2017