Investigation of Contralateral Arytenoid Sparing IMRT for T1a & T2a Larynx Cancer & Analysis of Post-treatment Laryngeal Function
| Status: | Terminated |
|---|---|
| Conditions: | Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 6/17/2018 |
| Start Date: | November 16, 2015 |
| End Date: | May 2018 |
A Phase II Investigation of Contralateral Arytenoid Sparing IMRT for T1a and T2a Larynx Cancer With Detailed Analysis of Post-treatment Laryngeal Function
The aim of this study is to define a new treatment technique for T1a larynx cancer that
maintains excellent local control with less extensive radiation fields. It is thought that
this will lead to patients having fewer changes to their voice and a higher quality of life
after treatment when compared to the current standard treatment.
maintains excellent local control with less extensive radiation fields. It is thought that
this will lead to patients having fewer changes to their voice and a higher quality of life
after treatment when compared to the current standard treatment.
Parallel opposed portal external beam radiation is the standard nonsurgical treatment for
T1-2N0 glottic cancer. This technique involves treatment of the entire larynx for tumors that
are small and limited. Although technological advances now allow radiation oncologists
selectively to target and avoid adjacent sub-portions of any organ, these tools have not been
applied T1-2N0 glottic cancer due to the perceived low toxicity of standard therapy. However,
radiotherapy for early glottic cancer is not without functional side effects and it is not
known whether post-treatment function after whole larynx radiation is superior to a more
targeted surgical approach.
This is a phase II study to treat unilateral glottic cancer (Stage T1a and T2aN0) with
intensity modulated radiation therapy (IMRT). In view of the anticipated small volume of
disease at presentation and need to limit the potential for a "marginal miss", treatment will
include the entire involved vocal fold, anterior commissure, and the anterior 1/3 of the
contralateral vocal fold thus sparing the contralateral arytenoid cartilage and musculature
("contralateral arytenoid sparing IMRT"). In addition, we propose to perform sophisticated
objective and patient reported measures regarding speech outcomes for two years after the
completion of therapy at specified intervals, to better gain an understanding of the effects
of therapy. Our findings will have the potential to dramatically advance the field of early
larynx cancer therapy by demonstrating the efficacy of limiting the volume of uninvolved
larynx that receives radiation and comprehensively assessing the functional outcomes of said
therapy.
T1-2N0 glottic cancer. This technique involves treatment of the entire larynx for tumors that
are small and limited. Although technological advances now allow radiation oncologists
selectively to target and avoid adjacent sub-portions of any organ, these tools have not been
applied T1-2N0 glottic cancer due to the perceived low toxicity of standard therapy. However,
radiotherapy for early glottic cancer is not without functional side effects and it is not
known whether post-treatment function after whole larynx radiation is superior to a more
targeted surgical approach.
This is a phase II study to treat unilateral glottic cancer (Stage T1a and T2aN0) with
intensity modulated radiation therapy (IMRT). In view of the anticipated small volume of
disease at presentation and need to limit the potential for a "marginal miss", treatment will
include the entire involved vocal fold, anterior commissure, and the anterior 1/3 of the
contralateral vocal fold thus sparing the contralateral arytenoid cartilage and musculature
("contralateral arytenoid sparing IMRT"). In addition, we propose to perform sophisticated
objective and patient reported measures regarding speech outcomes for two years after the
completion of therapy at specified intervals, to better gain an understanding of the effects
of therapy. Our findings will have the potential to dramatically advance the field of early
larynx cancer therapy by demonstrating the efficacy of limiting the volume of uninvolved
larynx that receives radiation and comprehensively assessing the functional outcomes of said
therapy.
- Inclusion Criteria:
- Patients with T1a or T2a squamous cell carcinoma of the glottic larynx (tumor
limited to one vocal cord with normal cord mobility).
- Patients must be able to read and write English to comply with the questionnaire
portions of the protocol.
- ECOG performance status of 0 or 1.
- Exclusion Criteria:
- Patients with verrucous or adenocarcinoma
- Patients with T1 tumors on both cords (T1b)
- Patients with T2b-T4 true larynx tumors
- Patients with primary supraglottic tumors that involve the true larynx
- Patients with a prior or concurrent malignancy (other than nonmelanoma skin
cancer or carcinoma in-situ of the cervix) are ineligible unless the previous
cancer was treated 5 years or more prior to the current tumor and the patient has
remained continually disease free
- Patients who have received prior radiation to the head and neck
- Pregnant or breastfeeding women
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