Phase II Randomized Trial of Neo-Adjuvant Chemotherapy Followed by Surgery and Post-Operative Radiation Versus Surgery and Post-Operative Radiation for Organ Preservation of T3 and T4a Nasal and Paranasal Sinus Squamous Cell Carcinoma (NPNSCC)
Summary
This randomized phase II trial studies how well chemotherapy before surgery and radiation therapy works compared to surgery and radiation therapy alone in treating patients with nasal and paranasal sinus cancer that can be removed by surgery. Drugs used in chemotherapy, such as docetaxel, cisplatin, and carboplatin work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Radiation therapy uses high-energy x-rays to kill tumor cells and shrink tumors. Giving chemotherapy before surgery and radiation therapy may make the tumor smaller and reduce the amount of normal tissue that needs to be removed and treated with radiation.
Detailed description
PRIMARY OBJECTIVES: I. Evaluate the structure preservation rate for patients with locally advanced resectable nasal and paranasal sinus squamous cell carcinoma (NPNSCC) with or without neoadjuvant therapy; all patients will undergo surgical resection and postoperative standard care. II. Evaluate overall survival (OS) for patients with locally advanced resectable NPNSCC with or without neoadjuvant therapy followed by surgical resection and postoperative standard care. SECONDARY OBJECTIVES: I. Evaluate progression-free survival (PFS) for this patient population. II. Examine the rate of structure preservation for the orbit (freedom from orbital exenteration). III. Evaluate site reported p16 data and correlate with outcome. IV. Determine the accuracy of baseline/post-chemotherapy magnetic resonance imaging (MRI) and fludeoxyglucose F-18 positron emission tomography/computed tomography (FDG PET/CT)-based prediction of orbit and skull base preservation. V. Determine the accuracy of baseline/post-chemotherapy MRI and/or FDG PET/CT-based prediction of 2-year overall survival. TERTIARY OBJECTIVES: I. To determine the effects of tobacco, operationalized as combustible tobacco (1a), other forms of tobacco (1b), and environmental tobacco exposure (ETS) (1c) on provider-reported cancer-treatment toxicity (adverse events \[both clinical and hematologic\] and dose modifications). II. To determine the effects of tobacco on patient-reported physical symptoms and psychological symptoms. III. To examine quitting behaviors and behavioral counseling/support and cessation medication utilization. IV. To explore the effect of tobacco use and exposure on treatment duration, relative dose intensity, and therapeutic benefit. OUTLINE: Patients are randomized to 1 of 2 arms. ARM A: Patients undergo standard of care surgery. Beginning 4-6 weeks after surgery, patients undergo image guided intensity modulated radiation therapy (IMRT) once daily (QD) for 5 fractions per week for 30 fractions. Patients with positive margins/positive extracapsular spread (ECS) in lymph nodes undergo image guided IMRT QD for 5 fractions per week for 30 fractions and cisplatin intravenously (IV) over 1-2 hours or carboplatin IV over 30 minutes (for patients who are ineligible to receive cisplatin) weekly for 6 weeks in the absence of disease progression or unacceptable toxicity. ARM B: Patients receive docetaxel IV over 1 hour and cisplatin IV over 1-2 hours on day 1. Patients who are ineligible to receive cisplatin receive carboplatin IV over 30 minutes on day 1. Treatment repeats every 21 days for up to 3 courses in the absence of disease progression or unacceptable toxicity. Patients then undergo standard of care surgery no later than 6 weeks following the last dose of chemotherapy. Beginning 4-6 weeks after surgery, patients undergo image guided IMRT QD for 5 fractions per week for 30 fractions. Patients with positive margins/positive ECS in lymph nodes undergo image guided IMRT QD for 5 fractions per week for 30 fractions and cisplatin IV over 1-2 hours or carboplatin IV over 30 minutes (for patients who are ineligible to receive cisplatin) weekly for 6 weeks in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months if \< 2 years from study entry and then every 6 months if 2-5 years from study entry.
Arms & interventions
- DrugCarboplatin
Given IV
- DrugCisplatin
Given IV
- DrugDocetaxel
Given IV
- RadiationImage Guided Radiation Therapy
Undergo image guided IMRT
- RadiationIntensity-Modulated Radiation Therapy
Undergo image guided IMRT
- OtherLaboratory Biomarker Analysis
Correlative studies
- OtherQuestionnaire Administration
Ancillary studies
- ProcedureTherapeutic Conventional Surgery
Undergo standard of care surgery
Outcome measures
Primary
Structure preservation rate defined as both skull base and orbit being preserved
Fisher?s exact test will be used to compare the structure preservation rate between the two arms. The comparison between the two arms for structure preservation will be conducted separately (each at one-sided 0.05 significance level).
Time frame: Up to 5 years
Overall survival (OS)
Log rank test will be used to compare OS between the two arms. The comparison between the two arms for OS will be conducted separately (each at one-sided 0.05 significance level).
Time frame: From date of randomization, censoring follow-up at last date of contact, assessed for up to 5 years
Eligibility criteria
Study locations (140)
University of Arizona Cancer Center-Orange Grove Campus
Tucson, Arizona, 85704
Banner University Medical Center - Tucson
Tucson, Arizona, 85719
University of Arizona Cancer Center-North Campus
Tucson, Arizona, 85719
Mercy Hospital Fort Smith
Fort Smith, Arkansas, 72903
UC San Diego Moores Cancer Center
La Jolla, California, 92093
Stanford Cancer Institute Palo Alto
Palo Alto, California, 94304
VA Palo Alto Health Care System
Palo Alto, California, 94304
Smilow Cancer Center/Yale-New Haven Hospital
New Haven, Connecticut, 06510
Yale University
New Haven, Connecticut, 06520
UM Sylvester Comprehensive Cancer Center at Coral Gables
Coral Gables, Florida, 33146
UM Sylvester Comprehensive Cancer Center at Deerfield Beach
Deerfield Beach, Florida, 33442
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, 33136
UM Sylvester Comprehensive Cancer Center at Plantation
Plantation, Florida, 33324
Moffitt Cancer Center-International Plaza
Tampa, Florida, 33607
Moffitt Cancer Center - McKinley Campus
Tampa, Florida, 33612
Moffitt Cancer Center
Tampa, Florida, 33612
Emory Proton Therapy Center
Atlanta, Georgia, 30308
Emory University Hospital Midtown
Atlanta, Georgia, 30308
Emory University Hospital/Winship Cancer Institute
Atlanta, Georgia, 30322
Saint Alphonsus Cancer Care Center-Boise
Boise, Idaho, 83706
Saint Alphonsus Cancer Care Center-Caldwell
Caldwell, Idaho, 83605
Kootenai Health - Coeur d'Alene
Coeur d'Alene, Idaho, 83814
Idaho Urologic Institute-Meridian
Meridian, Idaho, 83642
Saint Alphonsus Medical Center-Nampa
Nampa, Idaho, 83686
Kootenai Clinic Cancer Services - Post Falls
Post Falls, Idaho, 83854
Rush - Copley Medical Center
Aurora, Illinois, 60504
Northwestern University
Chicago, Illinois, 60611
Rush University Medical Center
Chicago, Illinois, 60612
Carle on Vermilion
Danville, Illinois, 61832
Carle Physician Group-Effingham
Effingham, Illinois, 62401
NorthShore University HealthSystem-Evanston Hospital
Evanston, Illinois, 60201
NorthShore University HealthSystem-Glenbrook Hospital
Glenview, Illinois, 60026
NorthShore University HealthSystem-Highland Park Hospital
Highland Park, Illinois, 60035
Carle Physician Group-Mattoon/Charleston
Mattoon, Illinois, 61938
Good Samaritan Regional Health Center
Mount Vernon, Illinois, 62864
Carle Cancer Center
Urbana, Illinois, 61801
The Carle Foundation Hospital
Urbana, Illinois, 61801
Saint Anthony Regional Hospital
Carroll, Iowa, 51401
Iowa Methodist Medical Center
Des Moines, Iowa, 50309
Medical Oncology and Hematology Associates-Des Moines
Des Moines, Iowa, 50309
Broadlawns Medical Center
Des Moines, Iowa, 50314
Iowa Lutheran Hospital
Des Moines, Iowa, 50316
Methodist West Hospital
West Des Moines, Iowa, 50266-7700
Central Care Cancer Center - Garden City
Garden City, Kansas, 67846
Central Care Cancer Center - Great Bend
Great Bend, Kansas, 67530
University of Kansas Cancer Center
Kansas City, Kansas, 66160
Lawrence Memorial Hospital
Lawrence, Kansas, 66044
Olathe Health Cancer Center
Olathe, Kansas, 66061
University of Kansas Cancer Center-Overland Park
Overland Park, Kansas, 66210
Ascension Via Christi - Pittsburg
Pittsburg, Kansas, 66762
Salina Regional Health Center
Salina, Kansas, 67401
University of Kansas Health System Saint Francis Campus
Topeka, Kansas, 66606
University of Kansas Hospital-Westwood Cancer Center
Westwood, Kansas, 66205
The James Graham Brown Cancer Center at University of Louisville
Louisville, Kentucky, 40202
Massachusetts General Hospital Cancer Center
Boston, Massachusetts, 02114
University of Michigan Comprehensive Cancer Center
Ann Arbor, Michigan, 48109
Henry Ford Cancer Institute-Downriver
Brownstown, Michigan, 48183
Henry Ford Macomb Hospital-Clinton Township
Clinton Township, Michigan, 48038
Henry Ford Medical Center-Fairlane
Dearborn, Michigan, 48126
Wayne State University/Karmanos Cancer Institute
Detroit, Michigan, 48201
Henry Ford Hospital
Detroit, Michigan, 48202
Weisberg Cancer Treatment Center
Farmington Hills, Michigan, 48334
Allegiance Health
Jackson, Michigan, 49201
Henry Ford Medical Center-Columbus
Novi, Michigan, 48377
Henry Ford Macomb Health Center - Shelby Township
Shelby, Michigan, 48315
Henry Ford West Bloomfield Hospital
West Bloomfield, Michigan, 48322
Sanford Joe Lueken Cancer Center
Bemidji, Minnesota, 56601
Saint Louis Cancer and Breast Institute-Ballwin
Ballwin, Missouri, 63011
Central Care Cancer Center - Bolivar
Bolivar, Missouri, 65613
Siteman Cancer Center at Saint Peters Hospital
City of Saint Peters, Missouri, 63376
Siteman Cancer Center at West County Hospital
Creve Coeur, Missouri, 63141
Freeman Health System
Joplin, Missouri, 64804
Mercy Hospital Joplin
Joplin, Missouri, 64804
University of Kansas Cancer Center - North
Kansas City, Missouri, 64154
University of Kansas Cancer Center at North Kansas City Hospital
North Kansas City, Missouri, 64116
Delbert Day Cancer Institute at PCRMC
Rolla, Missouri, 65401
Mercy Clinic-Rolla-Cancer and Hematology
Rolla, Missouri, 65401
Heartland Regional Medical Center
Saint Joseph, Missouri, 64506
Mercy Hospital Springfield
Springfield, Missouri, 65804
CoxHealth South Hospital
Springfield, Missouri, 65807
Washington University School of Medicine
St Louis, Missouri, 63110
Mercy Hospital South
St Louis, Missouri, 63128
Siteman Cancer Center-South County
St Louis, Missouri, 63129
Siteman Cancer Center at Christian Hospital
St Louis, Missouri, 63136
Mercy Hospital Saint Louis
St Louis, Missouri, 63141
Billings Clinic Cancer Center
Billings, Montana, 59101
Bozeman Deaconess Hospital
Bozeman, Montana, 59715
Benefis Healthcare- Sletten Cancer Institute
Great Falls, Montana, 59405
Great Falls Clinic
Great Falls, Montana, 59405
Kalispell Regional Medical Center
Kalispell, Montana, 59901
Community Medical Hospital
Missoula, Montana, 59804
Memorial Sloan Kettering Basking Ridge
Basking Ridge, New Jersey, 07920
Memorial Sloan Kettering Monmouth
Middletown, New Jersey, 07748
Memorial Sloan Kettering Bergen
Montvale, New Jersey, 07645
Northwell Health Imbert Cancer Center
Bay Shore, New York, 11706
Roswell Park Cancer Institute
Buffalo, New York, 14263
Northwell Health/Center for Advanced Medicine
Lake Success, New York, 11042
Long Island Jewish Medical Center
New Hyde Park, New York, 11040
Lenox Hill Hospital
New York, New York, 10021
Mount Sinai Hospital
New York, New York, 10029
Memorial Sloan Kettering Cancer Center
New York, New York, 10065
University of Rochester
Rochester, New York, 14642
Montefiore Medical Center-Einstein Campus
The Bronx, New York, 10461
Montefiore Medical Center-Weiler Hospital
The Bronx, New York, 10461
Montefiore Medical Center - Moses Campus
The Bronx, New York, 10467
UNC Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina, 27599
Sanford Bismarck Medical Center
Bismarck, North Dakota, 58501
Sanford Broadway Medical Center
Fargo, North Dakota, 58122
Sanford Roger Maris Cancer Center
Fargo, North Dakota, 58122
University of Cincinnati Cancer Center-UC Medical Center
Cincinnati, Ohio, 45219
University of Cincinnati Cancer Center-West Chester
West Chester, Ohio, 45069
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
Mercy Hospital Oklahoma City
Oklahoma City, Oklahoma, 73120
UPMC-Heritage Valley Health System Beaver
Beaver, Pennsylvania, 15009
UPMC Cancer Centers - Arnold Palmer Pavilion
Greensburg, Pennsylvania, 15601
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
Harrisburg, Pennsylvania, 17109
UPMC Jameson
New Castle, Pennsylvania, 16105
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, 19107
UPMC-Presbyterian Hospital
Pittsburgh, Pennsylvania, 15213
University of Pittsburgh Cancer Institute (UPCI)
Pittsburgh, Pennsylvania, 15232
UPMC-Shadyside Hospital
Pittsburgh, Pennsylvania, 15232
UPMC-Passavant Hospital
Pittsburgh, Pennsylvania, 15237
UPMC Washington Hospital Radiation Oncology
Washington, Pennsylvania, 15301
Sanford Cancer Center Oncology Clinic
Sioux Falls, South Dakota, 57104
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota, 57117-5134
Parkland Memorial Hospital
Dallas, Texas, 75235
UT Southwestern/Simmons Cancer Center-Dallas
Dallas, Texas, 75390
UT Southwestern Clinical Center at Richardson/Plano
Richardson, Texas, 75080
Inova Schar Cancer Institute
Fairfax, Virginia, 22031
Inova Fairfax Hospital
Falls Church, Virginia, 22042
Marshfield Medical Center-EC Cancer Center
Eau Claire, Wisconsin, 54701
Marshfield Medical Center-Marshfield
Marshfield, Wisconsin, 54449
Medical College of Wisconsin
Milwaukee, Wisconsin, 53226
Marshfield Clinic-Minocqua Center
Minocqua, Wisconsin, 54548
Marshfield Medical Center-Rice Lake
Rice Lake, Wisconsin, 54868
Marshfield Clinic Stevens Point Center
Stevens Point, Wisconsin, 54482
Marshfield Clinic-Wausau Center
Wausau, Wisconsin, 54401
Diagnostic and Treatment Center
Weston, Wisconsin, 54476
Marshfield Medical Center - Weston
Weston, Wisconsin, 54476
Welch Cancer Center
Sheridan, Wyoming, 82801
References
- Adilbay D, Valero C, Fitzgerald C, Yuan A, Mimica X, Gupta P, Wong RJ, Shah JP, Patel SG, Ganly I, Cohen MA. Outcomes in surgical management of sinonasal malignancy-A single comprehensive cancer center experience. Head Neck. 2022 Apr;44(4):933-942. doi: 10.1002/hed.26989. Epub 2022 Jan 25.(PubMed)