Adult Clinical Trials: HEAD AND NECK

RTOG 0920 

A Phase III Study of Postoperative Radiation Therapy (IMRT) +/- Cetuximab for Locally-Advanced Resected Head and Neck Cancer  

Pathologically (histologically) proven diagnosis of squamous cell carcinoma (including variants such as verrucous carcinoma, spindle cell carcinoma, carcinoma NOS, etc.) of the head/neck (oral cavity, oropharynx or larynx)

• Clinical stage T1, N1-2 or T2-3, N0-2, M0 including no distant metastases; Gross total resection of the primary tumor with curative intent must be completed within 7 weeks of registration with surgical pathology demonstrating one or more of the following "intermediate" risk factors: 
    ◦ Perineural invasion and or Lymphovascular invasion; 
    ◦ Single lymph node > 3cm or > 2 lymph nodes (all < 6cm) (no extracapsular extension); 
    ◦ Close margin (s) of resection, defined as cancer extending to within 5mm of a surgical margin; 
    ◦ T3 or microscopic T4a primary tumor (Note: Gross T4a or T4b is ineligible); 
    ◦ T2 oral cavity cancer with > 5mm depth of invasion.
• Adequate bone marrow, hepatic, and renal function as specified in the protocol;
• Patients must provide study specific informed consent prior to study entry, including consent for mandatory tissue submission for EGFR and for oropharyngeal patients, HPV analyses. 

Treatment:
Arm 1:  Radiation Therapy Alone, 2 Gy/day, in 30 fractions for a total of 60 Gy* 
Arm 2:  Radiation Therapy + Cetuximab

  • At least 5 days prior to RT: Cetuximab: Initial dose, 400 mg/m2
  • RT: 2 Gy/day in 30 fractions for a total of 60 Gy* plus cetuximab, 250 mg/m2/week x 6 weeks
  • plus cetuximab: 250 mg/m2/week x 4 weeks post-RT


*IMRT is mandatory. Dose is 60 Gy prescribed to at least 95% of the PTV. If IGRT is used, it should be daily to assure that error/variance is < 3.5 mm. Note: 66 Gy is permitted and optional.

Note: Prior to stratification and randomization, all patients must consent to submission of tissue for required EGFR analysis; analysis results are expected in approximately 7-8 business days. At that time, patients with non-oropharyngeal carcinoma can be randomized. In addition, patients with oropharyngeal carcinoma must consent to use of the submitted tissue for required HPV analysis; analysis results are expected in approximately 7-10 business days. At that time, patients with oropharyngeal carcinoma can be randomized. All institutions will receive a 0.5 case credit for submission of tissue for analysis. See Section 5.5 for details of registration/randomization.

RTOG 1008
A Randomized Phase II Study of Adjuvant Concurrent Radiation and Chemotherapy Versus Radiation Alone in Resected High-Risk Malignant Salivary Gland Tumors

  • Pathologically proven diagnosis of a malignant major salivary gland tumor of the following histologic subtypes: high grade mucoepidermoid carcinoma, salivary duct carcinoma or high grade adenocarcinoma
  • Surgical resection with curative intent within 8 weeks prior to registration; Pathologic stage T3-4 or N1-3 or T1-2, N0 with a close (<1mm) or microscopically positive surgical margin
  • Women of childbearing potential and male participants who are sexually active must practice adequate contraception during treatment and for 6 weeks following treatment.
  • Patients must be deemed able to comply with the treatment plan and follow-up schedule.

Treatment
Arm 1: Radiation: 60-66 Gy in 2 Gy daily fractions and Cisplatin: 40 mg/m2 weekly during radiation
for 7 doses
Arm 2: Radiation: 60-66 Gy in 2 Gy daily fractions