Head and Neck Neoplasms Clinical Trial
Official title:
Dutch Randomized Multicenter Trial COmparing twO PalliativE RAdiaTION Schemes for Incurable Head and Neck Cancer (COOPERATION)
RCT to compare two radiation schemes for palliative HeadNeck cancer
A substantial proportion of patients with head and neck (HNC) are not suitable for curative
treatment with surgery and/or (chemo)radiotherapy (CRT) because of very advanced stage,
significant comorbidities, bad general condition, distant metastasis, or a combination of
these factors. Although radiotherapy (RT) is a commonly used option to achieve durable
disease control and to alleviate troublesome symptoms, the data about the optimal radiation
scheme and the impact of these schedules on quality of life (QoL) of these vulnerable
patients is extremely scarce.
Although different radiation schemes are used worldwide (in the Netherlands, at least 15
different radiation schedules are used), it is currently not possible to identify the best RT
scheme, based only on retrospective studies because of the major differences between these
studies with regard to patient's demographics, radiation schedules given, the radiation
technique used etc. Furthermore, no any information is available on the impact of these
schemes on treatment-related toxicity and QoL.
This illustrates the urgent need for a multicenter randomized controlled trial (RCT) to
identify the most optimal schemes of RT for this group of patients. Therefore, the
investigators intend to initiate a prospective RCT comparing the survival, loco-regional
control, toxicity, and QoL of two commonly used schemes. This study will be the first of his
kind for palliative patients with HNC and will compare a short-course (6 fractions) with a
long-course of radiotherapy (16 fractions). Because most of patients with incurable HNC have
a poor performance status and major comorbidity and prefer limited number of visits to the
hospital, it is quite reasonable to investigate whether a short scheme of radiotherapy with
limited number of visits to the clinic as good as a relatively long-course of radiotherapy in
terms of outcome, toxicity and QoL. This delicate balance between outcomes, possible toxicity
and patient's comfort would justify the initiation of such randomized trial. The results of
this study will in the nearby future enable us to indicate the radiation scheme best suits
which patient category
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