Early Nutritional Intervention in NPC Patients Undergoing Concurrent Chemoradiotherapy

Malnutrition Clinical Trial

Official title:

A Randomized Controlled Trial of an Early Oral Nutritional Supplements Intervention Versus a Conventional Nutritional Intervention in Patients With Locally Advanced Nasopharyngeal Carcinoma Undergoing Concurrent Chemoradiotherapy

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04810936
• Other study ID #: GDREC2018296H(R1)
• Status: Recruiting
• Phase: N/A
• Start date: July 26, 2019
• Est. completion date: December 31, 2022

Study information

• Verified date: March 2021
• Source: Guangdong Provincial People's Hospital
• Contact: Yi Pan, Prof.
• Phone: +86020-83827812
• Email: panyiff01[@]163.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This single center, open-label, randomized controlled clinical trial was designed to investigate whether early nutritional intervention with oral nutrition supplements in patients with nasopharyngeal carcinoma undergoing chemoradiotherapy will improve nutritional status, quality of life and treatment tolerance.

Description:

Concurrent chemoradiotherapy is the standard treatment for locally advanced nasopharyngeal carcinoma (NPC). During chemoradiotherapy, malnutrition is present in 44-88% patients which is associated with adverse clinical outcomes. Although patients receive conventional nutritional intervention recommended by The European Society for Clinical Nutrition and Metabolism guidelines, there are still 35% NPC patients suffering from malnutrition during chemoradiotherapy.

Recent studies have shown that early nutritional intervention before radiotherapy reduced the prevalence of malnutrition. However, there are few randomized controlled clinical studies comparing early oral nutritional supplements (ONS) intervention to conventional nutritional intervention in NPC patients undergoing chemoradiotherapy.

This single center, open-label, randomized controlled clinical trial was designed to investigate whether early ONS intervention compared to conventional nutritional intervention improves nutritional status, treatment tolerance and quality of life, and decreases the incidence of grade 3-4 treatment related side-effects in NPC patients undergoing chemoradiotherapy.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 272
• Est. completion date: December 31, 2022
• Est. primary completion date: December 31, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 74 Years

Eligibility

Inclusion Criteria:

• Pathologically confirmed nasopharyngeal carcinoma (NPC).

• The clinical stage of NPC is T1-4 N1-3 M0 (AJCC 7th edition).

• Planned to receive concurrent chemoradiotherapy with intensity-modulated radiation therapy (IMRT).

• Age = 18 years and < 75 years.

• Performance status (PS) score 0-1.

• NRS2002<3 .

• Blood regular test should be satisfied the following conditions: white blood cell count =3.5×109/L, Neutrophil count =1.5×109/L,platelet count =100×109/L,hemoglobin =10g/L

• Liver and kidney functions test should be satisfied the following conditions:

aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) < 2.5 times the upper limit of normal value, bilirubin < 1.2 times the upper limit of normal value, creatinine < 1.2 times the upper limit of normal value, and alkaline phosphatase < 5 times the upper limit of normal value.

• Could complete required oral nutrition, questionnaire survey and follow-up.

• Signed informed consent voluntarily.

Exclusion Criteria:

• Had a history of head and neck radiotherapy.

• Known allergic reaction to any component of ONS, or severe allergic constitution.

• With any unstable systemic disease (such as uncontrolled infectious diseases, uncontrolled hypertension, uncontrolled metabolic diseases and so on).

• Serious cardiovascular diseases in 6 months (such as Congestive heart failure and myocardial infarction).

• Pregnancy and lactation.

• Other conditions that the investigators consider as inappropriate for enrolling into this study.

• Has a history of malignant tumors in 5 years, except for tumors that have been cured only by surgery and with a disease free survival for five years, cured basal cell carcinoma of skin and cured carcinoma in situ of the cervix.

Related Conditions & MeSH terms

• Carcinoma
• Malnutrition
• Nasopharyngeal Carcinoma

Intervention

Dietary Supplement:
• oral nutritional supplements
Oral nutritional supplements is usually administrated to improve nutritional status in cancer patients.

Locations

Country	Name	City	State
China	Guangdong Provincial People's Hospital	Guangzhou	Guangdong

Sponsors (1)

Lead Sponsor	Collaborator
Guangdong Provincial People's Hospital

Country where clinical trial is conducted

China, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The percentage of patients who lose >5% of initial body weight	Assess body weight at the end of radiotherapy (the weight at the end of radiotherapy - the weight at the beginning of radiotherapy) / the weight at the beginning of radiotherapy *100 %.	7 weeks
Secondary	Weight loss at the last day of radiotherapy	The changes of weight at the last day of radiotherapy	7 weeks
Secondary	Weight loss at the end of 4th week	The changes of weight at the end of 4th week	11 weeks
Secondary	Patient-generated Subjective Global Assessment (PG-SGA) at the end of the 2nd week, 4th week, the last day of radiotherapy and 1 month after radiotherapy	PG-SGA at the end of the 2nd week, 4th week, the last day of radiotherapy and 1 month after radiotherapy	11 weeks
Secondary	Incidence of radiation induced grade 3-4 mucositis (CTCAE 4.03) at the end of 4th week and the last day of radiotherapy	Incidence of radiation induced grade 3-4 mucositis at the end of 4th week and the last day of radiotherapy	7 weeks
Secondary	Incidence of any grade 3-4 side-effect (CTCAE 4.03).	Incidence of any grade 3-4 side-effect induced by radiotherapy or chemotherapy during chemoradiotherapy	7 weeks
Secondary	Incidence of prolonged radiation treatment time caused by side-effects	Incidence of prolonged radiation treatment time caused by chemoradiation related side-effects. Prolonged radiation treatment time is defined as the overall treatment time is longer than plan	7 weeks
Secondary	Days prolonged more than planed treatment time caused by side-effects	Days prolonged more than planed treatment time caused by chemoradiation related side-effects	7 weeks
Secondary	Incidence of unplanned hospitalization in 3 months after radiation	Incidence of unplanned hospitalization in 3 months after radiation. Unplanned hospitalization is defined as hospitalization caused by chemoradiotherapy related side effects	5 months
Secondary	The changes of QOL-C30 at the end of radiation, the 1st and the 3rd month after radiation as compared with the beginning of radiation	The changes of QOL-C30 at the end of radiation, the 1st and the 3rd month after radiation as compared with the beginning of radiation	5 months
Secondary	The treatment time of parenteral nutrition (PN) treatment	PN should be started if enteral nutrition (EN) is anticipated (60% of estimated energy expenditure) for more than 10 days. The treatment time of PN should be recorded	5 months
Secondary	The changes of EORTC Quality of LifeQuestionnaire (QLQ)-H&N35 at the end of radiation, the 1st and the 3rd month after radiation as compared with the beginning of radiation	The changes of EORTC Quality of LifeQuestionnaire (QLQ)-H&N35 at the end of radiation, the 1st and the 3rd month after radiation as compared with the beginning of radiation	5 months