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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT04850170
Other study ID # 202002052A3
Secondary ID CMRPVVL0081
Status Recruiting
Phase N/A
First received
Last updated
Start date August 1, 2021
Est. completion date December 31, 2025

Study information

Verified date April 2021
Source Chang Gung Memorial Hospital
Contact Tsung-Hsien Yang, MD
Phone 886-975-362-728
Email cgupanda@gmail.com
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The subjects in this study are the patients with head and neck cancer after completion of the radiotherapy. Radiation-induced fibrosis is inevitable and there is no effective treatment to prevent it. Therefore, there are two parts in this study : The first part is a pilot study. There will be 10 subjects included and manual therapy and rehabilitation will be arranged for 6 months. The manual therapy would be once a week at most, and the rehabilitation would be twice a week at most. The second part is a randomized controlled study. 60 patients would be randomized divided into two groups. The group 1 is manual therapy(once a week at most) and rehabilitation(twice a week at most), and the group 2 is rehabilitation only(twice a week at most). Patients would be evaluated at baseline, 3rd, 6th, and 12th month. The evaluation is including the degree of superficial soft tissue fibrosis, numerical rating scale of pain, range of motion(neck), range of motion(shoulder), width of mouth opening, EORTC QLQ C30, EORTC QLQ H&N 35, and functional oral intake scale. Besides, swallowing video fluoroscopy would be done at baseline, 6th, and 12th month. When the subject completes the evaluation in the 12th month, the study is ended. Because the radiation-induced fibrosis is progressed with time, we will follow up the condition of subjects at the next year and the following third year.


Recruitment information / eligibility

Status Recruiting
Enrollment 70
Est. completion date December 31, 2025
Est. primary completion date December 31, 2023
Accepts healthy volunteers No
Gender All
Age group 20 Years and older
Eligibility Inclusion Criteria : 1. Age > 20 years 2. Head and neck cancer 3. After Completion of radiation therapy for 4 to 6 weeks 4. Be willing to accept manual therapy and long-term follow up Exclusion Criteria : 1. Recurrence, metastatic cancer, or concurrent second cancer 2. With post-radiation dermatitis at neck or shoulder 3. Current pregnancy or lactation 4. Life expectancy of < 12 months.

Study Design


Related Conditions & MeSH terms


Intervention

Procedure:
manual therapy
release and stretch the muscles and fascia around shoulder girdle?upper arm and forearm; massage the masseter muscle and temporalis muscle; mobilization of the temporomandibular joint, the thoracic and cervical spine, shoulder, and elbow.
Speech therapy
include the stretching of the neck, facial and oral movement training, and swallowing training

Locations

Country Name City State
Taiwan New Taipei Municipal Tucheng Hospital New Taipei City

Sponsors (1)

Lead Sponsor Collaborator
Chang Gung Memorial Hospital

Country where clinical trial is conducted

Taiwan, 

References & Publications (8)

Davis AM, Dische S, Gerber L, Saunders M, Leung SF, O'Sullivan B. Measuring postirradiation subcutaneous soft-tissue fibrosis: state-of-the-art and future directions. Semin Radiat Oncol. 2003 Jul;13(3):203-13. Review. — View Citation

Hojan K, Milecki P. Opportunities for rehabilitation of patients with radiation fibrosis syndrome. Rep Pract Oncol Radiother. 2013 Aug 8;19(1):1-6. doi: 10.1016/j.rpor.2013.07.007. eCollection 2014 Jan. Review. — View Citation

Krisciunas GP, Golan H, Marinko LN, Pearson W, Jalisi S, Langmore SE. A novel manual therapy programme during radiation therapy for head and neck cancer - our clinical experience with five patients. Clin Otolaryngol. 2016 Aug;41(4):425-31. doi: 10.1111/coa.12535. Epub 2016 Feb 8. — View Citation

Krisciunas GP, Vakharia A, Lazarus C, Taborda SG, Martino R, Hutcheson K, McCulloch T, Langmore SE. Application of Manual Therapy for Dysphagia in Head and Neck Cancer Patients: A Preliminary National Survey of Treatment Trends and Adverse Events. Glob Adv Health Med. 2019 Apr 24;8:2164956119844151. doi: 10.1177/2164956119844151. eCollection 2019. — View Citation

Moloney EC, Brunner M, Alexander AJ, Clark J. Quantifying fibrosis in head and neck cancer treatment: An overview. Head Neck. 2015 Aug;37(8):1225-31. doi: 10.1002/hed.23722. Epub 2014 Jul 11. Review. — View Citation

Purkayastha A, Sharma N, Sarin A, Bhatnagar S, Chakravarty N, Mukundan H, Suhag V, Singh S. Radiation Fibrosis Syndrome: the Evergreen Menace of Radiation Therapy. Asia Pac J Oncol Nurs. 2019 Jul-Sep;6(3):238-245. doi: 10.4103/apjon.apjon_71_18. Review. — View Citation

Raj VS, Pugh TM, Yaguda SI, Mitchell CH, Mullan SS, Garces NS. The Who, What, Why, When, Where, and How of Team-Based Interdisciplinary Cancer Rehabilitation. Semin Oncol Nurs. 2020 Feb;36(1):150974. doi: 10.1016/j.soncn.2019.150974. Epub 2020 Jan 16. Review. — View Citation

Wang B, Wei J, Meng L, Wang H, Qu C, Chen X, Xin Y, Jiang X. Advances in pathogenic mechanisms and management of radiation-induced fibrosis. Biomed Pharmacother. 2020 Jan;121:109560. doi: 10.1016/j.biopha.2019.109560. Epub 2019 Nov 15. Review. — View Citation

Outcome

Type Measure Description Time frame Safety issue
Primary Change from Baseline range of motion, neck at the 3rd month including neck flexion, extension, right and left lateral flexion, and lateral rotation baseline and 3rd month
Primary Change from Baseline Functional oral intake scales at 3rd month in this scales, the maximum values is grade seven, the minimum values is grade one. The higher scores mean a better outcome. baseline and 3rd month
Secondary range of motion, shoulder to measure the degree of bilateral shoulder, including flexion, extension, abduction, adduction, external rotation, and internal rotation measure the range of motion at baseline, the 3rd month, the 6th month, the 12th month, the second year, and the third year
Secondary Width of mouth opening measure the maximum interincisal opening and range of the jaw and mouth at baseline, the 3rd month, the 6th month, the 12th month, the second year, and the third year
Secondary EORTC QLQ C30 the most widely used questionnaire for cancer patients; explore aspects of quality of life assessment, evaluation and interpretation. at baseline, the 3rd month, the 6th month, the 12th month, the second year, and the third year
Secondary EORTC H&N 35 questionnaire for head and neck cancer patients. at baseline, the 3rd month, the 6th month, the 12th month, the second year, and the third year
Secondary Numerical rating scale of pain evaluate the pain degree(0~10); higher scores mean a worse outcome at baseline, the 3rd month, the 6th month, the 12th month, the second year, and the third year
Secondary Swallowing Video Fluoroscopy Observe that the patient swallows items with different thicknesses and textures via using a special real-time form of x-ray. This examination allows us to test the ability to swallow safely and effectively. at baseline, the 6th month, and the 12th month
Secondary Change from Baseline range of motion, neck at the the 6th month including neck flexion, extension, right and left lateral flexion, and lateral rotation baseline and 6th month
Secondary Change from Baseline range of motion, neck at the the 12th month including neck flexion, extension, right and left lateral flexion, and lateral rotation baseline and 12th month
Secondary Change from Baseline range of motion, neck at the the 2nd year including neck flexion, extension, right and left lateral flexion, and lateral rotation baseline and 2nd year
Secondary Change from Baseline range of motion, neck at the the 3rd year including neck flexion, extension, right and left lateral flexion, and lateral rotation baseline and 3rd year
Secondary Change from Baseline Functional oral intake scales at 6th month in this scales, the maximum values is grade seven, the minimum values is grade one. The higher scores mean a better outcome. baseline and 6th month
Secondary Change from Baseline Functional oral intake scales at 12th month in this scales, the maximum values is grade seven, the minimum values is grade one. The higher scores mean a better outcome. baseline and 12th month
Secondary Change from Baseline Functional oral intake scales at 2nd year in this scales, the maximum values is grade seven, the minimum values is grade one. The higher scores mean a better outcome. baseline and 2nd year
Secondary Change from Baseline Functional oral intake scales at 3rd year in this scales, the maximum values is grade seven, the minimum values is grade one. The higher scores mean a better outcome. baseline and 3rd year