MRI-Guided Radiotherapy for Head and Neck Cancer

Overseen By Kevin Samnarine

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: H. Lee Moffitt Cancer Center and Research Institute

Disqualifiers: Pregnancy, Prior radiotherapy, Metastatic disease, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 6 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 10 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether MRI, an imaging technique that provides detailed internal body pictures, can help adjust radiation therapy for head and neck cancer. The goal is to personalize treatment by using MRI to target cancer more accurately while adhering to standard care guidelines. Individuals with squamous cell carcinoma in areas such as the mouth, throat, or voice box, who have not undergone prior radiation or surgery for their cancer, might be suitable candidates. As an unphased trial, this study offers a unique opportunity to contribute to innovative research that could enhance future cancer treatments.

Will I have to stop taking my current medications?

The trial protocol does not specify if you need to stop taking your current medications. However, if you are on a stable dose of a medication like warfarin and have no issues with blood clotting, you may still participate.

What prior data suggests that this MRI-guided radiotherapy technique is safe for head and neck cancer patients?

Research has shown that magnetic resonance-guided radiotherapy (MRgRT) is generally manageable for patients with head and neck cancer. Studies have found that MRgRT allows doctors to accurately target tumors while protecting nearby healthy tissue, reducing side effects compared to traditional methods.

Reports from previous studies suggest that patients experienced fewer negative reactions with MRgRT. The treatment uses high-quality imaging to adjust to changes in the body, limiting unnecessary radiation exposure.

Overall, evidence on MRgRT's safety is encouraging. Patients receiving this therapy have reported manageable side effects, making it a safe option for many with head and neck cancer. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about MRI-guided radiotherapy for head and neck cancer because it offers a more precise approach to targeting tumors compared to standard intensity-modulated radiotherapy (IMRT). This method allows for adaptive radiotherapy, which means the treatment plan can be adjusted in real-time based on daily MRI scans, potentially leading to better tumor control and reduced side effects. Unlike traditional treatments that rely on static planning, this technique tailors each session to the patient's current anatomy, providing a truly personalized treatment experience.

What evidence suggests that MRI-guided radiotherapy is effective for head and neck cancer?

This trial will evaluate MRI-guided radiotherapy for head and neck cancer. Research has shown that using MRI (magnetic resonance imaging) during radiotherapy can enhance treatment precision. MRI provides clearer images of soft tissues, enabling doctors to target the cancer more accurately. Studies have found that this method can adapt to changes in the tumor's size or position, potentially increasing treatment effectiveness. Using MRI during radiotherapy allows for real-time adjustments, better protecting healthy tissues and reducing side effects. Overall, promising evidence suggests that MRI-guided radiotherapy could be an effective option for treating head and neck squamous cell carcinoma. ^{1 2 3 6 7}

Who Is on the Research Team?

George Yang, MD

Principal Investigator

Moffitt Cancer Center

Are You a Good Fit for This Trial?

This trial is for adults with squamous cell carcinoma of the head and neck who haven't had surgery, radiotherapy, or systemic therapy for their cancer. They must be able to have MRIs (no pacemakers or certain metals in body), not pregnant, willing to follow study rules, and have a good performance status indicating they can carry out daily activities.

Inclusion Criteria

I am willing and able to follow all study rules and attend all appointments.

I am fully active or can carry out light work.

I have a confirmed diagnosis of squamous cell carcinoma in specific areas of my head or neck.

Exclusion Criteria

I have received radiation or systemic therapy for my head or neck cancer.

I have had surgery to remove my cancer.

My cancer has spread to distant parts of my body.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Patients undergo adaptive radiotherapy boost for head/neck squamous cell carcinomas, with MR simulation for boost treatment planning.

10 weeks

Weekly visits for treatment

Follow-up

Participants are monitored for safety and effectiveness after treatment

15 months

What Are the Treatments Tested in This Trial?

Interventions

• Intensity-modulated radiotherapy
• Magnetic Resonance Guidance

Trial Overview The trial tests if MRI can help adjust radiation therapy doses during treatment for head and neck cancer. The goal is to personalize the radiation dose based on how well the tumor responds using intensity-modulated radiotherapy within standard care guidelines.

How Is the Trial Designed?

Group I: Adaptive Radiotherapy treatment Experimental Treatment 2 Interventions

Patients will undergo adaptive radiotherapy boost for head/neck squamous cell carcinomas. A base conventional IMRT plan of 46-50Gy in 2 Gy to gross disease in the primary/nodes and 41.4-45 Gy in 1.8 Gy to the elective nodes per fraction will be utilized. The MR simulation will be utilized for boost treatment planning. Patients will receive their 6th fraction of the week on the adaptive platform treating the gross disease until completion of the base plan to 20 Gy in 2Gy daily fractions (10 fractions). Each ART treatment will be recontoured/replanned by the treating head/neck radiation oncologist as deemed clinically or dosimetrically necessary.

Intensity-modulated radiotherapy is already approved in European Union, United States, Canada, Japan, China, Switzerland for the following indications:

Approved in European Union as IMRT for:

• Head and neck cancers
• Brain tumors
• Prostate cancer

Approved in United States as IMRT for:

• Head and neck cancers
• Brain tumors
• Prostate cancer
• Breast cancer

Approved in Canada as IMRT for:

• Head and neck cancers
• Brain tumors
• Prostate cancer

Approved in Japan as IMRT for:

• Head and neck cancers
• Brain tumors
• Prostate cancer

Approved in China as IMRT for:

• Head and neck cancers
• Brain tumors
• Prostate cancer

Approved in Switzerland as IMRT for:

• Head and neck cancers
• Brain tumors
• Prostate cancer

Who Is Running the Clinical Trial?

H. Lee Moffitt Cancer Center and Research Institute

Lead Sponsor

Trials

576

Recruited

145,000+

Published Research Related to This Trial

Intensity-modulated radiation therapy (IMRT) significantly reduces the incidence of severe xerostomia (dry mouth) in patients with head and neck cancer compared to traditional 2D and 3D radiation therapies, as shown in a review of five randomized trials involving 871 patients.

IMRT provides these benefits without compromising loco-regional control or overall survival rates, indicating it is a safer and more effective option for managing head and neck cancers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intensity-modulated radiation therapy for head and neck cancer: systematic review and meta-analysis. Marta, GN., Silva, V., de Andrade Carvalho, H., et al.[2022]

A study involving 30 patients with advanced laryngeal cancer showed that dose-escalated chemo-IMRT is safe and feasible, with no acute grade 4 toxicities observed and good compliance to treatment.

Complete response rates were high, with 80% in the lower dose group and 87% in the higher dose group, indicating that higher radiation doses can be delivered without significantly increasing acute toxicity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A phase I study of dose-escalated chemoradiation with accelerated intensity modulated radiotherapy in locally advanced head and neck cancer. Guerrero Urbano, T., Clark, CH., Hansen, VN., et al.[2007]

Both MV-kV and CBCT imaging modalities produced similar setup error measurements for head-and-neck cancer patients, indicating that either method can be effectively used for image-guided radiation therapy.

MV-kV imaging was significantly faster and delivered a lower radiation dose (6.88 mGy) compared to CBCT (17.2 mGy), suggesting it could be a suitable alternative when reduced imaging time is necessary.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Setup margin for head-and-neck cancer patients receiving 2D-2D and 3D image-guided intensity-modulated radiation therapy]. Kovács, P., Szita, E., Schvarcz, K., et al.[2018]

In a study of 48 patients with aggressive extranodal non-Hodgkin lymphomas, those treated with image-guided intensity-modulated radiotherapy (IG-IMRT) showed a higher overall response rate (85%) compared to those receiving conventional radiotherapy (CRT) (73%).

IG-IMRT was associated with fewer acute and chronic side effects, suggesting a better safety profile while also indicating a trend towards improved survival outcomes, although the difference in 5-year overall survival rates was not statistically significant.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intensity-modulated Radiotherapy in Patients With Aggressive Extranodal Non-Hodgkin Lymphoma of the Head and Neck. Eismann, J., Elsayad, K., Rolf, D., et al.[2021]

Intensity-modulated radiation therapy (IMRT) allows for more precise radiation delivery in head and neck cancers, improving local control of tumors while minimizing damage to critical structures like the spine and parotid glands.

IMRT has been shown to preserve salivary function by sparing the parotid glands, although there are ongoing concerns about potential side effects, such as difficulties with swallowing and the risk of secondary cancers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intensity-modulated radiotherapy for head and neck cancer. Caglar, HB., Allen, AM.[2007]

Intensity-modulated radiation therapy (IMRT) offers improved dose targeting, which may reduce normal tissue damage compared to traditional radiation methods, making it a promising option in radiation oncology.

While preliminary results for IMRT in treating head and neck and prostate cancers are encouraging, the clinical data is still developing, and the number of patients studied remains relatively small.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intensity-modulated radiation therapy: emerging cancer treatment technology. Hong, TS., Ritter, MA., Tomé, WA., et al.[2018]

Intensity-modulated radiation therapy (IMRT) shows promise in treating head and neck cancer by delivering precise radiation doses, which may reduce side effects compared to traditional methods.

While advancements in IMRT techniques and target selection are being made, there is still a lack of mature clinical data to fully establish its safety and efficacy in head and neck cancer treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intensity-modulated radiation therapy in the management of head and neck cancer. Hong, TS., Tomé, WA., Harari, PM.[2019]

Intensity-modulated radiation therapy (IMRT) offers improved tumor control in head and neck cancer by delivering optimized, nonuniform radiation doses that spare surrounding healthy tissues.

Clinical studies have shown that IMRT significantly reduces the incidence of xerostomia (dry mouth) without compromising the effectiveness of cancer treatment, provided that careful planning and target delineation are followed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intensity-modulated radiation therapy for head and neck cancer. Ozyigit, G., Yang, T., Chao, KS.[2022]

Intensity-modulated radiotherapy (IMRT) offers significantly higher conformality in dose distribution compared to conventional 3-D conformal radiotherapy (3-DCRT), making it particularly beneficial for treating head and neck cancers where precise dosage is crucial.

IMRT allows for higher doses to be delivered to primary tumors while sparing surrounding healthy tissues, which can improve treatment outcomes and reduce side effects, especially in the context of recurrent head and neck malignancies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intensity-modulated radiotherapy for carcinoma of the head and neck. Peñagarícano, JA., Papanikolaou, N.[2019]

Intensity modulated radiation therapy (IMRT) represents a major advancement in treating cancers located near sensitive organs, such as those in the head and neck and prostate, by allowing for precise targeting of tumor volumes.

IMRT has been shown to significantly reduce xerostomia (dry mouth) and improve quality of life for head and neck cancer patients, while also enabling high radiation doses (76-80 Gy) for prostate cancer without causing serious late toxicities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Intensity modulated radiation therapy]. Nishimura, Y.[2015]

Intensity-modulated radiation therapy (IMRT) allows for higher doses of radiation to be delivered precisely to cancerous areas while minimizing exposure to surrounding healthy tissues, which can improve safety and reduce side effects.

IMRT is particularly beneficial for treating head and neck cancers due to the close proximity of tumors to critical structures, although there are concerns about the potential long-term risks of radiation exposure to non-target tissues, especially in younger patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intensity-modulated radiation therapy in the treatment of head and neck cancer. Eisbruch, A.[2018]

In a study of 103 head and neck cancer patients using intensity-modulated radiotherapy (IMRT), less-than-daily image-guided radiotherapy (RT) strategies showed a high risk of geometric misses, particularly with 3-mm uncertainty margins, where misses ranged from 15.7% to 50.5% depending on the imaging frequency.

To reduce the risk of treatment misses, the study suggests that less-than-daily RT protocols should use at least 5-mm margins, as this significantly lowers the incidence of geometric errors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of daily versus nondaily image-guided radiotherapy protocols for patients treated with intensity-modulated radiotherapy for head and neck cancer. Yu, Y., Michaud, AL., Sreeraman, R., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8911481/

Magnetic Resonance Guided Radiotherapy for Head and ... This article provides an overview of the literature supporting the current use of MRgRT for HNSCC, challenges with its use, and developing research areas.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9689607/

Magnetic Resonance-Guided Radiation Therapy for Head ... This article offers a structured review of the current literature on these established and upcoming roles of MRI for patients with head and neck cancer ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S1053429623000589

The Use of MR-Guided Radiation Therapy for Head and ... Goals of this article is to present and explain all different aspects of MR-guidance for radiotherapy of head and neck cancer, summarize evidence, as well as ...

4. frontiersin.org frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.616156/full

MR-Guided Radiotherapy for Head and Neck Cancer In general, the use of MRI during the course of HNC treatment is beneficial because of the superior soft-tissue contrast, thereby allowing for more precise ...

5. researchgate.net researchgate.net/publication/358981420_Magnetic_Resonance_Guided_Radiotherapy_for_Head_and_Neck_Cancers

Magnetic Resonance Guided Radiotherapy for Head and ... PDF | Radiotherapy is an integral component of head/neck squamous cell carcinomas (HNSCCs) treatment, and technological developments ...

6. ctro.science ctro.science/article/S2405-6308(24)00037-5/fulltext

MR-guided stereotactic radiation therapy for head and ... MRgRT has the advantage of utilizing high soft tissue contrast imaging to precisely track daily changes in target and critical organs, and enhance radiation ...

7. frontiersin.org frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.616156/pdf

MR-Guided Radiotherapy for Head and Neck Cancer The purpose of this article is to summarize and discuss the rationale, recent developments, and future perspectives of this promising ...