"I am glad that taking part in a trial might help others on their own cancer journey.”
A trial of proton beam radiotherapy for oropharyngeal cancer (TORPEdO)
More about this trial
Doctors can treat oropharyngeal cancer with a combination of chemotherapy and radiotherapy (
Intensity modulated radiotherapy (IMRT) is a type of conformal radiotherapy. Conformal radiotherapy shapes the radiation beams to closely fit the area of cancer.
They can form shapes that fit precisely around the treatment area. The lead leaves within the machine can move while the machine moves around the patient. This then shapes the beam of radiation to the tumour as the machine rotates.
This means that the tumour receives a very high dose and normal healthy cells nearby receive a much lower dose.
Each radiotherapy beam is divided into many small beamlets that can vary the intensity of radiation. This allows different doses of radiation to be given across the tumour.
Chemoradiotherapy works well at curing oropharyngeal cancers but the IMRT can cause short and long term side effects. These side effects can affect your quality of life.
Proton beam radiotherapy works differently to IMRT. Protons treat cancer by producing a burst of energy when they stop. So by directing the proton beams at a cancer and making them stop inside the tumour, they destroy the cancer. And they deliver less dose to the nearby healthy cells.
So researchers think it might cause fewer side effects.
Research and the use of proton beam radiotherapy in other countries show that it is safe and works well for cancer.
The main aim of this trial is to find if proton beam radiotherapy causes fewer side effects than IMRT.
Who can enter
The following bullet points list the entry conditions for this trial. Talk to your doctor or the trial team if you are unsure about any of these. They will be able to advise you.
Who can take part
You may be able to join the trial if your cancer is or isn’t caused by the
The cancer must be:
- less than 4cm across (stage T1, T2) with cancer in the l
ymph node(s) of the neck(N1, N2) or
- more than 4cm across (stage T3, T4) with or without cancer in the lymph nodes of the neck (N0, N1, N2)
And all of the following apply. You:
squamous cell canceroropharyngeal cancer
- are to have chemotherapy with radiotherapy (chemoradiotherapy) with radiotherapy to both sides of the neck
- are able to have at least 1
cycle of treatmentwith cisplatin
- are fully active but might not be able to do heavy physical work (performance status 0 or 1)
- have satisfactory blood test results
- are willing to use contraception during treatment and for 2 weeks after radiotherapy if you or your partner could become pregnant
- are at least 18 years old
Who can’t take part
You cannot join this trial if any of these apply. You:
- have a very large lymph node that is more than 6cm in length or for HPV negative cancer the lymph node is very large and or fixed to the muscle or skin (N3)
- have a feeding tube because you are unable to swallow. You can join if have a feeding tube just in case it is needed.
- are having surgery to your neck
- have had radiotherapy to your head or neck
- have major surgery within 6 months of joining the trial
- have a device in place that helps your heartbeat (pacemaker) or corrects your heartbeat (cardioverter-defibrillator)
- have had another cancer in the past 2 years apart from
non melanoma skin cancerand in situ carcinomaof the cervix
- have an active infection
- have or had heart problems such as congestive heart failure that caused symptoms, heart attack, an abnormal heart rhythm or chest pain (angina) that happens when resting or doing very little
- have or had a stomach (peptic) ulcer or inflammation of the lining of the stomach (gastritis)
- have any other medical condition or mental health problem that your doctor or the trial team think could affect you taking part
- have problems with talking or swallowing that isn’t due to cancer that your doctor think could affect you taking part
- are pregnant or breastfeeding
There is a sub study at The Christie Hospital in Manchester. This sub study is looking at whether a certain type of
You cannot join this sub study if any of the following apply. You:
- can’t have an MRI scan
- are allergic to or have reacted to the
contrast mediumcalled Gadolinium
This is a phase 3 trial. The trial team need 183 people to join.
Everyone has chemoradiotherapy.
The radiotherapy part is randomised. You have either:
- intensity modulated radiotherapy (IMRT) or
- proton beam radiotherapy
Neither you nor your doctor can choose which group you are in.
Out of every 3 people who join, 2 people go into the proton beam group and 1 person goes into the IMRT group.
You have radiotherapy for 6½ weeks. This is once a day Monday to Friday.
You have a planning appointment before starting treatment. This is to work out where to give the radiotherapy and how much to give.
You have a shell (mask) made to fit over your head and shoulders. You can see through the mask. It takes about 30 minutes to make. You use the shell for your planning appointment and when you have treatment.
Planning the radiotherapy takes about 45 minutes.
For treatment after you lie down on the radiotherapy couch. The
People in the IMRT group have their planning and treatment at their local hospital.
People in the proton beam group have their planning and treatment at either:
- The Christie Hospital, Manchester or
- University College Hospital, London
The proton beam key worker will arrange accommodation that is near the hospital if you don’t live in Manchester or London. You can have someone stay with you.
Quality of life
You fill in questionnaires:
- before starting treatment
- at the end of treatment
- 6 weeks after the end of treatment
- at 3 months then
- every 6 months to 2 years
- every year to 5 years
The questions ask about:
- any symptoms
- any side effects
- what you can do
This is a quality of life questionnaire.
You give blood samples a number of times during the trial. Researchers will use these to find out more about why some people have more side effects from radiotherapy than others. They will also be available for other researchers to use in the future.
You don’t have to agree to give these samples. You can still take part in the trial.
Sub studies at The Christies Hospital
The trial team will ask people from both groups having treatment at The Christie Hospital to take part in one or both sub studies.
The first is looking at a type of
The second is looking at how treatment affects cancer in the lymph nodes. This is for people who have cancer in the lymph nodes of the neck. For this sub study the team take a sample of tissue from the lymph node:
- before starting treatment and
- during the 3rd week of treatment
You don’t have to agree to take part in either of these sub studies.
You see the doctor to have some tests before taking part. These tests include:
- a CT scan and an MRI scan or CT scan and PET-CT scan
- heart trace (
- blood tests
- hearing test
- a jaw opening test
- swallowing test
- examination of the teeth (dental examination}
You see the doctor every week during treatment to see how you are and for blood tests.
You have a planning CT scan at week 3.
At the end of treatment you see the doctor for a physical examination and blood tests. You then see the doctor at:
- 6 weeks
- 3 months
- 6 months
- 1 year
- 1 ½ years
- 2 years then
- every year to 5 years
The trial team monitor you during treatment and afterwards. Contact your advice line or tell your doctor or nurse if any side effects are bad or not getting better.
Proton beam radiotherapy might have fewer side effects than IMRT but this isn’t known for sure. And this is one of the things researchers are trying to find out.
During your treatment side effects usually build up gradually. Most people experience some side effects. They are usually at their worst by week 5 to 6 of your treatment and continue at their peak for 2 weeks after completion of your treatment. Then over the next 4 weeks or so your treatment side effects will slowly start to get better.
Side effects of radiotherapy to this area of your body can include:
- tiredness or fatigue
- sore red skin to the treatment area (like a sunburn reaction)
- weight loss
- a sore throat and mouth (your throat may become more sore as you go through treatment)
- pain when swallowing
- difficulty swallowing
- a dry mouth
- loss of taste or a change in taste
- changes to your voice
We have more information about the long term side effects of radiotherapy.
Your doctor or a member of the trial team will talk to you about the possible side effects before you agree to take part.
How to join a clinical trial
Dr David Thomson
Cancer Research UK
Institute of Cancer Research (ICR)
The Taylor Family Foundation
This is Cancer Research UK trial number CRUK/18/010.