LiTEFORM light therapy effectiveness for oral mucositis

ISRCTN	ISRCTN14224600
DOI	https://doi.org/10.1186/ISRCTN14224600
Secondary identifying numbers	33975

Submission date: 27/03/2017
Registration date: 28/03/2017
Last edited: 21/03/2024

Recruitment status: No longer recruiting
Overall study status: Completed
Condition category: Cancer

Prospectively registered

Protocol

Statistical analysis plan

Results

Individual participant data

Plain English summary of protocol

https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-study-looking-at-whether-laser-therapy-helps-reduce-the-pain-and-impact-of-mouth-sores-in-people

Study website

Contact information

Mrs Jenn Bingham
Public

Newcastle Clinical Trials Unit
Newcastle University
1-4 Claremont Terrace
Newcastle upon Tyne
NE2 4AE
United Kingdom

Phone	+44 191 208 2520
Email	jenn.bingham@newcastle.ac.uk

Study information

Study design	Randomized; Interventional; Design type: Treatment, Prevention, Device
Primary study design	Interventional
Secondary study design	Randomised controlled trial
Study setting(s)	Hospital
Study type	Treatment
Participant information sheet	Not available in web format, please use the contact details to request a patient information sheet
Scientific title	A randomised controlled trial of the clinical and cost effectiveness of low level laser in the management of oral mucositis in head and neck cancer irradiation
Study acronym	LiTEFORM
Study objectives	The aim of this study is to establish the benefit of Low Level Laser Therapy delivered 3 times weekly delivered by trained staff in the management of oral mucositis in head and neck cancer irradiation.
Ethics approval(s)	West Midlands - Solihull Research Ethics Committee, 23/03/2017, ref: 17/WM/0096
Health condition(s) or problem(s) studied	Head and neck cancer
Intervention	Patients will be randomised to one of two groups using a method of random permuted blocks of concealed variable block size and stratified by planned treatment (radiotherapy alone or chemo-radiotherapy), and unilateral or bilateral radiotherapy fields. To ensure concealment of allocation, patients will be centrally randomised by the Newcastle Clinical Trials Unit using a secure web-based system. Intervention group: Participants receive LLLT plus standard care 3 times weekly by a non-contact method for a period of 6 weeks (from day 1 of radiotherapy dose). Control group: Participants receive sham LLLT plus standard care 3 times weekly by a non-contact method for a period of 6 weeks (from day 1 of radiotherapy dose). The LLLT will be a red laser, wavelength 660nm, power output 75mW beam area 1.5cm2, irradiance 50mW/cm2, exposure time 60 seconds, fluence 3J/cm2 per spot. LLLT will be administered within 60 minutes before the radiotherapy session, with a minimum of 24 hours between each of the 3 laser therapy sessions. Each session will last 20-30 minutes, with LLLT at 6 pre-determined anatomical sites in the oral cavity. All patients will also receive the standard care offered for oral mucositis by each centre. Standard care varies across NHS Trusts but typically consists of oral hygiene instruction, topical analgesics and coating gels. Follow ups will be done at the week 12, month 4 and month 14 standard care head and neck visits.
Intervention type	Other
Primary outcome measure	Clinical effectiveness and cost effectiveness of LLLT plus standard care vs standard care alone is measured by comparing the OMWQ-HN score at 6 weeks following the start of radiotherapy (+/- 2 weeks) in the two randomised arms.
Secondary outcome measures	1. Effectiveness of LLLT in preventing severe oral mucositis during radiotherapy for head and neck cancer is measured using OMWQ-HN and WHO mucositis at baseline and weekly during 1 to 6 of LLLT 2. Long term reported health related quality of life as measured by EORTC QLQ C30 (version 3.0), EORTC QLQ C30/H&N 35 (EORTC QOL Module for Head and Neck Cancer) and the EQ-5D-5L at baseline, week 6, month 4 and month 14, and MDADI at baseline, week 6, month 4 and month 14 3. Nutritional Parameters as measured by Performance Status Scale’s (PSS-HN) collected weekly at baseline, weeks 1-6, month 4 and month 14. Recording of weekly weight changes from baseline during treatment, the quantity of enteral nutrition consumed, number of days of feeding tube in situ 4. Changes in swallowing function measured by the timed water swallow test collected at baseline, week 6 of LLLT month 4 and month 14 5. Pain outcomes as measured by use of analgesics/ topical treatment and pain domain of EQ-5D-5L and OMWQ-HN at randomisation and weekly to week 6 during treatment 6. Safety, specifically adverse events attributed to LLLT and clinical complications notably number of days as inpatient hospital admissions and interruptions in CRT treatment (recorded weekly 1-6 during treatment) 7. Clinical outcomes specifically patient survival, quality-adjusted survival recurrence and persistence of disease at 14 months Economic outcomes: 1. Incremental cost per change in OMWQ-HN score recorded between baseline and at week 6 of therapy and incremental cost per QALY over 14 months 2. Quality-adjusted life years based upon EQ-5D-5L and EORTC-8D utility scores measured at baseline, week 6 and 4 and 14 months 3. Costs associated with treatment (weeks 0-6) will be collected weekly via the eCRFs (e.g. adverse events and use of analgesics) 4. Health care utilisation based on responses to Health Utilisation Questionnaire administered at 4 and 14 months (assessing: visits to the GP/walk-in clinic/A&E etc.) 5. Participant and family costs collected via the Time and Travel Questionnaire administered at 14 months 6. Total costs of LLLT and sham LLLT measured at 4 and 14 months, from the perspective of the NHS and personal and social services to participants and families Qualitative outcomes as identified through measurement of: 1. Observations of site initiation visits and device training conducted prior to the opening of each site 2. Interviews with health professionals delivering LLLT conducted and other relevant members of head and neck cancer team throughout the trial using purposeful sampling, with no more than 2 interviews per staff member 3. Interviews with patients, at 1-2 weeks after the recruitment discussion, and at approximately month 4 or month 14. There will be no more than 2 interviews per patient
Overall study start date	01/11/2016
Completion date	31/12/2019

Eligibility

Participant type(s)	Patient
Age group	Adult
Lower age limit	18 Years
Sex	Both
Target number of participants	Planned Sample Size: 380; UK Sample Size: 380
Total final enrolment	380
Key inclusion criteria	1. Adults aged ≥18 years diagnosed with HNC 2. Capacity to provide informed written consent 3. Histological diagnosis of squamous cell carcinoma of the oral cavity, oropharynx, nasopharynx, larynx, hypopharynx or unknown squamous cell primary of head and neck origin histologically confirmed 4. (C)RT patients discussed in a Head and Neck MDT meeting and deemed medically fit for an agreed treatment plan for primary or adjuvant radiotherapy ± concurrent or induction chemotherapy (cisplatin or cetuximab) 5. Patients planned to receive a minimum of 60Gy to a defined clinical target volume in the oral cavity or oropharynx, or neck levels Ia/b as defined by the current RTOG criteria
Key exclusion criteria	1. Known to be pregnant or planning to become pregnant within the trial treatment period 2. Parotid tumours 3. Previous radiotherapy for HNC 4. Current/ongoing OM and trismus limiting laser access for treatment 5. Patients who are experiencing active heavy tumour bleeding from the mouth (haemorrhage) 6. Patients for whom the MDT recommend short course palliative radiotherapy 7. Patients on immune suppressant drugs (except low dose steroids) 8. Participation in other trials assessing different treatments for OM 9. Unable to provide written informed consent
Date of first enrolment	28/04/2017
Date of final enrolment	30/04/2019

Locations

Countries of recruitment

England
United Kingdom
Wales

Study participating centres

Velindre Cancer Centre

Velindre Road
Whitchurch
Cardiff
CF14 2TL
United Kingdom

Leeds General Infirmary

Great George Street
Leeds
LS1 3EX
United Kingdom

Southampton General Hospital

Tremona Road
Southampton
SO16 6YD
United Kingdom

Sunderland Royal Hospital

Kayll Road
Sunderland
SR4 7TP
United Kingdom

Freeman Hospital

Freeman Road
High Heaton
Newcastle upon Tyne
NE7 7DN
United Kingdom

Sponsor information

The Newcastle Upon Tyne Hospitals NHS Foundation Trust
Hospital/treatment centre

Freeman Hospital
Freeman Road
High Heaton
Newcastle Upon Tyne
NE7 7DN
England
United Kingdom

Phone	+44 191 2825789
Email	Aaron.Jackson@nuth.nhs.uk
"ROR"	https://ror.org/05p40t847

Funders

Funder type

Government

National Institute for Health Research
Government organisation / National government

Alternative name(s): National Institute for Health Research, NIHR Research, NIHRresearch, NIHR - National Institute for Health Research, NIHR (The National Institute for Health and Care Research), NIHR
Location: United Kingdom

Results and Publications

Intention to publish date	31/12/2020
Individual participant data (IPD) Intention to share	No
IPD sharing plan summary	Data sharing statement to be made available at a later date
Publication and dissemination plan	The findings from this trial will be disseminated to the relevant stakeholders, including medical professionals involved in the Clinical Commissioning Groups, specialised service providers, cancer research institutes, Clinical Review Groups and patient organisations. Findings will also be published in peer reviewed journals, including open access publications, as well as conferences. The domain name www.liteform.org.uk will be used to retain stakeholder engagement as well as publicising the results. Findings from the qualitative sub study will be fed into the trial, as well as published in selected qualitative papers at the end of the trial.
IPD sharing plan	The current data sharing plans for the current study are unknown and will be made available at a later date.

Study outputs

Output type	Date created	Date added	Peer reviewed?	Patient-facing?
Results article	01/12/2022	12/12/2022	Yes	No
HRA research summary		28/06/2023	No	No
Plain English results		21/03/2024	No	Yes

Editorial Notes

21/03/2024: Cancer Research UK plain English results added.
12/12/2022: Publication reference and total final enrolment added.
26/03/2019: The condition has been changed from "Specialty: Cancer, Primary sub-specialty: Head and Neck Cancer; UKCRC code/ Disease: Cancer/ Malignant neoplasms of lip, oral cavity and pharynx" to "Head and neck cancer" following a request from the NIHR.
13/06/2018: Cancer Research UK lay summary link added to plain English summary field
14/05/2018: Internal review.
16/01/2018: Internal review.
16/10/2017: Internal review.