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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT03210103
Registration number
NCT03210103
Ethics application status
Date submitted
28/06/2017
Date registered
6/07/2017
Titles & IDs
Public title
Primary Radiotherapy Versus Primary Surgery for HPV-Associated Oropharyngeal Cancer
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Scientific title
A Randomized Trial of Treatment De-Escalation for HPV-Associated Oropharyngeal Squamous Cell Carcinoma: Radiotherapy vs. Trans-Oral Surgery (ORATOR II)
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Secondary ID [1]
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ORATOR2
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Universal Trial Number (UTN)
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Trial acronym
ORATOR2
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Oropharyngeal Cancer
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Condition category
Condition code
Cancer
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Head and neck
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Other - Radiation
Treatment: Surgery - Transoral Surgery (TOS) + Neck Dissection
Active comparator: Arm 1, Radiation +/- Chemotherapy - Standard Treatment (Radiation +/- Chemotherapy)
Experimental: Arm 2, TOS + Neck Dissection - Transoral Surgery (TOS) + Neck Dissection (plus radiation, if required)
Treatment: Other: Radiation
Standard of Care: Radiation +/- Chemotherapy
Treatment: Surgery: Transoral Surgery (TOS) + Neck Dissection
Transoral Surgery (TOS) + Neck Dissection (plus radiation, if required)
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Intervention code [1]
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Treatment: Other
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Intervention code [2]
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Treatment: Surgery
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Overall Survival
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Assessment method [1]
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Time from randomization to death from any cause
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Timepoint [1]
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2 years
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Secondary outcome [1]
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Quality of Life 1 year post treatment
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Assessment method [1]
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Quality of life 1 year post treatment as assessed with the MD Anderson Dysphagia Inventory (MDADI)
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Timepoint [1]
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1 year post treatment
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Secondary outcome [2]
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Progression free survival comparison with historical controls
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Assessment method [2]
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Defined as time from randomization to death from any cause
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Timepoint [2]
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5 years
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Secondary outcome [3]
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Quality of life
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Assessment method [3]
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Quality of Life using the following questionnaire: MD Anderson Dysphagia Inventory (MDADI)
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Timepoint [3]
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Baseline to 5 years follow up
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Secondary outcome [4]
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Quality of life
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Assessment method [4]
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Quality of Life using the following questionnaire: EORTC QLQ C30
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Timepoint [4]
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Baseline to 5 years follow up
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Secondary outcome [5]
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Quality of life
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Assessment method [5]
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Quality of Life using the following questionnaire: H\&N35 scale
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Timepoint [5]
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Baseline to 5 years follow up
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Secondary outcome [6]
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Quality of life
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Assessment method [6]
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Quality of Life using the following questionnaire: Voice Handicap Index (VHI-10)
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Timepoint [6]
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Baseline to 5 years follow up
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Secondary outcome [7]
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Quality of life
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Assessment method [7]
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Quality of Life using the following questionnaire: Neck Dissection Impairment Index (NDII)
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Timepoint [7]
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Baseline to 5 years follow up
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Secondary outcome [8]
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Quality of life
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Assessment method [8]
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Quality of Life using the following questionnaire: Patient Neurotoxicity Questionnaire (PNQ)
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Timepoint [8]
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Baseline to 5 years follow up
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Secondary outcome [9]
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toxicity profile of both study arms using the National Cancer Institute Common Toxicity Criteria (NCI-CTC) Version 4
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Assessment method [9]
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To determine to toxicity profile of both study arms using the National Cancer Institute Common Toxicity Criteria (NCI-CTC) Version 4
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Timepoint [9]
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Randomization until 5 years follow up
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Secondary outcome [10]
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Feeding tube rate at 1 year
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Assessment method [10]
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Measure other functional measurements such as feeding tube rate at 1 year
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Timepoint [10]
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baseline to 1 year post treatment
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Secondary outcome [11]
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CTCAE Dysphagia grade
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Assessment method [11]
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Measure other functional measurements such as CTCAE Dysphagia grade
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Timepoint [11]
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baseline to 5 years post treatment
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Secondary outcome [12]
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Speech intelligibility
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Assessment method [12]
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Measure other functional measurements such as speech intelligibility
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Timepoint [12]
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baseline to 5 years post treatment
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Secondary outcome [13]
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Normalcy of diet
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Assessment method [13]
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Measure other functional measurements such as normalcy of diet
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Timepoint [13]
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baseline to 5 years post treatment
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Secondary outcome [14]
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2 year progression-free survival comparison between Arm 1 and Arm 2
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Assessment method [14]
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Time from randomization to disease progress at any site or death from any cause
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Timepoint [14]
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2 years
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Eligibility
Key inclusion criteria
* Age 18 years or older
* willing to provide informed consent
* ECOG performance status 0-2
* Histologically confirmed squamous cell carcinoma
* P16 positive, or HPV positive
* Primary tumor site in the oropharynx (includes tonsil, soft palate, base of tongue, walls of oropharynx)
* Eligible for curative intent treatment, with likely negative resection margins at surgery. For patients where adequate transoral access is in question, they will first undergo an examination under anesthesia prior to randomization to ensure adequate exposure can be obtained.
* Smokers and non-smokers are included. Patients will be stratified by ,<10 pack years smoking history versus > or equal to 10 pack years.
* Tumor stage (AJCC 8th edition): T1 or T2
* Nodal stage (AJCC 8th edition): N0, N1, or N2
* For patients who may require chemotherapy (ie, patients with multiple lymph nodes positive or a single node more than 3 cm in size, in any plane, CBC/differential within 4 weeks prior to randomization with adequate bone marrow function, hepatic, and renal function defined as: Hemoglobin = 80 g/L; Absolute neutrophil count = 1.5 x 10 9/L, platelets = 100 x 10 9/L, bilirubin = 35 umol/L, AST or ALT = 3 x the upper limit of normal; serum creatinine = 130 umol/L or creatinine clearance = 50 ml/min
* patients assessed at head and neck multidisciplinary clinic (with assessment by radiation oncologist and surgeon) and presented at multidisciplinary tumor board prior to randomization
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* unambiguous clinical or radiological evidence of extranodaal extension on pre-treatment imaging. This includes the presence of matted notes, defined as 3 or more nodes that are abutting with loss of intervening fat planes
* Serious medical comorbidities or other contraindications to radiotherapy, chemotherapy or surgery
* prior history of head and neck cancer within 5 years
* prior head and neck radiation at any time
* metastatic disease
* inability to attend full course of radiotherapy or follow up visits
* prior invasive malignant disease unless disease-free for at least 5 years or more, with the exception of non-melanoma skin cancer
* pregnant or lactating women
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Active, not recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
26/01/2018
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
15/08/2028
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Actual
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Sample size
Target
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Accrual to date
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Final
61
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Recruitment in Australia
Recruitment state(s)
QLD
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Recruitment hospital [1]
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Gold Coast University Hospital - Gold Coast
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Recruitment hospital [2]
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Royal Adelaide Hospital - Adelaide
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Recruitment postcode(s) [1]
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- Gold Coast
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Recruitment postcode(s) [2]
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- Adelaide
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Recruitment outside Australia
Country [1]
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Canada
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State/province [1]
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Alberta
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Country [2]
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Canada
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State/province [2]
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British Columbia
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Country [3]
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Canada
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State/province [3]
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Ontario
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Country [4]
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Canada
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State/province [4]
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Quebec
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Funding & Sponsors
Primary sponsor type
Other
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Name
Lawson Health Research Institute
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Address
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Country
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Ethics approval
Ethics application status
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Summary
Brief summary
The goal of this randomized treatment de-escalation study is to formally compare outcomes in HPV related oropharyngeal cancer tumors treated with a primary radiotherapy versus a primary surgical approach, to provide a high level of evidence to guide the selection of treatment options for a subsequent phase III trial
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Trial website
https://clinicaltrials.gov/study/NCT03210103
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Trial related presentations / publications
Palma DA, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J, Eskander A, Higgins K, Karam I, Poon I, Husain Z, Enepekides D, Hier M, Sultanem K, Richardson K, Mlynarek A, Johnson-Obaseki S, Odell M, Bayley A, Dowthwaite S, Jackson JE, Dzienis M, O'Neil J, Chandarana S, Banerjee R, Hart R, Chung J, Tenenholtz T, Krishnan S, Le H, Yoo J, Mendez A, Winquist E, Kuruvilla S, Stewart P, Warner A, Mitchell S, Chen J, Parker C, Wehrli B, Kwan K, Theurer J, Sathya J, Hammond JA, Read N, Venkatesan V, MacNeil SD, Fung K, Nichols AC. Assessment of Toxic Effects and Survival in Treatment Deescalation With Radiotherapy vs Transoral Surgery for HPV-Associated Oropharyngeal Squamous Cell Carcinoma: The ORATOR2 Phase 2 Randomized Clinical Trial. JAMA Oncol. 2022 Jun 1;8(6):1-7. doi: 10.1001/jamaoncol.2022.0615. Nichols AC, Lang P, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J, Fung K, de Almeida JR, Bayley A, Goldstein DP, Eskander A, Husain Z, Bahig H, Christopoulous A, Hier M, Sultanem K, Richardson K, Mlynarek A, Krishnan S, Le H, Yoo J, MacNeil SD, Mendez A, Winquist E, Read N, Venkatesan V, Kuruvilla S, Warner A, Mitchell S, Corsten M, Rajaraman M, Johnson-Obaseki S, Eapen L, Odell M, Chandarana S, Banerjee R, Dort J, Matthews TW, Hart R, Kerr P, Dowthwaite S, Gupta M, Zhang H, Wright J, Parker C, Wehrli B, Kwan K, Theurer J, Palma DA. Treatment de-escalation for HPV-associated oropharyngeal squamous cell carcinoma with radiotherapy vs. trans-oral surgery (ORATOR2): study protocol for a randomized phase II trial. BMC Cancer. 2020 Feb 14;20(1):125. doi: 10.1186/s12885-020-6607-z.
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Public notes
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Contacts
Principal investigator
Name
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David Palma
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Address
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Lawson Health Research Institute
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Undecided
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT03210103