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Adjuvant Partial-breast Irradiation Using Stereotactic Body Radiation Therapy

Sponsor
Masaryk Memorial Cancer Institute (Other)
Overall Status
Completed
CT.gov ID
NCT06007118
Collaborator
(none)
85
Enrollment
1
Location
2
Arms
50.2
Actual Duration (Months)
1.7
Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The adjuvant radiotherapy (RT) of the early-stage breast cancer patients as local treatment aims to eliminate the potential microscopic residual disease in the surgery bed or satellites in its neighborhood. Nowadays accelerated partial breast irradiation (APBI) is recommended for highly selected patients. This prospective randomized study compares the targeted external beam APBI with commonly used accelerated whole-breast irradiation (WBI) in terms of feasibility, safety, tolerance, and cosmetic effects. It is designed as non-inferiority trial and its aim is to increase the level of evidence for establishment of external beam APBI in indicated patients into daily clinical practice.

Condition or Disease Intervention/Treatment Phase
  • Radiation: APBI
  • Radiation: WBI
 N/A

Detailed Description

Early-stage breast cancer patients after partial mastectomy are screened for eligibility. The inclusion criteria are age ˃ 50 years, non-lobular carcinoma histology, size ≤ 2 cm, negative margins ≥ 2 mm, L0, ER-positive, HER-2 negative. Enrolled patients are equally randomized into two arms according to radiotherapeutic regiment - external beam APBI (5× 6 Gy) and accelerated whole breast irradiation with the boost (15× 2,67Gy + 5× 2Gy). The follow-up visits are planned at the end of RT and 1, 3, 6, 9, and 12 months after radiation, in the second year every 4 months and then every 6 months. Cosmetics results and toxicity are evaluated using questionnaires, CTCAE criteria, and photodocumentation of the irradiated chest. The main objective of presented study is to evaluate the feasibility, safety, tolerance, and cosmetic effects of SBRT irradiation to the surgery bed in five fractions. In addition to standard clinical examination and evaluation of acute and late side effects, patients together with clinicians and nurses will independently complete a questionnaire on the impact of irradiation on the cosmetic effect. The technique of targeted external beam APBI should demonstrate better feasibility and less toxicity than the standard regimen in the adjuvant setting in treating early-stage breast cancer patients. Consequently, the presented study should increase the level of evidence for RT-indicated patients to the establishment of external APBI into daily clinical practice.

Study Design

Study Type:
Interventional
Actual Enrollment :
85 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Intervention Model Description:
The trial is designed as binary outcome parallel group non-inferiority trial.The trial is designed as binary outcome parallel group non-inferiority trial.
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
Adjuvant Partial-breast Irradiation of Early-stage Breast Cancer Using Stereotactic Body Radiation Therapy
Actual Study Start Date :
May 1, 2019
Actual Primary Completion Date :
Jul 7, 2023
Actual Study Completion Date :
Jul 7, 2023

Arms and Interventions

Arm Intervention/Treatment
Experimental: APBI, accelerated partial breast irradiation

The APBI group will be irradiated with a dose of 30Gy in 5 fractions in 5 working days.

Radiation: APBI
accelerated partial breast irradiation to the surgery bed (5 x 6,0 Gy; in 5 working days)
Active Comparator: WBI, whole breast irradiation

The control group of patients will be irradiated with a standard accelerated mode within 20 working days.

Radiation: WBI
accelerated whole breast irradiation with the boost to tumor bed (15x 2,67 Gy + 5x 2,0 Gy, every working day)

Outcome Measures

Primary Outcome Measures

  1. APBI vs. WBI - toxicity [44 months]

    Comparison of acute and late toxicity of the APBI of the early stage breast cancer with accelerated irradiation regimen.

  2. APBI vs. WBI - cosmetic effects [44 months]

    Comparison of cosmetic effects of the APBI of the early stage breast cancer with accelerated irradiation regimen. Cosmetic effects independently evaluated by patient, physician, and nurse scored using Harvard scale (4-point Likert scale). The scale contains 4 values - nearly identical as untreated (the best outcome), slightly different, clearly different, seriously distorted (the worst outcome)

  3. APBI - feasibility [44 months]

    Evaluation of feasibility of the APBI regimen based on the proportion of patients who completed radiation in a total of 10 days and the proportion of patients who were irradiated exactly according to technical guidelines.

  4. APBI vs. WBI - tolerance [44 months]

    Comparison of tolerance of the APBI of the early stage breast cancer with accelerated irradiation regimen. The toxicity was evaluated by CTCAE criteria (Common Terminology Criteria for Adverse Events). The outcome to define the tolerance a safety was CTCAE grade II or greater skin toxicity.

  5. APBI vs. WBI - safety [44 months]

    Comparison of safety of the APBI of the early stage breast cancer with accelerated irradiation regimen. The toxicity was evaluated by CTCAE criteria (Common Terminology Criteria for Adverse Events). The outcome to define the tolerance a safety was CTCAE grade II or greater skin toxicity.

Secondary Outcome Measures

  1. Quality of life C30 [44 months]

    Quality of Life assessment using the standardized European Organisation for Research and Treatment of Cancer (EORTC) questionnaire QLQ-C30. All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level. Thus a high score for a functional scale represents a high / healthy level of functioning, a high score for the global health status / QoL represents a high QoL, but a high score for a symptom scale / item represents a high level of symptomatology / problems.

  2. Quality of life BR45 [44 months]

    Quality of Life assessment using the standardized European Organisation for Research and Treatment of Cancer (EORTC) questionnaire with special module for patients with breast cancer (Breast QLQ-BR45). All of the scales and single item measures range in score from 0 to 100. A high score for the functional scales and functional single items represents a high/healthy level of functioning, whereas a high score for the symptom scales and symptom item represents a high level of symptomatology or problems.

  3. Effectivity [44 months]

    Assessment of effectivity of the treatment method by evaluating subsequent endpoints such as LC (local control) and OS (overall survival). Overall survival (OS) is defined as the time from randomization to death from any cause. Local control (LC) is defined as the time from randomization to the first local recurrence.

Eligibility Criteria

Criteria

Ages Eligible for Study:
50 Years and Older
Sexes Eligible for Study:
Female
Accepts Healthy Volunteers:
No

Patients referred to medical attention for adjuvant radiotherapy of early-stage breast cancer at the Department of Radiation Oncology, Masaryk Memorial Cancer Institute (MMCI) were screened for eligibility. If all inclusion/exclusion criteria will be met, they were invited to participate in the present study.

Inclusion Criteria:

  1. Age ≥50 years

  2. Karnofsky index > 70

  3. Partial mastectomy (breast-conserving surgery)

  4. DCIS G1/2 ≤ 2.5 cm with negative margins (≥ 3 mm) or invasive (non-lobular) luminal-like HER2 negative carcinoma ≤ 2 cm with negative margins (≥ 2 mm) without LVI

  5. In the case of invasive carcinoma, performing of axillary dissection (≥6 negative lymph nodes) or negative sentinel node biopsy

Exclusion Criteria:

  1. Prior to other chest or breast surgery (including breast reconstruction), the absence of surgical clips in the tumor bed

  2. Prior ipsilateral chest or breast radiotherapy

  3. Neoadjuvant systemic therapy

  4. Adjuvant chemotherapy

  5. Multifocal or multicentric involvement

  6. BRCA 1 or 2 mutations or known mutations in other high penetrance genes

  7. Any systemic illness (collagen vascular diseases) or unstable medical condition that might pose additional risks for the performance of radiotherapy including claustrophobia or jactation

  8. Any other factors that, in the opinion of the site investigators, would interfere with adherence to study requirements

  9. Pregnancy or breastfeeding

  10. Inability or unwillingness of the subject to sign written informed consent

Contacts and Locations

Locations

Site City State Country Postal Code
1 Masaryk Memorial Cancer Institute Brno Czech Republic Czechia 65653

Sponsors and Collaborators

  • Masaryk Memorial Cancer Institute

Investigators

  • Principal Investigator: Petr Burkon, M.D., Ph.D., Masaryk Memorial Cancer Institute, Dept. of Radiation Oncology,

Study Documents (Full-Text)

None provided.

More Information

Publications

Responsible Party:
Masaryk Memorial Cancer Institute
ClinicalTrials.gov Identifier:
NCT06007118
Other Study ID Numbers:
  • NV19-03-00354
First Posted:
Aug 23, 2023
Last Update Posted:
Aug 23, 2023
Last Verified:
Jul 1, 2023
Individual Participant Data (IPD) Sharing Statement:
No
Plan to Share IPD:
No
Studies a U.S. FDA-regulated Drug Product:
No
Studies a U.S. FDA-regulated Device Product:
No
Keywords provided by Masaryk Memorial Cancer Institute
breast cancer
adjuvant radiotherapy
accelerated partial breast irradiation
surgical bed
Additional relevant MeSH terms:
Breast Neoplasms

Study Results

No Results Posted as of Aug 23, 2023