Partial Breast Irradiation Using Accelerated Intensity Modulated Radiotherapy

This study has been terminated.
(The trial was terminated early because fair/poor cosmesis developed in 7 of 32 women.)
Sponsor:
Information provided by (Responsible Party):
University of Michigan Cancer Center
ClinicalTrials.gov Identifier:
NCT00581529
First received: December 20, 2007
Last updated: October 14, 2014
Last verified: October 2014
  Purpose

This is a phase I- II feasibility study for delivering partial breast irradiation (PBI) in selected patients with early stage, lymph node negative, breast cancer after breast-conserving surgery using accelerated Intensity Modulated Radiotherapy (IMRT).


Condition Intervention Phase
Breast Cancer
Radiation: IMRT
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Partial Breast Irradiation Using Accelerated Intensity Modulated Radiotherapy in Early Stage Breast Cancer After Breast-Conserving Surgery

Resource links provided by NLM:


Further study details as provided by University of Michigan Cancer Center:

Primary Outcome Measures:
  • Rate of Local Control at 5 Years [ Time Frame: 5 years ] [ Designated as safety issue: No ]
    The primary objective was to determine the rate of local control (the arrest of cancer growth at the site of origin) of cancer in the treated breast at 5 years following breast-conserving surgery and partial breast radiotherapy using IMRT.

  • Percentage of Participants That Experience Cosmetic Adverse Events (AEs) [ Time Frame: 5 years ] [ Designated as safety issue: Yes ]
    The primary outcome was to determine the rate of acute cosmetic adverse events and late cosmetic adverse events at follow-up visits over 5 years. To determine the rate of adverse events, the percentage of participants experiencing no cosmetic AEs, at least 1 grade 1 toxicity, at least 1 grade 2 toxicity, and at least 1 grade 3 toxicity were calculated.


Secondary Outcome Measures:
  • Dosimetric and Volumetric Differences Between Treatment Plans for Partial Breast Irradiation and Other Treatment Planning Methods [ Time Frame: not specific ] [ Designated as safety issue: No ]
    Dosimetric and volumetric differences between treatment plans for partial breast irradiation and other treatment planning methods for the target (partial breast) and organs at risk (e.g. heart, ipsilateral lung, contralateral breast)a subset of 20.

  • Ratio of Percentage of Prescription Dose Received to WBV [ Time Frame: 5 years ] [ Designated as safety issue: No ]
    One of the studies secondary outcomes was to evaluate the impact of short term accelerated partial breast radiation therapy on cosmetic results. To determine the association between dosimetric factors and cosmesis, the ratio of percentage of prescription dose received to WBV (Whole breast volume: corresponding region typically encompassed by traditional tangent fields) was compared among participants who developed fair/poor (F/P) cosmetic outcomes and participants who maintained excellent/good (E/G) cosmetic outcomes. Multiple percentages of prescription dose were examined: 5%, 20%, 50%, 80% and 100%.


Enrollment: 34
Study Start Date: November 2004
Study Completion Date: August 2014
Primary Completion Date: October 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Radiotherapy
IMRT (Intensity-modulated Radiation Therapy), 3.85 Gy per fraction, bid, for 5 consecutive days for a total dose of 38.5 Gy.
Radiation: IMRT
Patients on protocol will be treated with accelerated radiotherapy, 3.85 Gy per fraction, bid, for 5 consecutive days for a total dose of 38.5 Gy.

Detailed Description:

This is a non-randomized Phase I-II feasibility study of partial breast irradiation with accelerated IMRT technique. In this study, patients will be eligible if the estimated risk of breast cancer elsewhere in the breast (beyond the tumor bed) is low. The radiation treatment will be available to women who are older than 40 years, have a DCIS (Ductal carcinoma in situ) or T1, N0, M0, (AJCC classification, version 6.0), non-lobular infiltrating carcinoma treated with breast-conserving surgery.

Patients will undergo a pre-treatment planning free breathing CT with 5mm cuts in the treatment position, on a breast board, with both arms extended above their head that will be used to plan the traditional two field (tangent) plan. An Active Breathing Control (ABC) device will be used to minimize target motion due to breathing during a second CT scan. The lumpectomy cavity will be identified and delineated, and margins of approximately 1.5 cm in three dimensions will be used to allow for subclinical tumor extension and daily set-up error. The organs at risk (heart, lungs, contralateral breast) will be contoured on both CT scans. An inverse planning system and optimization tools will be employed in order to achieve the best IMRT plan (to minimize the dose to the heart, lungs and contralateral breast), that will be compared to the two field plan. If the IMRT plan is shown to be the optimal one, in terms of doses to organs at risk, then the patient will be enrolled in the protocol and will proceed with the treatment. Treatment will start approximately two weeks after the planning CT is obtained. All patients on protocol will be treated with accelerated radiotherapy, 3.85 Gy per fraction, bid, for 5 consecutive days for a total dose of 38.5 Gy.

  Eligibility

Ages Eligible for Study:   40 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patient with unifocal histologically proven breast cancer, with or without calcifications in mammogram.
  • DCIS (Ductal carcinoma in situ) (Tis, Stage 0)
  • Non-lobular infiltrating carcinoma, maximum of 2 cm in diameter. (T1, Stage I)
  • The patient was operated on and the tumor was excised with lumpectomy
  • The tumor is reported with negative margins >3 mm, as per our hospital protocol.
  • For invasive carcinoma, axillary lymph nodes are negative by sentinel lymph node (SLN) mapping and biopsy or by formal axillary lymph node dissection.
  • The patient is over 40 years old with life expectancy of at least 5 years
  • Karnofsky status must be at least 70. See appendix I.
  • Pre- and post-menopausal women are eligible for entry.
  • The patient must be aware of the neoplastic nature of her disease and must be willing to consent after being informed of the potential benefits, side effects and risks of radiotherapy. Institutional Review Board approval of this protocol and a consent form is required.

Exclusion Criteria:

  • No concurrent or neoadjuvant chemotherapy is allowed. Patient is permitted to be treated with chemotherapy or hormone therapy only after completion of the radiation treatment.
  • Patients with diffuse calcifications, multifocal or multicentric disease, lymph-vascular invasion are excluded.
  • Patients cannot participate if there is extensive LCIS (Lobular carcinoma in situ) in specimen or extensive DCIS.
  • Patients are excluded if systemic disease is present or the patient has been irradiated to the ipsilateral breast or the chest wall.
  • Patients who are carriers of BRCA 1/2 mutations or at high risk for hereditary breast cancer due to strong family history (more than one pre-menopausal family member with breast cancer or any ovarian cancer) are excluded because of the increased potential for in-breast recurrence elsewhere in the breast in the absence of whole breast radiotherapy.
  • Patients with scleroderma, or systemic or discoid lupus are excluded due to the potential for significant radiotherapy associated toxicity.
  • Pregnant woman cannot participate in the study.
  • Patients who have serious medical problems which would limit survival to <5 years or a psychiatric condition which would prevent informed consent cannot participate.
  • Patients who are unable to lie on their back and raise their arms above their heads in the treatment planning position for radiotherapy are excluded.
  • Patients that have mammographically occult disease are excluded.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00581529

Locations
United States, Michigan
University of Michigan
Ann Arbor, Michigan, United States, 48109-5010
Sponsors and Collaborators
University of Michigan Cancer Center
Investigators
Principal Investigator: Lori J Pierce, MD University of Michigan
  More Information

No publications provided

Responsible Party: University of Michigan Cancer Center
ClinicalTrials.gov Identifier: NCT00581529     History of Changes
Other Study ID Numbers: UMCC 2004.020, IRB #2004-0459 & HUM 44980
Study First Received: December 20, 2007
Results First Received: August 14, 2014
Last Updated: October 14, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by University of Michigan Cancer Center:
breast

Additional relevant MeSH terms:
Breast Neoplasms
Breast Diseases
Neoplasms
Neoplasms by Site
Skin Diseases

ClinicalTrials.gov processed this record on October 23, 2014