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Accelerated Partial Breast Irradiation With 3D-CRT and IMRT (APERT)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02003560
Recruitment Status : Active, not recruiting
First Posted : December 6, 2013
Last Update Posted : August 13, 2014
Information provided by (Responsible Party):
Csaba Polgár, National Institute of Oncology, Hungary

Brief Summary:
The purpose of this study is to determine in a phase II clinical trial whether accelerated partial breast irradiation after breast conserving surgery using 3 dimensional external beam radiotherapy (3D-CRT) and intensity modulated radiotherapy (IMRT) for low-risk invasive breast cancer patients is safe without causing serious late radiation side-effects.

Condition or disease Intervention/treatment Phase
Breast Cancer Radiation Toxicity Side Effects Radiation: accelerated partial breast irradiation Phase 2

Detailed Description:

It is a sequential phase II trial. Eligible patients after breast conserving surgery (BCS) are treated with accelerated partial breast irradiation (APBI) using three-dimensional conformal radiotherapy (3D-CRT) for the first 45 patients or intensity modulated radiotherapy (IMRT) for the second 45 patients.

Primary end-point of the study: late radiation side-effects at 5 years. Early stopping criteria: Not used as primary end-point is late side-effects. Interim analysis: Not planned Secondary end-points: cosmetic results, quality of life, local recurrence-free survival, regional recurrence free survival, distant metastasis free survival, relapse free survival, overall survival, cancer specific survival.

Null-hypothesis for primary end-point: The incidence of severe (>G2) late radiation side-effects after APBI using 3D-CRT or IMRT will not exceed 10%.


  • by treatment delivery: 3D-CRT - first 45 patients; IMRT - second 45 patients
  • by bra capsize: Capsize A-B; C; and D-D+

Treatment intervention: 9 x 4.1 Gy APBI using 3D-CRT (first 45 patients) or IMRT (second 45 patients) delivered within 5 days, using twice-a-day fractionation.

Clinical target volume (CTV) and Planning target volume (PTV) definition:

CTV = excision cavity + 20 mm minus the actual pathological surgical margin in mm PTV = CTV + 5 mm in each direction


  • ECOG PS, physical examination (inspection and palpation), registration of side-effects (RTOG (Radiation Therapy Oncology Group) EORTC (European Organization for Research and Treatment of Cancer)) early and late radiation morbidity scoring scheme) and cosmetic results (using the Harvard scale) : 7-14 days after RT, than in every 3 months for 2 years, and every 6 months for 5 years.
  • Mammography: at 6, 12, 18, 24 months, and annually thereafter
  • Quality of life questionnaire (QLQ) (e.g. EORTC (European Organization for Research and Treatment of Cancer) QLQ-30 and Breast (BR)-23) before RT, at 7-14 days after RT, at 3, 6, and 12 months, and annually thereafter
  • digital photography: before treatment, at 7-14 days after treatment, and yearly thereafter

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 90 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Accelerated Partial Breast Irradiation After Breast Conserving Surgery for Low-risk Invasive Breast Cancer: 3D Conformal Radiotherapy (3D-CRT) and Intensity Modulated Radiotherapy (IMRT) - Prospective Phase II Study
Study Start Date : December 2006
Estimated Primary Completion Date : March 2019
Estimated Study Completion Date : March 2024

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Accelerated partial breast irradiation
Accelerated partial breast irradiation delivered by 3 dimensional conformal radiotherapy or intensity modulated radiotherapy
Radiation: accelerated partial breast irradiation
9 x 4.1 Gy accelerated partial breast irradiation delivered by 3D-CRT or IMRT over 5 consecutive days, using twice-a-day fractionation.

Primary Outcome Measures :
  1. late radiation side-effect [ Time Frame: 5 years ]
    Late radiation side-effects at 5 years scored by the RTOG (Radiation Therapy Oncology Group) EORTC (European Organization for Research and Treatment of Cancer) late radiation morbidity scoring scheme

Secondary Outcome Measures :
  1. cosmetic results [ Time Frame: 5 years ]
    cosmetic results at 5 years measured by the Harvard criteria

  2. local tumor control [ Time Frame: 5 years ]
    Local tumor control defined as reappearance of the tumor in the ipsilateral breast

  3. regional tumor control [ Time Frame: 5 years ]
    regional tumor control at 5 years

  4. overall survival [ Time Frame: 5 years ]
    overall survival at 5 years

  5. disease free survival [ Time Frame: 5 years ]
    disease free survival at 5 years

  6. cancer specific survival [ Time Frame: 5 years ]
    cancer specific survival at 5 years

Other Outcome Measures:
  1. quality of life [ Time Frame: 5 years ]
    quality of life measured by the EORTC (European Organization for Research and Treatment of Cancer) QLQ-30 and BR-23 questionnaires

Information from the National Library of Medicine

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Ages Eligible for Study:   40 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • previous breast conserving surgery within 12 weeks (in case of adjuvant chemotherapy within 28 days after completion of chemotherapy)
  • patient age > 40 years
  • ECOG performance status: 0-1
  • life expectancy >5 years
  • invasive ductal, papillary, mucinous, medullary or tubular carcinoma
  • unifocal tumor
  • pathological tumor size < or = 30 mm
  • pathological negative axillary nodal status with axillary dissection or sentinel lymph node biopsy
  • surgical clips in the tumor bed
  • pathological surgical free margins of at least 2 mm
  • written informed consent of patients

Exclusion Criteria:

  • Stage III-IV
  • multifocal tumor
  • extensive intraductal component (EIC)
  • ductal or lobular carcinoma in situ (DCIS or LCIS)
  • invasive lobular cancer (ILC)
  • lymph-vascular invasion (LVI)
  • contralateral breast cancer
  • history of treatment for previous breast cancer
  • lactation or breast feeding women
  • Paget-disease of the nipple
  • psychiatric disorder
  • increased radiosensitivity (e.g. collagen vascular disease)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02003560

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National Institute of Oncology
Budapest, Hungary, H-1122
Sponsors and Collaborators
National Institute of Oncology, Hungary
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Study Chair: Csaba Polgár, MD, PhD, MSc National Institute of Oncology
Principal Investigator: Norbert Mészáros, MD National Institute of Oncology
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Csaba Polgár, Professor, National Institute of Oncology, Hungary Identifier: NCT02003560    
Other Study ID Numbers: NIO-APERT_01
First Posted: December 6, 2013    Key Record Dates
Last Update Posted: August 13, 2014
Last Verified: August 2014
Keywords provided by Csaba Polgár, National Institute of Oncology, Hungary:
breast cancer
breast conserving therapy
accelerated partial breast irradiation
3D conformal radiotherapy
intensity modulated radiotherapy
Additional relevant MeSH terms:
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Breast Neoplasms
Neoplasms by Site
Breast Diseases
Skin Diseases