Breast Cancer
Conditions
Keywords
neoadjuvant chemotherapy, preoperative radiotherapy, capsular contraction, immediate reconstruction
Brief summary
The NEORAD trial tests whether preoperative radiotherapy results in an improved DFS and less radiation induced late effect compared to postoperative radiotherapy in higher risk breast cancer after NACT.
Detailed description
The standard of care for high-risk breast cancer consists of neoadjuvant chemotherapy and surgery followed by postoperative whole breast/chest wall irradiation+/- an additional boost (= irradiation restricted to the tumour bed in the case of breast-conserving therapy). In case of lymph node involvement in most patients require additional radiation of the regional lymph nodes. Adjuvant radiotherapy significantly reduces ipsilateral breast cancer recurrences, breast cancer specific mortality, and overall mortality. The optimal time of radiotherapy in patients, who are candidates for neoadjuvant chemotherapy (NACT) has never been addressed in a randomised controlled trial. The Study Chairman of the NEORAD trial is Prof. Dr. med. Christiane Matuschek. The deputies of the Study Chairman are Prof. Dr. med. Wilfried Budach and Prof. Dr. med. Tanja Fehm.
Interventions
RADIATIONpreoperative radiotherapy
preoperative radiotherapy instead of postoperative radiotherapy in breast cancer after neoadjuvant chemotherapy
RADIATIONpostoperative radiotherapy
postoperative radiotherapy in breast cancer after neoadjuvant chemotherapy
Sponsors
Bielefeld University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
randomized, multicenter
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histologically proven invasive, unilateral breast cancer * Indication for radiotherapy * Indication for neoadjuvant chemotherapy (+/- antibody treatment or other targeted therapies) in accordance with national and international guidelines * Female * Informed consent for the trial signed by the patient * Hormone receptor and HER2 status: no restrictions * All grades G1-G3 * Age ≥ 18 years at the time of informed consent * Performance status ≤ 2 * No pre-existing conditions that prohibit therapy
Exclusion criteria
* Neoadjuvant treatment solely with endocrine therapy * Bilateral breast cancer * Pregnancy or lactation * Prior radiotherapy of the thorax * Connective tissue disease, including rheumatoid arthritis and thromboangiitis obliterans * Pre-existing symptomatic chronic lung disease (fibrosis, pneumoconiosis, adult-onset allergies, such as farmer's lung, severe lung emphysema, COPD °III) * Cardiac comorbidities: symptomatic coronary heart disease, prior heart attack, heart failure NYHA ≥II or AHA ≥C, pacemaker, and/or implanted defibrillator * Malignoma except basalioma or in-situ-carcinomas in complete response * Distant metastasis * Plexopathies of the arm of the treated side * Stiffness of the shoulder of the arm of the side of the breast cancer of any origin (e.g. following a road accident) * Lymph edema ≥°II of the arm at the side of the breast cancer * Other medical conditions that prohibit the neoadjuvant radiotherapy (i.e. Expected non-compliance, etc.) * Male patients * Patients who have previously been assessed for chemotherapy response
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| disease free survival (DFS): | 6 to 10 years | Time interval in which the patient does not show any signs or symptoms of the treated cancer (local or regional recurrence, distant metastases, or death of any cause) beginning after randomisation to a study arm. This is a way to measure how well the new treatment is working. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| locoregional recurrence rate (LRR) | 6 to 10 years | Rate of new cancer at any locations (regional lymph nodes, chest wall/mastectomy site) on side which was previously affected by the primary cancer. This is a way to measure how well the new treatment is working. |
| disease metastases free survival (DMFS) | 6 to 10 years | Time interval beginning after randomisation in which the patient survives and the cancer has not metastasized. This is a way to measure how well the new treatment is working. |
| overall survival (OS) | 6 to 10 years | Length of time beginning after randomisation in the study that the patient survives. This is a way to measure how well the new treatment is working. |
| disease specific survival (DSS) | 6 to 10 years | Length of time from the beginning of the study after randomisation in a study arm that the patient survives the specific cancer. This is a way to measure how well the new treatment is working. |
| Assesment of cosmetic results by the physicians and the patient using a 5 point Scoring System* | 6 to 10 years | A grading scale is provided for cosmetic results (5 Point Scoring System): E0 Excellent aesthetic result: At first sight no visible therapy sequellae. Both breasts have a similar appearance E1 Good: minimal changes in pigmentation, a visible scar, localized teleangieectasia. E2 Moderate: marked sequellae with a clear deformation of the breast contour, nipple displacement, or marked skin changes, but yet acceptable. E3 Bad: severe retraction or fibrosis, severe teleangiectasia. E4 Complications: skin necrosis |
| local recurrence rate [in affected breast] (LR) | 6 to 10 years | Rate of cancer that has recurred at the same location as the primary cancer. This is a way to measure how well the new treatment is working. |
| Measurement of the quality of life (QOL): functional scale | 6 to 10 years | QoL will be assessed by EORTC (European Organisation for Research and Treatment of Cancer) QLQ-C30 questionnaires for overall QoL and EORTC QLQ-BR23 for breast-specific QoL. The QLQ-C30 consists of 30 questions categorized in functional and symptom-specific scales and provides a global score through two general questions concerning health and quality of life. QLQ-BR23 is a standard instrument for measuring QoL in patients with breast cancer. The questionnaire has 23 items with four possible answers each (not at all, a little, quite a bit, very much). Results are reported using functional scales (e.g. body image, sexual functioning) and symptom-related items (e.g. systemic therapy side effects, breast symptoms). It is also common practice to classify the summary scores into four distinct categories with functional scales (0-25 bad; 26-50 moderate; 51-75 good; 76-100 excellent) and symptom-related scales. |
| Measurement of the quality of life (QOL): symptom-related scale | 6 to 10 years | QoL will be assessed by EORTC (European Organisation for Research and Treatment of Cancer) QLQ-C30 questionnaires for overall QoL and EORTC QLQ-BR23 for breast-specific QoL. The QLQ-C30 consists of 30 questions categorized in functional and symptom-specific scales and provides a global score through two general questions concerning health and quality of life. QLQ-BR23 is a standard instrument for measuring QoL in patients with breast cancer. The questionnaire has 23 items with four possible answers each (not at all, a little, quite a bit, very much). Results are reported using functional scales (e.g. body image, sexual functioning) and symptom-related items (e.g. systemic therapy side effects, breast symptoms). It is also common practice to classify the summary scores into four distinct categories with functional scales and symptom-related scales: (0-25 excellent; 26-50 good; 51-75 moderate, 76-100 bad) |
| Assessment of arm lymphedema rates by the physicians using common toxicity criteria for adverse events CTCAE, version 5.0 | 6 to 10 years | Lymphedema: 'A disorder characterized by excessive fluid collection in tissues that causes swelling.' A grading scale is provided for arm lymphoedema rates higher than Grade 1 of the irradiated side (0= not present, 1= Trace thickening or faint discoloration, 2= Marked discoloration; leathery skin texture; papillary formation; limiting instrumental ADL\*, 3= Severe symptoms; limiting self care ADL) using common toxicity criteria for adverse events CTCAE, version 5.0 \*ADL = activities of daily living |
| Assessment of plexopathia higher than Grade 1 of brachial plexus on irradiated side by the physicians using common toxicity criteria for adverse events CTCAE, version 5.0 | 6 to 10 years | Brachial plexopathia:'A disorder characterized by regional paresthesia of the brachial plexus, marked discomfort and muscle weakness, and limited movement in the arm or hand.' A grading scale is provided for plexopathia of brachial plexus on the irradiated side higher than Grade 1 (0= not present, 1= Aysmptomatic; clinical or diagnostic observations only; intervention not indicated, 2= Moderate symptoms; limiting instrumental ADL\*, 3= Severe symptoms, limiting self care ADL) using common toxicity criteria for adverse events CTCAE, version 5.0 \*ADL = activities of daily living |
| Assessment of treatment-related toxicity measured by the physicians using standardized common toxicity criteria for adverse events CTCAE, version 5.0. | 6 to 10 years | A grading scale is provided for each side effect (0= not present, 1=asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated, 3=moderate; minimal, local or noninvasive intervention indicated; -4=severe or medically significant but not immediately life-threatening) |
| Assesment of cosmetic results by the physicians using breast retraction assessment-Score (BRA Score)* | 6 to 10 years | \*The BRA Score measures breast symmetry of the treated breast in comparison to the untreated breast. The average in the general population is 1.2 cm. A higher BRA score is worse. A BRA score of 0 cm is optimal. |
Countries
Germany
Contacts
Primary ContactChristiane Matuschek, MD Prof.
Backup ContactDeborah Wöstenfeld, M. A.
Outcome results
None listed