Breast Cancer, Breast Cancer Recurrent
Conditions
Keywords
Hypofractionated
Brief summary
Breast-conserving surgery followed by re-irradiation with partial breast irradiation (rPBI) has recently been found to be a safe alternative to mastectomy for women who have undergone prior whole breast radiation. By reducing the volume of tissue receiving radiation, rPBI has been associated with less toxicity and improved cosmetic outcomes. For many women with early-stage breast cancer, shorter 1-week (5-fraction) courses of breast radiation (ultra-fractionation) have been found to be equivalent to longer fractionation schedules in the upfront treatment setting. These 1-week schedules are more convenient for patients, with fewer treatments and shorter overall treatment time. The investigators hypothesize that a 1-week ultra-hypofractionated rPBI regimen following breast-conserving surgery (BCS) for local recurrence or new primary breast cancer in the previously irradiated breast (LR) will be associated with acceptable toxicity at 1 year (\<13% grade \>3 toxicity).
Detailed description
Most women affected by breast cancer are treated with breast-conserving surgery to remove the tumour, followed by radiation to reduce the risk of recurrence. Unfortunately, some women will experience recurrence of the cancer in the previously treated breast. These recurrences have historically been treated by removing the whole breast or a second breast-conserving surgery followed by 3 to 5 weeks of radiation. These treatments can negatively impact mental health and quality of life or lead to harmful side effects that could impact the skin, breast, ribs, heart and lungs. Breast-conserving surgery followed by re-irradiation with partial breast irradiation (rPBI) has recently been found to be a safe alternative to mastectomy for women who have undergone prior whole breast radiation. By reducing the volume of tissue receiving radiation, rPBI has been associated with less toxicity and improved cosmetic outcomes. For many women with early-stage breast cancer, shorter 1-week (5-fraction) courses of breast radiation (ultra-fractionation) have been found to be equivalent to longer fractionation schedules in the upfront treatment setting. These 1-week schedules are more convenient for patients, with fewer treatments and shorter overall treatment time. The investigators hypothesize that a 1-week ultra-hypofractionated rPBI regimen following breast-conserving surgery (BCS) for local recurrence or new primary breast cancer in the previously irradiated breast (LR) will be associated with acceptable toxicity at 1 year (\<13% grade \>3 toxicity). The target population for this study is women with localized recurrent or new primary breast cancer in the previously irradiated breast. This is a prospective single arm phase 2 trial of external beam rPBI using 26Gy in 5 fractions delivered daily over 1-week after a second lumpectomy for LR following prior BCS and adjuvant whole or partial breast irradiation. Using a multi-institutional and international network of comprehensive cancer centers, this study will advance global knowledge of how to optimally treat women with this disease.
Interventions
RADIATIONrPBI
External beam partial breast reirradiation (rPBI) using 26Gy in 5 fractions delivered daily over 1-week
Sponsors
University Health Network, Toronto
Sunnybrook Health Sciences Centre
Royal Victoria Regional Health Centre
AC Camargo Cancer Center
King Hussein Cancer Center
NYU Langone Health
Centre hospitalier de l'Université de Montréal (CHUM)
Peter MacCallum Cancer Centre, Australia
CHU de Quebec-Universite Laval
Tel-Aviv Sourasky Medical Center
Virginia Commonwealth University
AOU Careggi
McGill University Health Centre/Research Institute of the McGill University Health Centre
Maisonneuve-Rosemont Hospital
Columbia University
Lakeridge Health
London Health Sciences Centre
Clínica IRAM
University Malaysia Medical Centre
Aga Khan University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 99 Years
Healthy volunteers
No
Inclusion criteria
* Age \> 18 years * In-breast recurrence or new primary (ductal carcinoma in situ (DCIS) or invasive carcinoma) * Tumour \<3.0 cm in greatest diameter on pathologic examination, including both invasive and non-invasive components * \>5 years after completion of prior adjuvant whole or partial breast radiotherapy (prior nodal radiotherapy permitted) * Clinically node negative * Negative margins (no tumour on ink) * Recovered from surgery with the incision completely healed and no signs of infection
Exclusion criteria
* Multicentric disease (patients with multifocal breast cancer in the same quadrant are eligible) * Tumour histology limited to lobular carcinoma only * T4 disease * Node positive or distant metastatic disease * Serious non-malignant disease (cardiovascular, pulmonary, systemic lupus erythematosus, scleroderma), which would preclude radiation treatment * Currently pregnant or lactating * Presence of an ipsilateral breast implant or pacemaker * Unable to commence radiation within 16 weeks of breast-conserving surgery (or last surgical procedure on the breast) or within 12 weeks from last cycle of adjuvant chemotherapy * Unable to clearly define the surgical cavity (oncoplastic procedures are permitted provided the tumor bed is well delineated with surgical clips). * Psychiatric disorders which would preclude obtaining informed consent or adherence to protocol * Grade II or more late skin toxicity from prior radiation evaluated and graded using CTCAE v5.0 * Current or prior diagnosis of bilateral breast cancer
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Grade ≥3 toxicity associated with treatment | During accrual period, up to 3 years | TThe primary endpoint, grade ≥3 toxicity associated with treatment will be summarized using frequency and percentage with 95% Clopper-Pearson confidence intervals by grade at each scheduled follow up. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Frequency radiation-associated toxicity (acute) | 3 months, 1 year, 2 year, 3 years, 4 years and 5 years post rPBI | Radiation-associated toxicities (acute) will be graded according to CTCAE v5.0 by physicians. Toxicity associated with treatment will be summarized using frequency with 95% Clopper-Pearson confidence intervals by grade at each scheduled follow up. |
| Percentage radiation-associated toxicity (acute) | 3 months, 1 year, 2 year, 3 years, 4 years and 5 years post rPBI | Radiation-associated toxicities (acute) will be graded according to CTCAE v5.0 by physicians. Toxicity associated with treatment will be summarized using percentage with 95% Clopper-Pearson confidence intervals by grade at each scheduled follow up. |
| Frequency radiation-associated toxicity (late) | 3 months, 1 year, 2 year, 3 years, 4 years and 5 years post rPBI | Radiation-associated toxicities (late) will be graded according to CTCAE v5.0 by physicians. Toxicity associated with treatment will be summarized using frequency with 95% Clopper-Pearson confidence intervals by grade at each scheduled follow up. |
| Percentage radiation-associated toxicity (late) | 3 months, 1 year, 2 year, 3 years, 4 years and 5 years post rPBI | Radiation-associated toxicities (late) will be graded according to CTCAE v5.0 by physicians. Toxicity associated with treatment will be summarized using percentage with 95% Clopper-Pearson confidence intervals by grade at each scheduled follow up. |
| Risk of local recurrence (invasive and DCIS) | 3 months, 1 year, 2 year, 3 years, 4 years and 5 years post rPBI | Cumulative incidence function will be used to estimate local recurrence with death as a competing risk. |
| Risk of distant recurrence (invasive and DCIS) | 3 months, 1 year, 2 year, 3 years, 4 years and 5 years post rPBI | Cumulative incidence function will be used to estimate distant recurrence and distance recurrence with death as a competing risk. |
| Location of local recurrence (in-field) (frequency) | 3 months, 1 year, 2 year, 3 years, 4 years and 5 years post rPBI | Location of recurrence will be summarized by frequency. |
| Location of local recurrence (in-field) (percentage) | 3 months, 1 year, 2 year, 3 years, 4 years and 5 years post rPBI | Location of recurrence will be summarized by percentage. |
| Location of local recurrence (out-of-field) (frequency) | 3 months, 1 year, 2 year, 3 years, 4 years and 5 years post rPBI | Location of recurrence will be summarized by frequency. |
| Location of local recurrence (out-of-field) (percentage) | 3 months, 1 year, 2 year, 3 years, 4 years and 5 years post rPBI | Location of recurrence will be summarized by percentage |
| Risk of local recurrence after rPBI requiring mastectomy | 3 months, 1 year, 2 year, 3 years, 4 years and 5 years post rPBI | Cumulative incidence function will be used to estimate local recurrence after rPBI requiring mastectomy with death as a competing risk |
| Invasive breast cancer free survival | 3 months, 1 year, 2 year, 3 years, 4 years and 5 years post rPBI | Kaplan-Meier method will be used to estimate invasive breast cancer free survival |
| Overall survival | 3 months, 1 year, 2 year, 3 years, 4 years and 5 years post rPBI | Kaplan-Meier method will be used to estimate overall survival |
| Satisfaction with breasts | Baseline, 1 year, 3 years, and 5 years post rPBI | Quality of life questionnaire will be used to obtain scores and will summarized using mean and standard deviation at baseline and follow up. Change in score compared to baseline will be summarized using mean and standard deviation, and assessed with paired t-test. Number and proportion of patients with a minimal clinically important difference will be calculated. |
| Financial toxicity associated with treatment | Baseline, 3 months, 1 year, and 3 years post rPBI | Quality of life questionnaire will be used to obtain scores and will summarized using mean and standard deviation at baseline and follow up. Change in score compared to baseline will be summarized using mean and standard deviation, and assessed with paired t-test. Number and proportion of patients with a minimal clinically important difference will be calculated. |
Countries
Australia, Brazil, Canada, Chile, Israel, Italy, Jordan, Kenya, Malaysia, United States
Contacts
CONTACTDanielle Rodin, MD
CONTACTAnne Koch, MD
PRINCIPAL_INVESTIGATORDanielle Rodin, MD
Princess Margaret Cancer Centre
PRINCIPAL_INVESTIGATORAnne Koch, MD
Princess Margaret Cancer Centre
Outcome results
None listed