Partial Breast Irradiation (PBI) for Selected Patients With Early Breast Cancer

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
Washington University School of Medicine
ClinicalTrials.gov Identifier:
NCT00325598
First received: May 12, 2006
Last updated: June 2, 2014
Last verified: June 2014
  Purpose

This study investigates the feasibility and safety of delivering radiation therapy only to part of the breast, (the tumor bed and selected areas) rather than the whole breast, for patients with early stage breast cancer.


Condition Intervention Phase
Breast Neoplasms
Procedure: Partial Breast Irradiation (PBI)
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Partial Breast Irradiation (PBI) for Selected Patients With Early Breast Cancer: A Phase I/II Feasibility Study

Resource links provided by NLM:


Further study details as provided by Washington University School of Medicine:

Primary Outcome Measures:
  • Evaluate feasibility of PBI directed external radiotherapy [ Time Frame: Within 1 year of protocol registration ] [ Designated as safety issue: Yes ]

    The study will be deemed infeasible if, at any time, more than 4 patients have at least one of the following negative outcomes:

    1. Patient cannot be given the treatment because her tumor is such that a dosimetrically satisfactory treatment plan cannot be devised for her.
    2. Within 1 year of protocol registration, the patient develops histological fat necrosis or other grade 4 skin or grade 4 subcutaneous toxicity, or requires surgery for her skin or subcutaneous toxicity.


Secondary Outcome Measures:
  • Incidence and severity of cutaneous toxicity [ Time Frame: 5 years ] [ Designated as safety issue: Yes ]
  • Incidence of breast fibrosis and fat necrosis [ Time Frame: 5 years ] [ Designated as safety issue: Yes ]
  • Cosmetic outcome [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  • Local, regional, and distant control rates [ Time Frame: 5 years ] [ Designated as safety issue: No ]

Enrollment: 100
Study Start Date: February 2006
Estimated Study Completion Date: April 2017
Primary Completion Date: April 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Group 1
36 Gy in 9 fractions BID x 4 1/2 treatment days
Procedure: Partial Breast Irradiation (PBI)
Experimental: Group 2
40 Gy in 10 fractions BID over 5 treatment days
Procedure: Partial Breast Irradiation (PBI)

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria

  1. Histologic Documentation:

    • Patients will have histologically confirmed Unicentric Stage I (T1 N0 M0) invasive ductal breast cancer.
    • Histologically negative tumor margin 2 mm or more from any inked edges, or no tumor in a re-excision specimen or final shaved specimen.
    • Tubular, mucinous and medullary variant histologies of infiltrating ductal carcinoma are permitted.
    • Low-grade DCIS (I and II) of 2 cm or less with histologically negative margins of at least 2 mm margins (or a negative re-excision) are permitted.
    • Women age 70 years or older with T1 invasive ductal carcinoma which are estrogen-receptor positive (ER+) with clinically negative axillary nodes who do not undergo surgical lymph node evaluation are also eligible if patient will take hormonal therapy.
    • Patients with T1N0 (i+) tumors on sentinel lymph node mapping or dissection (i.e. is tumor deposit is 0.2mm or less, regardless of whether the deposit is detected by IHC or H&E staining) will also be eligible, provided that completion axillary dissection has been performed to confirm N0 status.
    • In the case where invasive cancer is present, the invasive cancer's pathology will be used regardless if DCIS is also present.
  2. Prior Treatment: Patient may have been treated with adjuvant chemotherapy. Patients may be on adjuvant hormonal therapy or begin hormonal therapy following XRT at the discretion of the medical oncologist.

    Radiation therapy should begin within:

    • 4-12 weeks from definitive surgical procedure
    • 2-6 weeks after chemotherapy, if chemotherapy given first
    • Radiation cannot be delivered concurrently with chemotherapy.
  3. Age >= 18 years of age
  4. ECOG Performance Status 0-2.
  5. Signed Informed Consent

Exclusion Criteria

The following guidelines are to assist physicians in selecting patients for whom protocol therapy is safe and appropriate. Physicians should recognize that the following may seriously increase the risk to the patient entering this protocol. Patients who meet the following criteria should not be entered in this study:

1a Multicentric IDC of the breast defined as discontiguous tumors separated by at least 5 cm of uninvolved tissue; alternatively, discontiguous tumors that are clinically or mammographically within separate breast quadrants or subareolar central region.

  1. b Multifocal IDC of the breast, defined as discontiguous discrete foci of invasive carcinoma, separated by uninvolved intervening tissue, but within an overall span of 5cm, or within the same breast quadrant or subareolar central region.
  2. Tumor > 2.0 cm, nodal involvement on H&E staining, or metastatic involvement
  3. Histological evidence of:

    1. Lymphovascular invasion: as defined by a tumor embolus present in an endothelial-lined space; cases with tumor emboli present in a space not lined by endothelial cells but otherwise very suspicious for an angiolymphatic space were also considered ineligible.
    2. EIC (Extensive Intraductal Component): defined as the presence of intraductal carcinoma both within the primary infiltrating ductal tumor (comprising at least 25% of the tumor area) and intraductal carcinoma present clearly beyond the edges of the invasive tumor, or as a predominantly intraductal tumor with one or more areas of focal invasion 7, 55.
    3. Invasive Lobular Carcinoma
    4. Infiltrating carcinoma with mixed ductal and lobular features: cases with ambiguous or mixed histologic features that showed positive E-cadherin staining throughout the tumor by immunohistochemistry were classified as ductal type and considered eligible 56, 57.
    5. Infiltrating papillary carcinoma
    6. Margins: In-situ or invasive carcinoma present less than 2 mm from the inked resection margin.
  4. History of cosmetic or reconstructive breast surgery
  5. Psychiatric illness which would prevent the patient from giving informed consent. Medical condition such as uncontrolled infection (including HIV), uncontrolled diabetes mellitus or connective tissue diseases (lupus, systemic sclerosis or other collagen vascular diseases) which, in the opinion of the treating physician, would make this protocol unreasonably hazardous for the patient.
  6. Patients with a "currently active" second malignancy other than non-melanoma skin cancers. Patients are not considered to have a "currently active" malignancy if they have completed therapy and considered by their physician to be at less than 5% risk of relapse within three years.
  7. Patients with diffuse (> 1 quadrant or > 5cm) suspicious microcalcifications
  8. Women who are pregnant.
  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: NCT00325598

Locations
United States, Missouri
Washington University School of Medicine
St. Louis, Missouri, United States, 63110
Sponsors and Collaborators
Washington University School of Medicine
Investigators
Principal Investigator: Imran Zoberi, M.D. Washington University School of Medicine
  More Information

Additional Information:
No publications provided

Responsible Party: Washington University School of Medicine
ClinicalTrials.gov Identifier: NCT00325598     History of Changes
Other Study ID Numbers: 05-1053 / 201103235
Study First Received: May 12, 2006
Last Updated: June 2, 2014
Health Authority: United States: Institutional Review Board

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

ClinicalTrials.gov processed this record on September 18, 2014