4D Image-Guided Partial Breast Radiation in Stage 0 and l Breast Cancer

This study is currently recruiting participants. (see Contacts and Locations)
Verified June 2014 by Yale University
Sponsor:
Information provided by (Responsible Party):
Yale University
ClinicalTrials.gov Identifier:
NCT01646346
First received: March 11, 2012
Last updated: June 16, 2014
Last verified: June 2014
  Purpose

The Purpose of this study is to evaluate the feasibility of using image guidance and four-dimensional computed tomography to reduce the volume of non target breast tissue that is treated with accelerated partial breast irradiation via the external beam technique.


Condition Intervention
Breast Cancer
Radiation: 4D Conformal Image-Guided Partial Breast RT

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Pilot Study of Four-Dimensional Conformal Image Guided Accelerated Partial Breast Irradiation In The Treatment Of Stage 0 and l Breast Cancer

Resource links provided by NLM:


Further study details as provided by Yale University:

Primary Outcome Measures:
  • Reduction in incidental radiation [ Time Frame: 5 day ] [ Designated as safety issue: No ]
    Reduction in breast radiation V50 less than 45% and V100 less than 23.5%.List instrument or scale


Secondary Outcome Measures:
  • Cosmesis by patient report [ Time Frame: Within no more than 8 weeks of surgery, but prior to the start of radiation ] [ Designated as safety issue: No ]
    patient will be provided with cosmesis scale and self grade cosmesis of breast

  • Cosmesis by patient report [ Time Frame: 1 year post treatment ] [ Designated as safety issue: No ]
    patient will be provided with cosmesis scale and self grade cosmesis of breast

  • Cosmesis by patient report [ Time Frame: 3 year post treatment ] [ Designated as safety issue: No ]
    patient will be provided with cosmesis scale and self grade cosmesis of breast

  • Cosmesis by medical doctor report [ Time Frame: Within no more than 8 weeks of surgery, but prior to the start of radiation ] [ Designated as safety issue: No ]
    medical doctor will be provided with cosmesis scale and grade cosmesis of breast

  • Cosmesis by medical doctor report [ Time Frame: 1 yr post treatment ] [ Designated as safety issue: No ]
    medical doctor will be provided with cosmesis scale and grade cosmesis of breast

  • Cosmesis by medical doctor report [ Time Frame: 3 yr post treatment ] [ Designated as safety issue: No ]
    medical doctor will be provided with cosmesis scale and grade cosmesis of breast


Estimated Enrollment: 30
Study Start Date: February 2012
Estimated Study Completion Date: January 2018
Estimated Primary Completion Date: January 2018 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 4D Conformal Image-Guided Partial Breast RT
This is a single arm trial designed to look at the results in women treated with partial breast irradiation twice daily for 5 days.
Radiation: 4D Conformal Image-Guided Partial Breast RT
External beam partial breast radiation to target a portion of the breast twice a day for 5 days.
Other Name: 4D conformal image guided radiation therapy

Detailed Description:

This is a pilot study enrolling about 30 patients to evaluate the feasibility of using 4D CT and daily image guidance in Accelerated Partial Breast Irradiation (APBI) to decrease set-up error and individualized planning target volumes to limit the non-target breast tissue dose. The two specific breasts constraints which shall be decreased are the V50 (percent volume of breast receiving 50% of the prescribed dose) and the V100 (percent volume of breast receiving 100% of the prescribed dose). The goal will be to decrease these to 45% and 23.5% respectively, which is down 33% from the NSABP B39 standard of 60% and 35%.

  Eligibility

Ages Eligible for Study:   50 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • The patient must consent to be in the study and must have a signed an approved consent form conforming with institutional guidelines.
  • Patient must be > 50 years old.
  • The patient should have a life expectancy of at least two years with a karnofsky performance status > 70.
  • The patient must have stage 0 or I breast cancer.
  • On histological examination, the tumor must be DCIS or invasive adenocarcinoma of the breast.
  • Surgical treatment of the breast must have been lumpectomy. The margins of the resected specimen must be histologically free of tumor (>2mm, DCIS and invasive). Re-excision of surgical margins is permitted.
  • Gross disease must be unifocal with pathologic (invasive and/or DCIS) tumor size 2 cm or less. (Patients with microscopic multifocality are eligible as long as total pathologic tumor size is 2 cm or less.)
  • Patients with invasive breast cancer are required to have axillary staging which can include sentinel node biopsy alone (if negative), sentinel node biopsy followed by axillary dissection or sampling with a minimum total of 6 axillary nodes or axillary dissection alone (with a minimum of 6 axillary nodes). Axillary staging is NOT required for patients with DCIS.
  • The patient must have simulation within 8 weeks/56 days of the final surgery for their breast cancer (lumpectomy, re-excision of margins, or axillary staging procedure).
  • Patients with a history of non-ipsilateral breast malignancies are eligible if they have been disease-free for 2 or more years prior to enrollment. Patients with the following cancers are eligible even if diagnosed and treated within the past 2 years: carcinoma in situ of the cervix, colon, melanoma in situ, and basal cell and squamous cell carcinoma of the skin.
  • Chemotherapy is permitted if planned for ≥ 2 weeks after radiation.
  • Urine pregnancy test must be performed and be negative on all women younger than 60 who have not had a tubal ligation, oophorectomy, or hysterectomy.
  • Separate incisions for the lumpectomy and sentinel node biopsy should be present. Use of only one incision will typically result in a contiguous cavity with the tumor bed and the sentinel node sampling, and inability of the radiation oncologist to delineate the tumor bed from the sentinel node bed.
  • The patient must have a cavity which is able to be targeted with external beam APBI, either through surgical clip placement, or CVS 3 or higher. The cavity to whole breast ratio must be 30% or less.

Exclusion Criteria:

  • Men are not eligible for this study as men are not breast conservation candidates.
  • T0, T2 (> 2.0 cm), T3, node positive, stage III or IV breast cancer.
  • Any positive axillary nodes.
  • Palpable or radiographically suspicious ipsilateral or contralateral axillary, supraclavicular, infraclavicular or internal mammary nodes, unless biopsy proven to be negative for tumor.
  • Suspicious microcalcifications, densities or palpable abnormalities in either breast unless biopsy proven to be benign.
  • Non-epithelial breast malignancies such as sarcoma or lymphoma.
  • Proven multicentric carcinoma in more than one quadrant or separated by more than 2 centimeters.
  • Paget's disease of the nipple.
  • History of invasive breast cancer or DCIS in the same breast.
  • Surgical margins that cannot be microscopically assessed or are less then 2 mm.
  • Collagen vascular disease, specifically dermatomyositis with a CPK level above normal or with an active skin rash, systemic lupus erythematosis or scleroderma.
  • Pregnancy or lactation at the time of proposed radiation. Women of reproductive potential must agree to use an effective non-hormonal method of contraception during therapy.
  • Psychiatric or addictive disorders or other conditions that, in the opinion of the treating physician, would preclude the patient from meeting the study requirements.
  • Patients with coexisting medical conditions in whom life expectancy is < 2 years.
  • Patients with skin involvement, regardless of tumor size.
  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: NCT01646346

Contacts
Contact: Jeannie Kluytenaar, RN 203-785-2368 jeannie.kluytenaar@yale.edu
Contact: Anne McKeon, BS 203-737-2587 anne.mckeon@yale.edu

Locations
United States, Connecticut
Yale New Haven Hospital Recruiting
New Haven, Connecticut, United States, 06510
Sponsors and Collaborators
Yale University
Investigators
Principal Investigator: Suzanne Evans, MD Yale University
Principal Investigator: Joanne Weidhaas, MD Yale University
  More Information

No publications provided

Responsible Party: Yale University
ClinicalTrials.gov Identifier: NCT01646346     History of Changes
Other Study ID Numbers: 1110009173
Study First Received: March 11, 2012
Last Updated: June 16, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by Yale University:
Breast Cancer
Radiation for Breast Cancer

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

ClinicalTrials.gov processed this record on August 18, 2014