Nipple-Areola Complex (NAC) Irradiation After Nipple-Sparing Mastectomy and Reconstruction - Full Text View

Purpose

Overall rationale: Prophylactic NAC irradiation after nipple-areola sparing mastectomy and immediate reconstruction for patient with ductal carcinoma in-situ or invasive breast cancer will allow better cosmesis and patient's satisfaction.

Study design: Phase I trial assessing the safety, feasibility and toxicity of prophylactic NAC irradiation after nipple-areola sparing mastectomy and immediate reconstruction in patients with ductal carcinoma in-situ or invasive breast cancer.

Primary objective: To determine the recommended phase I dose of post-operative prophylactic NAC irradiation.

Secondary objectives: To provide extensive descriptive data regarding NAC-sparing surgery with reconstruction, including both surgeon experience and patient evaluation of cosmetic results. Survival and recurrence will be assessed.

Study size: Between 12 and 18 patients will be enrolled in this phase I study.

Condition	Intervention	Phase
Breast Cancer Ductal Carcinoma	Procedure: Nipple Area Complex-Sparing Mastectomy Radiation: Nipple Area Complex Irradiation Procedure: Breast Reconstruction Procedure: Axillary Dissection or Sentinel Node Biopsy (SNB) Drug: Chemotherapy	Phase 1

Study Type:	Interventional
Study Design:	Allocation: Non-Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	A Phase I Trial Assessing the Safety and Feasibility of Prophylactic Nipple-Areola Complex (NAC) Irradiation After Nipple-Sparing Mastectomy and Immediate Reconstruction in Patients With In-Situ or Invasive Breast Cancer

Resource links provided by NLM:

Genetics Home Reference related topics: breast cancer

MedlinePlus related topics: Breast Cancer Breast Reconstruction Cancer Mastectomy Plastic and Cosmetic Surgery

U.S. FDA Resources

Further study details as provided by University of Miami Sylvester Comprehensive Cancer Center:

Primary Outcome Measures:

To determine the recommended phase II dose of post-operative prophylactic NAC irradiation. [ Time Frame: 2 to 3 Years ] [ Designated as safety issue: Yes ]
The recommended phase II dose will be the highest irradiation dose level at which <= 1 out of 6 study patients experiences dose-limiting toxicity (DLT). This dose will be the phase dose II of post-operative prophylactic NAC irradiation after NAC-sparing mastectomy with reconstruction in patients with ductal carcinoma in-situ or invasive breast cancer.

Secondary Outcome Measures:

To provide extensive descriptive data regarding NAC-sparing surgery with reconstruction, including both surgeon experience and patient evaluation of cosmetic results. [ Time Frame: Up to 5 Years ] [ Designated as safety issue: No ]
Surgery success rate, defined as the proportion of patients who had successful NAC sparing surgery with reconstruction divided by the total number of study patients, will be determined.

Cosmetic results will be assessed by both the physician(s) and the patients at 3, 6 and 12 months, using a 4-category ordinal scale (excellent, good, fair, and poor).
Survival [ Time Frame: Up to 5 years ] [ Designated as safety issue: No ]

Estimated Enrollment:	18
Study Start Date:	October 2009
Estimated Primary Completion Date:	October 2014 (Final data collection date for primary outcome measure)

Intervention Details:

Prior to radiation therapy

Other Name: NAC-Sparing Mastectomy

Prophylactic NAC irradiation twice daily, minimum of 4 to 6 hours apart, for 5 days, preferable in consecutive working days.

Immediate reconstruction (after NAC-Sparing Mastectomy) of the breast will be performed by the plastic surgeon's discretion and patient's desire.

At surgeon's discretion.

Chemotherapy, if indicated, at the discretion of the treating physician

Detailed Description:

The use of NAC-sparing mastectomy followed by postoperative NAC (nipple-areola complex) external beam radiotherapy for selected patient with early stage invasive or in-situ breast cancers will be technically feasible and with acceptable complication rates.
The cosmetic results after NAC-sparing mastectomy followed by postoperative external beam radiotherapy to the NAC will be better comparable with Skin Sparing Mastectomy.
The local control rate in the NAC will be more than expected for a NAC sparing mastectomy without postoperative radiotherapy.
The patient's satisfaction after NAC-sparing mastectomy followed by postoperative NAC external beam radiotherapy will be better than after Skin Sparing Mastectomy.

Eligibility

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

Criteria

Inclusion Criteria:

Patients must have histologically confirmed in-situ or invasive breast carcinoma.
Tis, T1, T2 invasive or non-invasive carcinoma of the breast; lesion less than 4 cm.
Unifocal, multifocal or multicentric breast cancers that can be removed by nipple sparing mastectomy with negative margins.
Negative surgical margins.
No extensive intraductal component or patient with distant metastases.
Patients must be > 18 years of age.
No concomitant or history of nipple discharge or skin involvement.
No prior history of malignancy (less than 5 years prior to study entry), except non-melanomatous skin cancer.
No prior history of radiation to the chest.
No collagenous disease (systemic lupus erythematosis, scleroderma, dermatomyositis)No previous non-hormonal therapy including radiation or chemotherapy for current breast cancer.
No patients with Paget's disease of the nipple.
No patients with co-existing medical conditions with life expectancy < 2 years.
No pregnant or lactating women.
ECOG 0 - 2.
Signed study-specific informed consent form prior to the study entry.

Exclusion Criteria:

Retroareolar breast cancer lesions.
Concomitant or history of nipple discharge or skin involvement.
Patient with distant metastases.
Patient with extensive intraductal carcinoma.
Any previously irradiated ipsilateral breast cancer.
Patients with Paget's disease of the nipple.
Patients with collagenous diseases, as systemic lupus erythematosis, scleroderma or dermatomyosis.
Other malignancy, except non-melanomatous skin cancer, less than 5 years prior to participation in this study.
Patients who are pregnant or lactating due to potential exposure of the fetus to RT and unknown effects of RT to lactating females.
Patients with BRCA 1-2 mutations.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01208974

Locations

United States, Florida
University of Miami Sylvester Comprehensive Cancer Center	Recruiting
Miami, Florida, United States, 33136
Contact: University of Miami Sylvester Comprehensive Cancer Center 866-574-5124 Sylvester@emergingmed.com
Principal Investigator: Eli Avisar, MD
Principal Investigator: Cristiane Takita, MD
Sub-Investigator: Zubin Panthaki, MD

Sponsors and Collaborators

University of Miami Sylvester Comprehensive Cancer Center

Investigators

Study Chair:

Cristiane Takita, MD

University of Miami Sylvester Comprehensive Cancer Center

More Information

No publications provided

Responsible Party:	University of Miami Sylvester Comprehensive Cancer Center
ClinicalTrials.gov Identifier:	NCT01208974 History of Changes
Other Study ID Numbers:	EPROST-20090299, SCCC-2009004
Study First Received:	September 22, 2010
Last Updated:	December 17, 2012
Health Authority:	United States: Food and Drug Administration

Keywords provided by University of Miami Sylvester Comprehensive Cancer Center:

Breast Cancer
Nipple Area Complex
Mastectomy

Radiation Therapy
Nipple-Sparing
Breast Reconstruction

Additional relevant MeSH terms:

Breast Neoplasms
Carcinoma
Carcinoma, Ductal, Breast
Carcinoma, Ductal
Neoplasms by Site
Neoplasms

Breast Diseases
Skin Diseases
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Adenocarcinoma
Neoplasms, Ductal, Lobular, and Medullary

ClinicalTrials.gov processed this record on May 16, 2013