Radiation Therapy Using Gold Markers in Treating Women With Early-Stage Breast Cancer

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00749437
Recruitment Status : Completed
First Posted : September 9, 2008
Last Update Posted : June 14, 2012
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Rutgers, The State University of New Jersey ( University of Medicine and Dentistry of New Jersey )

Brief Summary:

RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Placing gold markers in the area where the tumor was removed may help doctors better direct radiation therapy and help reduce the risk of cancer recurrence.

PURPOSE: This phase I trial is studying how well radiation therapy using gold markers works in treating women with early-stage breast cancer.

Condition or disease Intervention/treatment Phase
Breast Cancer Radiation: 3-dimensional conformal accelerated partial breast irradiation Phase 1

Detailed Description:



  • To determine if the delivery of external-beam accelerated partial breast irradiation (APBI) based on gold fiducial markers is more accurate when compared to the delivery of radiotherapy based on bony anatomy in women with early-stage, node-negative breast cancer.


  • To assess the migration of fiducial markers during a course of APBI.
  • To quantify the change in the volume of the seroma (lumpectomy) cavity during a course of APBI.
  • To compare overall operative time for suturing fiducial markers into place vs current standard method of placing surgical clips.

OUTLINE: Patients undergo planned lumpectomy with gold fiducial marker placement (if procedure not already performed). Patients who meet the post lumpectomy criteria for continue treatment in this study proceed to accelerated partial breast irradiation (APBI). Between 15-80 days after surgery, patients undergo 3-dimensional APBI (may be intensity-modulated radiotherapy) using CT-guided planning (with gold fiducial markers placed at lumpectomy) once daily, 5 days a week, for 15 days.

Patients undergo fluoroscopy weekly to determine real-time movement of bony anatomy and fiducial markers and cone-beam CT weekly to determine any change in volume of seroma cavity.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 34 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Feasibility of 3-D Conformal Accelerated Partial Breast Irradiation (APBI) for Early Stage, Node Negative Breast Cancer Patients Using Acculoc Fiducial Markers: A Phase I Trial
Study Start Date : October 2008
Actual Primary Completion Date : July 2010
Actual Study Completion Date : July 2010

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Breast Cancer

Intervention Details:
  • Radiation: 3-dimensional conformal accelerated partial breast irradiation
    Accelerated partial breast irradiation following lumpectomy with placement of Acculoc fiducial markers.

Primary Outcome Measures :
  1. Amount of the shifts of the radiation fields based on bony anatomy as compared to that of gold fiducial markers [ Time Frame: During radiation therapy ]

Secondary Outcome Measures :
  1. Movement of the fiducial markers themselves and the change in volume of the seroma cavity during a 15-fraction course of accelerated radiotherapy compared with the pre-radiation volume [ Time Frame: During radiation therapy ]

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Ages Eligible for Study:   45 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No


Inclusion criteria:

  • Histologically confirmed ductal carcinoma in situ or invasive carcinoma of the breast (including ductal, medullary, papillary, colloid [mucinous], or tubular histologies) meeting all of the following criteria:

    • AJCC stage 0, I, or II (Tis, T1N0, or T2N0) disease with a lesion ≤ 3 cm treated with lumpectomy and either sentinel node biopsy or axillary dissection (if invasive carcinoma is present)
    • Unifocal breast cancer (i.e., single focus that can be encompassed by one lumpectomy)
  • Underwent or plan to undergo lumpectomy with placement of gold fiducial markers (markers placed concurrently with the surgery or on a later date)

    • Patients who has underwent lumpectomy must meet all of the following criteria:

      • Must be enrolled between 14-60 days from date of last surgery, and radiation must start within 15-80 days of date of last surgery
      • Four to six gold fiducial markers placed in the tumor bed, delineating the margins of the lumpectomy cavity
      • Negative, inked histologic margins of lumpectomy (> 1 mm) or re-excision specimen to be confirmed prior to radiation

        • Margins are unacceptable if there is invasive or non-invasive tumor within 1 mm of the inked margin
  • Negative post-excision mammography if malignancy-associated microcalcifications were initially present
  • Hormone receptor status not specified

Exclusion criteria:

  • Evidence of suspicious microcalcifications in the breast prior to the start of radiation
  • One or more positive axillary nodes or positive sentinel biopsy
  • Distant metastases
  • Invasive or extensive in-situ lobular carcinoma or non-epithelial breast malignancies such as sarcoma or lymphoma
  • Proven multicentric carcinoma (tumors in different quadrants of the breast or tumor separated by at least 4 cm) with other clinically or radiographically suspicious areas in the ipsilateral breast unless confirmed to be negative for malignancy by biopsy
  • Palpable or radiographically suspicious contralateral axillary, supraclavicular, infraclavicular, or internal mammary nodes, unless there is histologic confirmation that these nodes are negative for tumor
  • Paget's disease of the nipple
  • Skin involvement, regardless of tumor size


  • Female
  • Menopausal status not specified
  • ECOG performance status 0-1
  • Life expectancy ≥ 2 years
  • Not pregnant or nursing
  • No prior treated breast carcinoma within the past 5 years
  • No collagen vascular diseases, specifically systemic lupus erythematosus, scleroderma, or dermatomyositis
  • No co-existing medical conditions
  • No patients with medical conditions that would preclude compliance with the trial, as determined by the investigator
  • No other malignancy, except non-melanomatous skin cancer, within the past 5 years

    • Disease-free interval from any prior carcinoma must be continuous
  • No breast technically unsuitable for radiotherapy


  • See Disease Characteristics
  • Concurrent tamoxifen citrate, anastrozole, or other hormonal therapy allowed
  • Future chemotherapy allowed provided it is administered after the APBI and begins no earlier than 2 weeks after completion of radiotherapy
  • No tylectomies so extensive that the cosmetic result is low or poor prior to radiation
  • No prior radiation to the ipsilateral breast
  • No prior non-hormonal therapy or radiotherapy for this disease
  • No chemotherapy in the past 2 weeks
  • No concurrent chemotherapy, immunotherapy, or experimental medications

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00749437

United States, New Jersey
Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School
New Brunswick, New Jersey, United States, 08903
Sponsors and Collaborators
University of Medicine and Dentistry of New Jersey
National Cancer Institute (NCI)
Principal Investigator: Bruce G. Haffty, MD Rutgers Cancer Institute of New Jersey

Responsible Party: University of Medicine and Dentistry of New Jersey Identifier: NCT00749437     History of Changes
Other Study ID Numbers: 040801
P30CA072720 ( U.S. NIH Grant/Contract )
First Posted: September 9, 2008    Key Record Dates
Last Update Posted: June 14, 2012
Last Verified: June 2012

Keywords provided by Rutgers, The State University of New Jersey ( University of Medicine and Dentistry of New Jersey ):
stage I breast cancer
stage II breast cancer
ductal breast carcinoma in situ
invasive ductal breast carcinoma
medullary ductal breast carcinoma with lymphocytic infiltrate
papillary ductal breast carcinoma
tubular ductal breast carcinoma
mucinous ductal breast carcinoma
breast cancer in situ

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