Safety and Efficacy Study of the Xoft® Axxent® eBx™ IORT System
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|ClinicalTrials.gov Identifier: NCT01644669|
Recruitment Status : Active, not recruiting
First Posted : July 19, 2012
Last Update Posted : November 8, 2018
|Condition or disease||Intervention/treatment||Phase|
|Invasive Ductal Carcinoma Ductal Carcinoma in Situ||Radiation: Intra-operative Radiation Therapy - IORT||Not Applicable|
The rationale for IORT as the sole radiation therapy is:
Favorable preliminary results in feasibility, safety and efficacy outcomes: Accelerated Partial Breast Irradiation (APBI) is an accepted alternative to whole breast irradiation following breast-conserving surgery for early stage breast cancer. Intra-Operative Radiation Therapy (IORT) is a form of APBI that allows radiation to be delivered directly to the open tumor bed following Breast Conservation Surgery (BCS). After 4 years of follow-up, IORT has shown equivalent disease control rates as whole breast irradiation.
Direct and timely radiation to the tumor bed: Radiation is delivered at to the target tissue (adjacent to the resection margins at the time of lumpectomy). It avoids treatment delays and eliminates weeks or months of post-surgical radiation therapy during which residual cancer cells might proliferate. An in vitro study showed that un-irradiated wound fluid stimulated the growth of breast cancer cells while irradiated wound fluid did not. Each month of delay in radiation treatment is associated with a 1% increase in the recurrence rate. Huang, et al., found a 5.8% recurrence rate in patients who received WBRT within 8 weeks of BCS compared with a 9.1% recurrence rate in patients who started radiotherapy 9-16 weeks after BCS.
Increased patient treatment compliance compared to conventional radiation therapy: Suitable early stage breast cancer patients are able to complete their breast cancer radiotherapy treatment at the time of BCS, which offers a convenient and potentially life-saving benefit to patients who might otherwise omit radiation therapy if it required lengthy travel or time commitments. In addition, healthcare resources, including both personnel and facilities, will be conserved by eliminating the overhead cost of multiple patient visits, eliminating waiting time for patients, and consolidating therapy to one visit combined with the surgical procedure.
Available Technology: The Xoft Axxent controller, x-ray source, and balloon applicator are cleared by the United States Food and Drug Administration (FDA) to deliver brachytherapy treatments using high dose rate x-ray radiation. The Xoft Axxent System has been used to treat breast cancer subjects using a multi-fraction APBI technique on an outpatient basis as part of two multi-center studies. The Xoft Axxent System enables the Radiation Oncologist to administer electronic brachytherapy without the use of a radioactive isotope in minimally shielded rooms. Characteristics of the Xoft System that make it well-suited for IORT include its portability and low energy photons, allowing for minimal shielding during the radiation therapy.
This protocol has been developed to further study the use of the Xoft Axxent eBx System in the delivery of IORT for subjects with early-stage breast cancer. The Xoft Axxent eBx System will be used according to the United States Food and Drug Administration (FDA) 510(k) cleared labeling; therefore, the use of the technology in this study is considered on-label and within the scope of the FDA cleared indication.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||1200 participants|
|Intervention Model:||Single Group Assignment|
|Intervention Model Description:||Single 20Gy dose of electronic brachytherapy (IORT)|
|Masking:||None (Open Label)|
|Official Title:||A Safety and Efficacy Study of Intra-Operative Radiation Therapy (IORT) Using the Xoft® Axxent® eBx™ System at the Time of Breast Conservation Surgery for Early Stage Breast Cancer|
|Actual Study Start Date :||May 2012|
|Estimated Primary Completion Date :||February 2023|
|Estimated Study Completion Date :||December 2024|
Experimental: Intra-operative Radiation Therapy - IORT
Intra-operative Radiation Therapy
Radiation: Intra-operative Radiation Therapy - IORT
Single dose of 20 Gy
Other Name: Electronic Brachytherapy
- Assess the rate of ipsilateral breast tumor recurrence (IBTR) at 5 years [ Time Frame: Change from baseline reported at 5 years ]IBTR is defined as biopsy-proven reappearance of cancer in the treated breast. IBTR will be assessed at Month 6, Month 12, Month 18, Year 2, and then annually through ten (10) year follow-up. A non-inferiority comparison to whole breast irradiation will be made at 5 years.
- Assess the rate of regional breast tumor recurrence (RBTR) [ Time Frame: Report at 10 yrs ]Regional breast tumor recurrence is defined as biopsy-proven reappearance of cancer in the axilla. Regional recurrence will be assessed at Month 6, Month 12, Month 18, Year 2, and then annually through ten (10) year follow-up. Regional recurrence rates will be compared to the historical control of WBI at 5 and 10 years.
- Disease Free Survival Rate (DFSR) and Overall Survival rate [ Time Frame: Report at 5 and 10 years ]Disease free survival (DFS) is defined as the length of time from IORT to any first recurrence. The incidence of disease free survival will be assessed at Month 1, Month 6, Month 12, Month 18, Year 2, and then annually through ten (10) year follow-up. DFS will be compared to the historical control at 5 and 10 years.
- Cosmetic Outcome [ Time Frame: Report at 5 and 10 yrs ]Cosmetic outcome will be recorded at baseline, Month 12, Month 18, Year 2, and then annually through ten (10) year follow-up. a. Physician evaluation will be done using the Harvard Scale.
- Quality of Life (QOL) [ Time Frame: Reported at 5 and 10 yrs ]Quality of Life will be assessed at baseline and at each follow-up visit: Month 1, Month 6, Month 12, Month 18, Year 2, and then annually through ten (10) year follow-up. QOL will be measured using the FACT-B self-reporting questionnaires.
- Assess the safety of single fraction IORT at the time of breast conserving surgery for early stage breast cancer [ Time Frame: On-going monitoring, report at 5 and 10 years ]The rates and severity of Adverse Events (AEs), Adverse Device Effects (ADEs), and Unanticipated Adverse Device Effects (UADEs) during and following IORT will be assessed at each follow-up visit. Safety events will be compared to the historical control of WBI at 5 and 10 years. Each event will be classified according to the following: Device Related, Procedure Related or Radiation Related.
- Assess the rate of ipsilateral breast tumor recurrence (IBTR) at 10 years [ Time Frame: Change from baseline reported at 10 years ]IBTR is defined as biopsy-proven reappearance of cancer in the treated breast. IBTR will be assessed at Month 6, Month 12, Month 18, Year 2, and then annually through ten (10) year follow-up. A non-inferiority comparison to whole breast irradiation will be made at 10 years.
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 ClinicalTrials.gov identifier (NCT number): NCT01644669
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|Principal Investigator:||Helena Chang, MD, PhD||University of California, Los Angeles|
|Principal Investigator:||A.M. Nisar Syed, MD||Long Beach Memorial Medical Center|