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Radiation Therapy Before Surgery in Treating Patients With Hormone Receptor Positive, HER2 Negative 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: NCT03359954
Recruitment Status : Active, not recruiting
First Posted : December 2, 2017
Last Update Posted : January 29, 2020
National Cancer Institute (NCI)
Information provided by (Responsible Party):
M.D. Anderson Cancer Center

Brief Summary:
This phase II trial studies how well radiation therapy before surgery works in treating patients with hormone receptor positive, HER2 negative breast cancer. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Giving radiation therapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed.

Condition or disease Intervention/treatment Phase
Estrogen Receptor Positive HER2/Neu Negative Invasive Breast Carcinoma Progesterone Receptor Positive Radiation: Radiation Therapy Procedure: Therapeutic Conventional Surgery Phase 2

Detailed Description:


I. To evaluate the change in percent tumor-infiltrating lymphocytes (TIL) as a continuous variable before and after preoperative boost radiotherapy (RT) in hormone receptor (HR)+/human epidermal growth factor receptor2 (HER2)- breast cancers.


I. To evaluate the safety of preoperative boost RT administered to patients with HR+/HER2- breast cancer.


  • I. To assess the mechanisms of cell death induced by preoperative boost RT.
  • II. To assess immunologic and molecular responses to preoperative boost RT.
  • III. To assess the correlations between immune markers, cell death markers, and their changes during treatment.
  • IV. To determine if magnetic resonance imaging (MRI) can be used to predict breast tumor response to neoadjuvant radiation.


Patients undergo boost radiation therapy 6-8 days before breast surgery. After surgery, patients continue to receive standard of care radiation therapy.

After completion of study treatment, patients are followed up at 6 months.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 25 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: PRECISE: Preoperative Radiotherapy to Elicit Critical Immune Stimulating Effects
Actual Study Start Date : November 16, 2017
Estimated Primary Completion Date : October 31, 2020
Estimated Study Completion Date : October 31, 2020

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Treatment (radiation therapy, surgery)
Patients undergo boost radiation therapy 6-8 days before breast surgery. After surgery, patients continue to receive standard of care radiation therapy.
Radiation: Radiation Therapy
Undergo radiation therapy
Other Names:
  • Cancer Radiotherapy
  • Irradiate
  • Irradiated
  • irradiation
  • Radiation
  • Radiotherapeutics
  • RT
  • Therapy, Radiation

Procedure: Therapeutic Conventional Surgery
Undergo breast surgery

Primary Outcome Measures :
  1. Evaluation of Change in Percent of Tumor-Infiltrating Lymphocytes (TIL) [ Time Frame: 6 to 8 days after preoperative radiotherapy ]
    With 20 patients, a 95% confidence interval for the mean difference between TIL measurements would extend 0.44*s units from the mean (where "s" is the standard deviation of the TIL differences). If the differences are not normally distributed, researchers will report the median difference along with appropriate 95% confidence intervals. Appropriate graphs used to visualize the data.

Secondary Outcome Measures :
  1. Delay Rate of Surgery Following Boost RT [ Time Frame: 4 weeks after boost RT ]

    Delay rate defined as the proportion of patients experiencing a > 4 week interval between boost RT and surgery.

    The method of Thall, Simon, and Estey employed to perform interim delay rate monitoring.

  2. Tumor Changes between pre and post boost [ Time Frame: Up to 4 weeks after surgery ]
    For tumor measures, descriptive statistics including plots, tabulations, mean, median, and standard deviations will be used to summarize data. Differences and/or percentage changes will be calculated between pre- and post- therapy samples from each patient and described as continuous measures by using paired t-tests will be explored to evaluate the changes in markers pre- and post-boost therapy. Scatter plots will be used to visualize how correlated between changes in immune markers and extent of tumor cell apoptosis, and the Spearman correlation coefficients will be calculated to evaluate the association between changes in immune markers and extent of tumor cell death markers.

  3. Toxicity calculated using the CTCAE v4.0 [ Time Frame: 6 months after adjuvant RT ]
    Toxicity and cosmesis will be calculated and reported, to enable comparisons to other published reports of breast cancer-related toxicity using the CTCAE v4.0.

  4. Changes in dynamic contrast enhanced (DCE) [ Time Frame: 4 weeks after surgery ]
    Changes in DCE, internal texture, ADC values, z-spectrum asymmetry on CEST measures will be assessed between the simulation MRI and the MRI obtained following radiation boost.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:


  • Age >/=18 years at time of study entry
  • Histologically confirmed HR+/HER2- (according to American Society of Clinical Oncology/College of American Pathologists guidelines) invasive carcinoma of the breast
  • Presence of a clip in the primary breast cancer
  • Biopsy-amenable residual disease in the breast measuring >/= 1cm in at least one dimension on ultrasound cm in at least one dimension on ultrasound
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0-1
  • Signed written informed consent
  • Planned for multidisciplinary evaluation by a Breast Surgical Oncologist and Breast Radiation Oncologist. For patients undergoing mastectomy and desirous of reconstruction or those undergoing breast conservation in whom oncoplastic local tissue rearrangement or reduction mammoplasty is being considered, this multidisciplinary evaluation will also include a plastic surgeon.


  • Women who are pregnant or breast-feeding
  • Contraindication to receive radiotherapy

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): NCT03359954

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United States, Texas
M D Anderson Cancer Center
Houston, Texas, United States, 77030
Sponsors and Collaborators
M.D. Anderson Cancer Center
National Cancer Institute (NCI)
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Principal Investigator: Simona F Shaitelman M.D. Anderson Cancer Center
Additional Information:
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Responsible Party: M.D. Anderson Cancer Center Identifier: NCT03359954    
Other Study ID Numbers: 2017-0362
NCI-2018-00993 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
2017-0362 ( Other Identifier: M D Anderson Cancer Center )
P30CA016672 ( U.S. NIH Grant/Contract )
First Posted: December 2, 2017    Key Record Dates
Last Update Posted: January 29, 2020
Last Verified: January 2020

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Breast Neoplasms
Neoplasms by Site
Breast Diseases
Skin Diseases