Repeat Breast Conserving Surgery Followed by Daily Partial Breast Irradiation for Participants With Ipsilateral Breast Tumor Recurrence Treated Initially With Breast Conserving Surgery and Whole Breast Radiation Therapy
Summary
The standard treatment for participants whose cancer has returned after breast conserving surgery is radiation given twice daily (separated by at least 6 hours) for a total of 30 treatments. The purpose of this study is to find out if giving radiation once a day for 15 treatments after repeat breast conserving surgery works as well as giving it the standard way.
Detailed description
Breast cancer survival rates have greatly improved with advances in both screening and treatment. The standard of care for both early stage and selected locally advanced breast cancers is breast conserving therapy (BCT), consisting of a partial mastectomy followed by radiation treatment. Traditionally, a salvage mastectomy was the standard treatment for women who initially underwent BCT and experienced an ipsilateral breast tumor recurrence (IBTR). Many participants have become increasingly motivated to avoid mastectomy, and there has been rising interest in repeat BCS (Breast Conserving Surgery) with focal radiation for certain participants motivated to keep their breast. The current standard of care for breast re-irradiation after an in-breast tumor recurrence is partial breast irradiation consisting of a dose of 45 Gy delivered BID for 30 fractions. While this regimen demonstrated excellent local control and low AEs, the regimen itself is difficult for participants. Receiving RT twice daily at smaller doses per fraction (1.5 Gy) for 30 treatments can be burdensome, especially for those without reliable transportation or difficulty getting time away from work. Given the excellent local control rates and low rate of AEs, in this study, we hypothesize that daily hypofractionated EBRT(External Beam Radiation Therapy) for re-irradiation after repeat BCS would be at least as well tolerated with good local control and provide a more convenient option for participants than the current standard of care established by RTOG 1014. Some participants will present with high-risk features (e.g. age \<50, high grade, ER negative tumors, close margins) making dose escalation an attractive option to improve local control. Options for dose escalation include sequential and concurrent administration of a boost.
Arms & interventions
- RadiationRadiation Therapy
Weeks 1, 2 and 3 * Weeks 1, 2 and 3 will include 5 days of treatment. * One radiation treatment to breast on each of the 5 days. Each radiation treatment session will last a 30 minutes.
Outcome measures
Primary
Treatment-related adverse events as graded by CTCAE criteria
Rate of grade 3+ treatment-related skin, fibrosis, and breast pain adverse events occurring within 1 year from the completion of re-irradiation as graded by CTCAE criteria.
Time frame: 1 year from the completion of re-irradiation
Secondary
In-breast tumor recurrence rate
Time frame: 3 years
In-breast tumor recurrence rate
Time frame: 5 years
In-breast tumor recurrence rate
Time frame: 10 years
Rate of freedom from mastectomy
Time frame: 3 years
Rate of freedom from mastectomy
Time frame: 5 years
Rate of freedom from mastectomy
Time frame: 10 years
Treatment-related adverse events
Time frame: 1 year from completion of re-irradiation
Treatment-related adverse events
Time frame: Overall for 3 years from completion of re-irradiation
Evaluation of Cosmesis
Time frame: 1 year
Evaluation of Cosmesis
Time frame: 3 years
Overall survival rate
Time frame: 3 years
Overall survival rate
Time frame: 5 years
Overall survival rate
Time frame: 10 years
Mastectomy-free survival rate
Time frame: 3 years
Mastectomy-free survival rate
Time frame: 5 years
Mastectomy-free survival rate
Time frame: 10 years
Eligibility criteria
Study locations (2)
University Hospitals Cleveland Medical Center, Seidman Cancer Center, Case Comprehensive Cancer Center
Cleveland, Ohio, 44106-5065
Cleveland Clinic Taussig Cancer Center, Case Comprehensive Cancer Center
Cleveland, Ohio, 44195