RAPID: Randomized Trial of Accelerated Partial Breast Irradiation

Not Applicable

Completed

• Conditions: Breast Cancer
• Interventions: Radiation: APBI utilizing 3D-CRT radiation; Radiation: Whole breast irradiation

• Registration Number: NCT00282035
• Lead Sponsor: Ontario Clinical Oncology Group (OCOG)

Brief Summary

To determine if Accelerated Partial Breast Irradiation, using 3D CRT, is as effective as Whole Breast Irradiation following breast conserving surgery in women with an new histological diagnosis of ductal carcinoma in situ only or invasive breast cancer without evidence of metastatic disease. Effectiveness will be determined by the rate of ipsilateral breast tumour recurrence.

General objective is to improve the convenience and quality of life of female patients who receive breast irradiation.

Detailed Description

Following breast conserving surgery or on completion of chemotherapy, patients will be stratified according to age, tumour histology, tumour size, adjuvant hormonal therapy and clinical centre. Patients will be allocated to receive either whole breast irradiation or 3D CRT accelerated partial breast irradiation.

Radiation therapy will be administered as soon as possible following the healing of the surgical incision (3-4 weeks) and within 12 weeks if the patient is not treated with chemotherapy. If the patient is treated with chemotherapy, radiation therapy will begin after 2 weeks and not beyond 8 weeks after the last dose of chemotherapy.

Patients treated with whole breast irradiation will receive a total dose of 42.5 Gy in 16 fractions, given on a daily basis, over a time period of 22 days. Patients with large breast size are permitted to receive a total dose of 50 Gy in 25 fractions, given on a daily basis, over a time period of 35 days. Boost irradiation is permitted in patients treated with whole breast irradiation. Boost irradiation of 10 Gy/4-5 fractions daily over a time period of 4-7 days is permitted for patients deemed at moderate to high risk of local recurrence as per local cancer centre guidelines.

Patients treated with 3D CRT accelerated partial breast irradiation will receive a total dose of 38.5 Gy in 10 fractions, delivered twice a day, over a time period of 5-8 days. Each daily dose must be separated by 6-8 hours.

Patients will be followed indefinitely and assessed formally at 6 and 12 months after the date of randomization and then on a yearly basis. Patients will be assessed for acute and late radiation toxicity, cardiac toxicity, recurrent disease, new primary cancer, cosmetic outcome, quality of life and overall survival.

Study Timeline

• Study Start: 2006-01
• Study First Submitted: 2006-01-23
• Study First Submitted QC: 2006-01-23
• Study First Posted: 2006-01-25
• Primary Completion: 2018-03-31
• Study Completion: 2018-03-31
• Status Verified: 2018-07
• Last Update Submitted: 2018-07-11
• Last Update Posted: 2018-07-13

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Female
• Target Recruitment: 2135

Inclusion Criteria

• 1a. Female patient with a new histological diagnosis of DCIS only. OR

  1b. Female patient with a new histological diagnosis of invasive carcinoma of the breast and no evidence of metastatic disease.

  2. Treated by BCS with microscopically clear resection margins for invasive and non-invasive disease (or no residual disease on re- excision).

  3. Negative axillary node involvement including micrometastasis <= 0.2mm or positive cells only identified by IHC as determined either by: (i) sentinel node biopsy (ii) axillary node dissection or (iii) clinical exam for patients with DCIS only

Exclusion Criteria

• 1. Age < 40 years.

  2. A known deleterious mutation in BRCA 1 and/or BRCA 2.

  3. Tumour size > 3 cm in greatest diameter on pathological examination (including both the invasive and non-invasive component).

  4. Tumour histology limited to lobular carcinoma only.

  5. History of cancer:

  • Patients with another active malignancy or malignancy treated < 5 years prior to randomization are excluded.

  • Patients with a prior diagnosis of invasive or non-invasive breast cancer in either breast are excluded regardless of disease free interval. Patients with concurrent invasive or non-invasive contralateral breast cancer are also excluded.

  • Patients with prior or concurrent basal cell or squamous cell skin cancers are eligible for the trial.

    6. More than one primary tumour in different quadrants of the same breast.

    7. Previous irradiation to the ipsilateral breast that would preclude whole breast irradiation.

    8. Presence of an ipsilateral breast implant or pacemaker.

    9. Serious non-malignant disease (e.g. cardiovascular, pulmonary, systemic lupus erythematosus (SLE), scleroderma) which would preclude definitive radiation treatment.

    10. Estrogen receptor status (ER) not known.

    11. For patients not treated with adjuvant chemotherapy: unable to commence radiation therapy within 12 weeks of the last surgical procedure on the breast.

    12. For patients treated with adjuvant chemotherapy: unable to commence within 8 weeks of the last dose of chemotherapy.

    13. Currently pregnant or lactating.

    14. Psychiatric or addictive disorders which would preclude obtaining informed consent or adherence to protocol.

    15. Geographic inaccessibility for follow-up.

    16. Inability to localize surgical cavity on CT (i.e., no evidence of surgical clips or seroma).

    17. Inability to adequately plan the patient for the experimental technique.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
APBI utilizing 3D-CRT radiation	APBI utilizing 3D-CRT radiation	Accelerated partial breast irradiation utilizing 3D-CRT
Whole breast irradiation	Whole breast irradiation	Whole breast irradiation

Primary Outcome Measures

Name	Time	Method
ipsilateral breast tumour recurrence defined as recurrent invasive or in situ cancer in the ipsilateral breast including the axillary tail.	ongoing throughout study	ipsilateral breast tumour recurrence

Secondary Outcome Measures

Name	Time	Method
adverse cosmetic outcome	evaluated at 1, 3, 5, 7 and 10 years	adverse cosmetic outcome
disease free survival	ongoing throughout study	disease free survival
event free survival	ongoing throughout study	event free survival
overall survival	ongoing throughout study	overall survival
radiation toxicity	ongoing throughout study	radiation toxicity
quality of life based on questionnaire responses	ongoing throughout study	quality of life
cost effectiveness	end of study	cost effectiveness

Trial Locations

Locations (31)

British Columbia Cancer Agency - Vancouver Island Centre; 🇨🇦 Vancouver, British Columbia, Canada

British Columbia Cancer Agency - Centre for the Southern Interior; 🇨🇦 Kelowna, British Columbia, Canada

British Columbia Cancer Agency - Fraser Valley Centre; 🇨🇦 Surrey, British Columbia, Canada

Auckland City Hospital; 🇳🇿 Auckland, Auckland Region, New Zealand

Peter MacCallum Cancer Centre; 🇦🇺 East Melbourne, Victoria, Australia

Cross Cancer Institute; 🇨🇦 Edmonton, Alberta, Canada

Peter MacCallum Cancer Centre - Monash Medical Centre Moorabbin; 🇦🇺 Melbourne, Victoria, Australia

Grand River Regional Cancer Centre; 🇨🇦 Kitchener, Ontario, Canada

CHUM - Hospital Notre Dame; 🇨🇦 Montreal, Quebec, Canada

McGill University - Montreal General Hospital; 🇨🇦 Montreal, Quebec, Canada

CHUQ, L'Hotel Dieu de Quebec; 🇨🇦 Quebec City, Quebec, Canada

British Columbia Cancer Agency - Vancouver Centre; 🇨🇦 Vancouver, British Columbia, Canada

Juravinski Cancer Centre; 🇨🇦 Hamilton, Ontario, Canada

Cancer Care Manitoba; 🇨🇦 Winnipeg, Manitoba, Canada

BC Cancer Agency - Abbotsford Centre; 🇨🇦 Abbotsford, British Columbia, Canada

London Regional Cancer Centre; 🇨🇦 London, Ontario, Canada

Irving Greenberg Family Cancer Centre; 🇨🇦 Ottawa, Ontario, Canada

Windsor Regional Cancer centre; 🇨🇦 Windsor, Ontario, Canada

McGill University - Jewish General Hospital; 🇨🇦 Montreal, Quebec, Canada

Northeastern Regional Cancer Centre; 🇨🇦 Sudbury, Ontario, Canada

Brantford General Hospital; 🇨🇦 Brantford, Ontario, Canada

Tom Baker Cancer Centre; 🇨🇦 Calgary, Alberta, Canada

Atlantic Health Sciences Corporation; 🇨🇦 Saint John, New Brunswick, Canada

Niagara Health System; 🇨🇦 St. Catharines, Ontario, Canada

Princess Margaret Hospital - University Health Network; 🇨🇦 Toronto, Ontario, Canada

QE II HSC - Nova Scotia Cancer Centre; 🇨🇦 Halifax, Nova Scotia, Canada

Credit Valley Hospital - Carlo Fidani Peel Regional Cancer Center; 🇨🇦 Mississauga, Ontario, Canada

CHUS - Hopital Fleurimont; 🇨🇦 Fleurimont, Quebec, Canada

Hopital Maisonneuve-Rosemont; 🇨🇦 Montreal, Quebec, Canada

Durham Regional Cancer Centre - Lakeridge Health Corporation; 🇨🇦 Oshawa, Ontario, Canada

The Ottawa Hospital Cancer Centre; 🇨🇦 Ottawa, Ontario, Canada