Phase II Protocol of Proton Therapy for Partial Breast Irradiation in Early Stage Breast Cancer
Overview
- Phase
- Phase 2
- Intervention
- Not specified
- Conditions
- Breast Cancer
- Sponsor
- Proton Collaborative Group
- Enrollment
- 132
- Locations
- 9
- Primary Endpoint
- To assess events of freedom from ipsilateral breast recurrence occurrences in patients receiving partial breast proton radiation therapy limited to the region of the tumor.
- Status
- Recruiting
- Last Updated
- 7 months ago
Overview
Brief Summary
The purpose of this research study is to compare the effects (good and bad) on women and their cancer using proton radiation therapy.
This study is being done to see if proton radiation therapy will prove to be beneficial for women with early stage breast cancer. A clinical study is necessary to compare the results (good or bad) of proton radiation therapy.
Detailed Description
Current standard of care for early stage breast cancer is mastectomy or breast conserving therapy with whole breast irradiation following lumpectomy. However, studies of breast cancer recurrence have demonstrated the majority of tumors to recur in or adjacent to the original tumor site. The question has thus been raised as to whether radiation to the whole breast is necessary or justified. Limiting radiation to the area of the original tumor may reduce acute and long-term skin and organ toxicities while making radiation therapy more convenient and less expensive. Several clinical trials are underway comparing partial breast irradiation (PBI) to whole breast irradiation. Numerous centers are offering partial breast irradiation outside of clinical trials as well, despite the lack of long-term safety and efficacy data on PBI. Available PBI methods include brachytherapy, in which catheters or balloons are surgically inserted to deliver radiation therapy to the lumpectomy cavity, and conventional external beam radiation therapy, or EBRT. External beam photon therapy is attractive for its non-invasive nature and ability to deliver a more homogenous dose distribution compared to brachytherapy, however it also delivers a greater radiation dose to surrounding normal breast tissue.Proton therapy has the capacity to provide the same advantages as photon EBRT while minimizing dose to normal surrounding tissue. Clinical data on PBI with protons is minimal, however, leaving many questions unanswered. The impetus behind this protocol is to address these gaps by further investigating the feasibility, safety, and efficacy of proton therapy for partial breast irradiation.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Must sign study-specific, IRB approved informed consent form prior to study entry. Note consent by legally authorized representative is not allowed for this trial.
- •Must be female.
- •Must be \> = 50 years of age.
- •Must have a life expectancy of at least 5 years based on age and co-morbidities.
- •Must have pathology proven invasive ductal carcinoma (lobular is not allowed) and/or ductal carcinoma in situ (DCIS).
- •One of the following criteria must be met: (a) Tumors that are microscopically multifocal must be 3.0 cm or less in total aggregate size and encompassed within a single scar (b) Patient does not have microscopically multifocal tumor.
- •For tumors that are invasive, if in the presence of extensive intraductal component (EIC), the entire pathologic tumor size (including both the intraductal and invasive component) must be 3.0 cm or less.
- •Must be Stage 0, I, II (Tis, T1, or T2, N0, M0 per AJCC criteria 7th and/or 8th Ed.). If stage II, the tumor size must be \< = 3.0 cm. A patient with invasive histology must have nodal stage pN0 by H\&E stains on sentinel node biopsy or axillary lymph node dissection.
- •Must have ER positive disease with ER/PR report available.
- •For tumors that are invasive, HER2 must be performed (positive or negative is acceptable).
Exclusion Criteria
- •Previous history of ipsilateral invasive breast cancer or DCIS.
- •Any clinical or radiographically suspicious nodes, unless biopsy proven benign.
- •Non-epithelial malignancies such as sarcoma or lymphoma.
- •Suspicious residual microcalcifications on mammography of either breast, unless negative for malignancy on pathology.
- •Multicentric or bilateral disease unless biopsy of the clinical abnormalities are performed and result is negative.
- •Lymphovascular space invasion (LVSI) on pathology specimen.
- •Any previously treated breast carcinoma or synchronous breast carcinoma in ipsilateral breast.
- •Prior radiation therapy to the ipsilateral breast or thorax.
- •Paget's disease of the nipple.
- •Histologic examination showing invasive lobular histology.
Outcomes
Primary Outcomes
To assess events of freedom from ipsilateral breast recurrence occurrences in patients receiving partial breast proton radiation therapy limited to the region of the tumor.
Time Frame: At 3 years
Freedom from failure (FFF): The events for FFF will be the first ipsilateral breast cancer recurrence. It is expected that less than 3% of patients will experience an ipsilateral breast cancer recurrence (FFF ≥ 97%). A recurrence rate of ≥ 10% (FFF ≤ 90%) is considered unacceptable. Therefore, the null hypothesis is the FFF of ipsilateral breast cancer recurrence is 90% or lower and the alternative hypothesis is that FFF of ipsilateral breast cancer is 97% or higher.
Secondary Outcomes
- Determine quality of life results.(Average every 6 months for 3 years)
- To assess relationship between breast size and partial breast dosimetry.(Average every 6 months for 3 years)
- To determine overall survival rate of patients with breast cancer treated with proton radiation.(At 3 years)
- To determine recurrence pattern of patients with breast cancer treated with proton partial breast irradiation.(At 3 years)
- Assess number and severity of acute and long-term toxicity of partial breast irradiation using proton therapy for the treatment of early stage breast cancer.(On average every 6 months for life)