Trial Evaluating Role of Post Mastectomy Radiotherapy in Women With Node Negative Early Breast Cancer

Not Applicable

Recruiting

Brief Summary: Postmastectomy radiotherapy (PMRT) is unequivocally beneficial in reducing the recurrences as well as improving survival in node positive breast cancer patients. PMRT for women with T1-T2 tumors and negative axillary nodes is not generally warranted because of the presumed low risk of recurrence in this population as a whole. However, in the setting of multiple adverse prognostic factors, the recurrence risk approaches and in some cases surpasses the risk of recurrence documented for patients with one to three positive lymph nodes. Numerous retrospective series have reported the outcome and patterns of failure for post-mastectomy patients treated without radiation. Many of these series have analyzed several high risk factors which were predictive of loco-regional recurrence wherein the role of adjuvant post-mastectomy radiation can be considered. Some authors have used combinations of prognostic factors, such as age, tumour size, grade, receptor status, Her2neu status and lympho-vascular space invasion to define subgroups with more specific risks of loco-regional recurrence than single factors alone. The current trial hypothesizes that "Post-mastectomy radiation in high risk, node negative early breast cancer patients decreases rates of loco-regional recurrence and improves disease free survival" and propose to address the question in randomized setting.

Recruitment & Eligibility

Inclusion Criteria

Women with unilateral pT1,2N0M0 breast cancer or multifocal breast cancer if largest discrete tumour at least 2cm or if the tumour area comprises multiple small adjacent foci of invasive carcinoma then overall maximum dimension taken. This must be greater than 2cm.
Upfront total mastectomy (with minimum 1 mm margin clear of invasive cancer or DCIS) and axillary staging procedure (clearance, sampling or SNB)
T2 tumors with one risk factor or T1 tumors with any of the following two high risk factors such as presence of high grade, lymphovascular invasion, ER/PR negative, HER2 positivity, age < 35 years.
Fit to receive adjuvant radiation +/- chemotherapy (if indicated) +/- hormonal therapy (if indicated)
Written, informed consent

Exclusion Criteria

Any pTis/3/4, M1 patients
Patients who have any pathologically involved axillary nodes (micro-metastasis may be allowed)
Patients who have undergone neoadjuvant systemic therapy.
Previous or concurrent malignancy other than non melanomatous skin cancer and carcinoma in situ of the cervix
Pregnancy
Bilateral breast cancer
Not fit for surgery, radiotherapy or adjuvant systemic therapy
Unable or unwilling to give informed consent

Arm && Interventions

Group	Intervention	Description
Post Mastectomy Radiation Therapy (PMRT)	Post Mastectomy Radiation therapy	Post mastectomy radiotherapy will be given

Primary Outcome Measures

Name	Time	Method
Disease free survival	5 years	This will be measured using Kaplan Meier time to event analysis

Secondary Outcome Measures

Name	Time	Method
Regional recurrence	5 years	This is the incidence of recurrence in the regional lymphatics
Acute Morbidity of radiotherapy	4 weeks from the start of radiotherapy	RTOG Acute radiation morbidity scoring
Chest wall recurrence	5 years	This is the incidence of local recurrence in the chest wall
Metastasis-free survival	5 years	This will be measured using Kaplan Meier time to event analysis
Overall survival	5 years	This will be measured using Kaplan Meier time to event analysis
Late Morbidity of radiotherapy	6 months from end of radiotherapy to 5 years	RTOG Late radiation morbidity scoring
Quality of life scores under different domains of the QLQ C-30 and BR-23 questionnaires	5 years post surgery	Quality of life will be assesses by EORTC QLQ C-30 core questionnaire and the breast cancer specific module BR-23 questionnaire

Locations (7): Tata Memorial Centre
🇮🇳
Mumbai, Maharashtra, India
Post Graduate Institute of Medical Education & Research
🇮🇳
Chandigarh, India
Bhagwan Mahaveer Cancer Hospital and Research Centre
🇮🇳
Jaipur, Rajasthan, India
Max Super Speciality Hospital(A unit of Devki Devi Foundation)
🇮🇳
New Delhi, Delhi, India
All India Institute of Medical Sciences
🇮🇳
New Delhi, Delhi, India
Max Super Speciality Hospital, Shalimar Bagh
🇮🇳
Delhi, India
Kolhapur Cancer Centre Pvt Ltd
🇮🇳
Kolhapur, Maharashtra, India