Trial Radar AI | ||
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Clinical Trial NCT02700386 for Breast Cancer is active, not recruiting. See the Trial Radar Card View and AI discovery tools for all the details. Or ask anything here. | ||
Shorter Course Radiation for the Treatment of Breast Cancer That Has Spread to Lymph Nodes Phase 2 108
Hypofractionated, Comprehensive Radiation Therapy for Node-Positive Breast Cancer
- 15-1329.cc
Cancer
Hypofractionated
Node-Positive Breast Cancer
Radiation Therapy
Comprehensive Radiation Therapy
| Participant Group/Arm | Intervention/Treatment |
|---|---|
ExperimentalAdjuvant Hypofractionated Radiation Adjuvant Hypofractionated Radiation (4005 cGy) will last 3-4 weeks with 15 treatments, +/- 4 additional fractions as a boost. Radiation should commence within 180 days of the date of primary surgery. Four additional fractions (a "boost" or "conedown") to areas deemed to be at particularly high risk of recurrence may be added at the end of the radiation course. Fraction size for the boost treatment will continue at 26...Show More | Adjuvant Hypofractionated Radiation Hypofractionation is the delivery of radiotherapy in single daily doses greater than the 180-200 cGy. Hypofractionation, through use of larger doses per fraction and fewer total treatments, is a method of shortening overall treatment time in breast cancer therapy. |
| Outcome Measure | Measure Description | Time Frame |
|---|---|---|
Number of Participants With at Least One Treatment-related Adverse Event of Interest | The composite endpoint is "yes" for a given patient if that patient experienced at least one of six component adverse events: lymphedema, shoulder ROM impairment, cardiac ischemia, symptomatic rib fracture, brachial plexopathy Grade 2 ('moderate symptoms; limiting instrumental activity of daily living (ADL)') or Grade 3 ('severe symptoms; limiting self-care ADL'), or Grade 2 pneumonitis (requires steroids). AEs were assessed by CTCAE version 4.03. | 12 months and 36 months |
Number of Participants With Lymphedema Severity by Measuring Interlimb Circumference | An increase in interlimb arm circumference of at least 10% in the lower arm or the upper arm, or both, compared with the contralateral arm at the same timepoint, will be judged to be clinically significant lymphedema. Arm circumference 15 cm above the medial epicondyle (upper arms) and 15 cm below the medial epicondyle (lower arms) will be assessed at 12 months and at 36 months. | 12 months and 36 months |
Number of Participants With Symptomatic Rib Fracture as Measured by Plain Film or CT | Symptomatic rib fracture will be diagnosed by evidence of a correlative lesion on plain film or CT. | 12 months and 36 months |
Number of Participants With New Development of Ischemic Heart Disease as Measured by EKG | Ischemic heart disease will be measured by the new development of angina with corresponding EKG changes, or myocardial infraction. | 12 months and 36 months |
Number of Participants Reporting Shoulder Stiffness as Measured by the EORTC QLQ-BR23 | Shoulder stiffness severity is assessed using the European Organization for Research and Treatment of Cancer Quality of Life questionnaire breast cancer module (EORTC QLQ-BR23). It is assessed based on patient response to the questionnaire item, "During the past week, was it difficult to raise your arm or to move it sideways?", which is scored from 1 to 4 with 1 being "not at all" and 4 being "very much". Shoulder stiffness is identified in a patient when their response to that question is 3 or 4 AND if their response increased numerically from their response on day 1. | 12 months and 36 months |
Number of Participants With Grade 2 or Higher Pneumonitis | Number of patients who experience pneumonitis as an adverse event at Grade 2 or higher as assessed by CTCAE v 4.03. | 12 months and 36 months |
Number of Participants With Grade 2 or Higher Brachial Plexopathy | Number of patients who experience brachial plexopathy as an adverse event at Grade 2 or higher as assessed by CTCAE v 4.03. | 12 months and 36 months |
| Outcome Measure | Measure Description | Time Frame |
|---|---|---|
Number of Participants With Disease Recurrence | Recurrent disease presentation within axillary lymph node levels I, II, or III. The supraclavicular region is not included in this endpoint. | Up to 60 months |
Number of Participants With Metastasis-free Survival | Measured by the time from date of enrollment to earlier of clinical detection of metastatic disease beyond the breast/chestwall and regional lymph nodes or death. | 12 months and 36 months |
Number of Participants With Local-regional Failure Free Survival | Measured by the time from date of enrollment to earlier of clinical detection of any ipsilateral recurrent disease to the breast/chestwall or regional lymph nodes (levels I, II, III, supraclavicular, and internal mammary lymph nodes) or death. | 12 months and 36 months |
Number of Participants With a Change in Quality of Life Score as Measured by the EORTC QLQ-C30 | Patient's quality of life from pre-treatment to post-treatment, reported by the quality of life questionnaire \[EORTC QLQ-C30 V1\]. Summary scores and missing data handling were performed according to the EORTC QLQ-C30. The minimum score is 0, and the maximum score is 100. A higher score is a better outcome. A change in score is defined as a score increase of at least 10 points at the 12 month mark compared to baseline. | From baseline up to 12 months |
Number of Participants With a Change in Quality of Life Score as Measured by the EORTC QLQ-BR23 | Patient's quality of life from pre-treatment to post-treatment, reported by the quality of life questionnaire breast cancer module \[EORTC QLQ-BR23 V1\]. Summary scores and missing data handling were performed according to the EORTC QLQ-BR23. The minimum score is 0, and the maximum score is 100. A higher score is a better outcome. A change in score is defined as a score increase of at least 10 points from baseline. | Baseline to 1 year post-intervention |
Adult women (≥18 years old) with breast cancer who have undergone surgery for their primary breast tumor (either lumpectomy or mastectomy +/- reconstruction) and are confirmed to have involved lymph nodes on surgical pathology.
Patient who have undergone either a total mastectomy or a lumpectomy are eligible.
Acceptable procedures for assessment of axillary nodal status at the time of surgery include:
- axillary node dissection;
- sentinel node biopsy alone; or
- sentinel node biopsy followed by axillary node dissection.
Eligible women include AJCC (American Joint Committee on Cancer) 7th ed. Stage cN0 or cN1 subsequently staged after surgery as Stage pIB (N1mic), pIIA, pIIB, pIIIA, pIIIB, or N3a (10 or more axillary nodes) only: note that ypN0 will also be eligible if pathologic confirmation of nodal involvement was documented prior to neoadjuvant chemotherapy and the patient was found to be node-negative at the time of surgery. Note that women less than 50 years of age, women who received chemotherapy, patients staged as pN0 (i+ or mol+), and large-breasted women are eligible for enrollment.
The patient must have recovered from surgery with the incision completely healed and no signs of infection. If adjuvant chemotherapy was administered, chemotherapy-related toxicity that may interfere with delivery of radiation therapy should have resolved. The patient must have an ECOG performance status of 0 or 1 (KPS >70%).
The interval between the last surgery for breast cancer (including re-excision of margins) and randomization must be no more than 180 days if chemotherapy is not delivered adjuvantly. If adjuvant chemotherapy was administered, the interval between the last chemotherapy treatment and randomization must be no more than 180 days.
Before the patient is enrolled, the consent form, including any addenda, must be signed and dated by the patient and the person who explains the study to that patient.
Subjects will have the ability to understand, and the willingness to sign a written informed consent document.
- patients <18 years old
- pregnant women
- male patients
- women with T4 disease, including inflammatory breast cancer
- women who have declined or otherwise not received preceding surgery
- women with positive margins after primary surgery
- women with node-negative disease
- women without histologic confirmation of nodal involvement
- women more than 180 days out from primary breast surgery or adjuvant chemotherapy
- patients with clinically detected or suspicious lymph node involvement not readily amenable to surgical treatment (≥cN2 disease)
- patients with synchronous bilateral breast cancers
- patients with prior ipsilateral thoracic or breast radiation
- patients with distant metastatic disease (cM1) or a life expectancy of less than 5 years
- active collagen vascular disease, specifically dermatomyositis with a CPK level above normal or with an active skin rash, systemic lupus erythematosus, or scleroderma.
- other non-malignant systemic disease that would preclude the patient from receiving study treatment or would prevent required follow-up.
- patients with psychiatric or addictive disorders or other conditions that, in the opinion of the Investigator, would preclude the patient from meeting the study requirements.
- patients with a separate non-cutaneous cancer diagnosis for which the patient has not been without evidence of disease for at least 5 years.
Note: women <50 years of age, women who received chemotherapy, pN0 (i+ or mol+), and large-breasted women are eligible for enrollment.
Colorado