Dose Optimization for Pulsed-dose-rate (PDR)/High-dose-rate (HDR) Brachytherapy Alone for Early Breast Cancer

University Hospital Erlangen

Status and phase

Unknown

Phase 2

Conditions

Breast Cancer

Treatments

Radiation: Interstitial multicatheter brachytherapy

Study type

Interventional

Funder types

Other

Identifiers

NCT01175694

Brachy-APBI-03

Details and patient eligibility

About

Accelerated partial breast irradiation (APBI) leads to a equivalent local control rate with lower toxicity as external beam irradiation (EBI) after breast conserving surgery (BCS) in a highly selected subgroup of patients with low risk invasive carcinoma and low risk duct carcinoma in-situ (DCIS). The goal of this trial is to assess the role of a modified dose of pulsed-dose-rate (PDR) and high-dose-rate (HDR) brachytherapy alone as Accelerated Partial Breast Irradiation (APBI) in a defined low-risk group of invasive breast cancer or ductal carcinoma in situ concerning local failure (all ipsilateral local recurrences), in particular regarding the local recurrences, the toxicity and for the cosmetic result. It is a phase II study. According to study protocol altogether 200 female patients will be treated.

Full description

Focus of this trial is to assess the role a modified dose of PDR- and HDR-brachytherapy as Accelerated Partial Breast Irradiation (APBI) alone in a defined low-risk group of invasive breast cancer or ductal carcinoma in situ concerning local failure(all ipsilateral local recurrences, in particular regarding the local recurrences, the toxicity and for the cosmetic result.

Enrollment

200 estimated patients

Sex

Female

Ages

50+ years old

Volunteers

No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion criteria

Stage 0, I or II breast cancer.
Invasive ductal, papillary, mucinous, tubular, medullary or lobular carcinoma.
Ductal carcinoma in situ (DCIS) alone.
No lymph invasion (L0) and no hemangiosis (V0).
Lesions of < 3 cm diameter, histopathologically assured.
pN0 (a minimum of 6 nodes in specimen, or a negative sentinel node is acceptable).
M0.
Clear resection margins at least 2 mm in any direction; by lobular histology or DCIS histology only the resection margins must be clear at least 5 mm.
For DCIS only: lesions must be classified as low or intermediate risk group
Unifocal and unicentric DCIS or breast cancer.
Age > 50 years.
Time interval from final definitive breast surgical procedure to the start of external beam therapy or to brachytherapy is less than 12 weeks (84 days). If patients receive chemotherapy the radiotherapy can be started before systemic treatment (within 12 weeks). The radiation therapy can be also given in the interval between the chemotherapy courses. It is also possible to start radiation therapy after chemotherapy is completed according local protocols as soon as possible within 4 weeks after chemotherapy.
Signed study-specific consent form

Exclusion Criteria:

Stage III or IV breast cancer.
Surgical margins that cannot be microscopically assessed.
Extensive intraductal component (EIC).
Paget's disease or pathological skin involvement.
Synchronous or previous breast cancer.
Prior malignancy (< 5 years prior to enrollment in study) except non-melanoma skin cancer or cervical carcinoma International Federation of Gynecology and Obstetrics (FIGO) 0 and I if patient is continuously disease-free.
Pregnant or lactating women.
Collagen vascular disease.
The presence of congenital diseases with increased radiation sensitivity, for example Ataxia telangiectatic or similar.
Psychiatric disorders.
Patient with breast deemed technically unsatisfactory for brachytherapy.