Trial to Compare MRI-guided Precision Prone Irradiation (PPI) Versus CT-guided Breast Irradiation

Weill Cornell Medicine (WCM)

Status: Active, not recruiting

Conditions: Breast Cancer

Treatments: Radiation: Radiation Therapy to partial breast

Study type: Interventional

Funder types: Other

Identifiers

NCT05731791

22-01024342

Details and patient eligibility

About

The Investigators are investigating the potential role of MRI-guided Radiation Therapy for patients receiving breast radiotherapy in the prone position with a MRI-Linac radiotherapy system, the Precision Prone Irradiation (PPI) technique.

Hypothesis: The investigators would like to hypothesize that breast radiation therapy using MRI-guided system including the MRI-Linac (Arm 2) is comparable to the current standard of treatment using conventional CT-based system (Arm 1), in terms of local control of the disease at 2 year time point.

Full description

Breast conserving surgery and adjuvant whole breast radiotherapy is a standard treatment option for most patients with early-stage invasive breast cancer. Recent technological advances in radiotherapy have enabled shorter treatment courses, smaller radiation fields, prone positioning, and fewer side effects associated with breast cancer treatment. To further improve target accuracy in breast radiation delivery, an emerging radiotherapy technology takes advantage of on-table MRI imaging and daily adaptive planning during the radiation delivery process.

The objectives of the study are to compare side effects in patients treated under either of these treatment settings and to compare recurrence (if the cancer comes back) rates at a 2-year time point. Patients will have annual follow ups up to 10 years and recurrence rates will be measured at 5-year and at 10-year time points.

Enrollment: 17 patients

Sex: Female

Ages: 50 to 90 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Patients ≥ 50 yrs with histologically confirmed unilateral DCIS or Stage I invasive breast cancer; received breast conserving surgery (pN0 or pNx) with tumor pathology ≤ 2 cm and excision margin ≥ 1 mm

Inclusion Criteria:

• Women status post segmental mastectomy
• If unilateral, pT1 breast cancer excised with negative margins AND/OR pTis excised with negative margins.
• If bilateral, pT1 breast cancer excised with negative margins AND/OR pTis excised with negative margins.
• Clinically N0 or pN0 or sentinel node negative
• Ductal carcinoma in situ DCIS with negative margins (no DCIS on inked margins).

Exclusion Criteria:

• Previous radiation therapy to the ipsilateral breast.
• > 90 days from last surgery, unless s/p adjuvant chemotherapy
• > 60 days from last chemotherapy
• Patients unable to tolerate MRI or are otherwise unsuitable for MRI-based RT treatment
• Metastatic disease

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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17 participants in 2 patient groups

ARM 1 - CT-based breast radiation treatment

Active Comparator group

Description:

Patients randomized to ARM 1 will receive 3000 cGy in 5 fractions partial breast radiotherapy with CT-based breast radiation treatment.

Treatment:

Radiation: Radiation Therapy to partial breast

ARM 2 - MRI-based breast radiation treatment

Active Comparator group

Description:

Patients randomized to ARM 2 will receive 3000 cGy in 5 fractions partial breast radiotherapy with MRI-based breast radiation treatment.

Treatment:

Radiation: Radiation Therapy to partial breast