Hypofractionated Radiotherapy for Breast Cancer

(RHEAL Trial)

Recruiting in Palo Alto (17 mi)

+19 other locations

Overseen by Timothy J. Whelan

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 3

Recruiting

Sponsor: Ontario Clinical Oncology Group (OCOG)

Must not be taking: Neoadjuvant endocrine therapy

Disqualifiers: Age < 18, T4/N3 stages, others

No Placebo Group

Pivotal Trial (Near Approval)

Prior Safety Data

Approved in 3 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial compares two radiation schedules for breast cancer patients to see if a shorter, higher-dose treatment is as effective as a longer, lower-dose one.

Do I need to stop my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Hypofractionated Radiotherapy for Breast Cancer?

Research shows that hypofractionated radiotherapy, which uses higher doses of radiation over a shorter period, is safe and effective for treating early breast cancer. It is considered a standard treatment in the UK and parts of Canada, and studies have shown it to be as effective as longer courses of radiation, with the added benefits of being more convenient and less costly. ^{1 2 3 4 5}

Is hypofractionated radiotherapy safe for humans?

Research shows that hypofractionated radiotherapy is generally safe for treating early breast cancer, with long-term studies confirming its safety and effectiveness. It is considered a standard treatment in the UK and parts of Canada, although there are some concerns about potential increased side effects. ^{1 6 7 8 9}

How is hypofractionated radiotherapy different from other breast cancer treatments?

Hypofractionated radiotherapy for breast cancer involves giving fewer, larger doses of radiation over a shorter period, typically 3 weeks, compared to conventional treatments. This approach is considered safe and effective, with similar outcomes to traditional methods, and is already a standard of care in some regions like the UK and parts of Canada. ^{1 5 10 11 12}

Research Team

Timothy J. Whelan

Principal Investigator

Juravinski Cancer Centre, McMaster University, Hamilton

Eligibility Criteria

This trial is for adults with newly diagnosed node-positive breast cancer who've had surgery and need radiotherapy, but haven't spread to other body parts. It's not for those with recent non-breast cancers (except certain skin cancers), previous chest radiation, severe diseases like scleroderma or serious heart/lung conditions, under 18s, advanced tumor stages T4/N3, arm swelling after surgery, pregnant/breastfeeding women, or if they can't follow up for 5 years.

Inclusion Criteria

My cancer has not spread to other parts of my body.

I have recently been diagnosed with breast cancer and have undergone surgery.

I am eligible for targeted radiation therapy after my surgery.

Exclusion Criteria

I have had breast cancer or DCIS on the same side treated with radiation before.

My cancer is at an advanced stage, affecting nearby tissues or lymph nodes.

I haven't had cancer other than non-melanoma skin cancer or treated in-situ carcinoma in the last 5 years.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either conventional or hypofractionated locoregional radiotherapy

1-3 weeks

5-15 visits (in-person)

Follow-up

Participants are monitored for lymphedema, radiation toxicity, and other outcomes

5 years

Annual visits (in-person)

Long-term follow-up

Participants are assessed for breast cancer recurrence, new second cancers, and overall survival

5 years

Treatment Details

Interventions

• Locoregional radiation treatment (Radiation)

Trial Overview The study compares two ways of giving radiotherapy: the standard method over 3 weeks versus a shorter one-week course. The goal is to see if the short course works just as well without making patients come in for treatment as often.

Participant Groups

Group I: Experimental Experimental Treatment 1 Intervention

Hypofractionation for locoregional radiotherapy

Group II: Control Active Control 1 Intervention

Conventional fractionation for locoregional radiotherapy

Locoregional radiation treatment is already approved in Canada for the following indications:

Approved in Canada as Locoregional Radiation Therapy for:

• Breast cancer
• Node-positive breast cancer

Who Is Running the Clinical Trial?

Ontario Clinical Oncology Group (OCOG)

Lead Sponsor

Trials

65

Recruited

42,000+

Dr. Matthew Anderson

Ontario Clinical Oncology Group (OCOG)

Chief Executive Officer since 2020

MD from the University of Toronto

Dr. Chris Simpson

Ontario Clinical Oncology Group (OCOG)

Chief Medical Officer since 2021

MD from Queen's University

Findings from Research

The use of hypofractionated radiation therapy (RT) for breast cancer treatment increased from 3.8% in 2006 to 13.6% by 2009-2010 among low-risk older patients, indicating a growing acceptance of this more convenient and cost-effective treatment option.

Despite the increase in hypofractionation use, it remained low overall, especially among patients over 80 years old, while the adoption of intensity-modulated RT (IMRT) rose significantly during the same period, highlighting a disparity in the uptake of these two treatment approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adoption of hypofractionated radiation therapy for breast cancer after publication of randomized trials. Jagsi, R., Falchook, AD., Hendrix, LH., et al.[2022]

In a study of 2309 breast cancer patients, those receiving hypofractionated radiotherapy experienced significantly less acute skin reactions and pain compared to those receiving conventional fractionation, indicating a safer treatment option.

Hypofractionation also resulted in lower levels of patient-reported symptoms like burning, swelling, and fatigue during treatment, suggesting it may enhance patient comfort without compromising long-term outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Differences in the Acute Toxic Effects of Breast Radiotherapy by Fractionation Schedule: Comparative Analysis of Physician-Assessed and Patient-Reported Outcomes in a Large Multicenter Cohort. Jagsi, R., Griffith, KA., Boike, TP., et al.[2022]

In a study of 274 early breast cancer patients treated with hypofractionated radiation treatment (HFRT) over a median follow-up of 7 years, the local recurrence-free survival rate was very high at 97.2%, indicating that HFRT is effective in preventing local cancer recurrence.

The acute toxicity associated with HFRT was generally low, with most patients experiencing less than grade 3 side effects, suggesting that HFRT is a safe treatment option for eligible patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hypofractionated radiation treatment in early breast cancer: Results in a New Zealand setting. James, ML., Dehn, G., Robinson, BA.[2018]

In a study of 81 patients with localized breast cancer treated with hypofractionated radiotherapy (HFRT), the treatment was well-tolerated, with low rates of late toxicities such as chest pain (11%) and limb pain (12%).

The five-year overall survival rate was 76.5%, and there were no locoregional recurrences, indicating that HFRT is effective in controlling the disease while minimizing side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessment of toxicities and outcomes in patients with breast cancer treated with hypofractionated radiotherapy. Sindhu, M., Malik, M., Ahmed, SF., et al.[2022]

Hypofractionated radiotherapy is gaining popularity for breast cancer treatment in the UK and Canada, but there are concerns about potential increased toxicity associated with this approach.

The article emphasizes the importance of careful planning and dosimetry in hypofractionated radiotherapy to ensure effective treatment while minimizing risks, and it provides recommendations for both planning and monitoring during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

What are the minimal standards of radiotherapy planning and dosimetry for "hypofractionated" radiotherapy in breast cancer? MacLeod, N., McIntyre, A., Canney, PA.[2018]

Hypofractionated radiation therapy, which delivers fewer but larger doses of radiation over a shorter period, has shown comparable outcomes to conventional radiation in treating breast cancer, suggesting it could be an effective alternative.

Ongoing phase 3 trials are investigating hypofractionated whole breast irradiation and accelerated partial breast irradiation, which may lead to broader acceptance of these methods for early-stage breast cancer, although concerns about patient selection and late toxicity remain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hypofractionated radiation therapy in the treatment of early-stage breast cancer. Freedman, GM.[2021]

References

1. France pubmed.ncbi.nlm.nih.gov

Role of hypofractionated radiotherapy in breast locoregional radiation. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

Hypofractionated Regional Nodal Irradiation for Women With Node-Positive Breast Cancer. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Hypofractionated Radiation Therapy (HFRT) of Breast/Chest Wall and Regional Nodes in Locally Advanced Breast Cancer: Toxicity Profile and Survival Outcomes in Retrospective Monoistitutional Study. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Adoption of hypofractionated radiation therapy for breast cancer after publication of randomized trials. [2022]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Emerging Role of Hypofractionated Radiotherapy with Simultaneous Integrated Boost in Modern Radiotherapy of Breast Cancer. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

Differences in the Acute Toxic Effects of Breast Radiotherapy by Fractionation Schedule: Comparative Analysis of Physician-Assessed and Patient-Reported Outcomes in a Large Multicenter Cohort. [2022]

7. Australia pubmed.ncbi.nlm.nih.gov

Hypofractionated radiation treatment in early breast cancer: Results in a New Zealand setting. [2018]

8. India pubmed.ncbi.nlm.nih.gov

Assessment of toxicities and outcomes in patients with breast cancer treated with hypofractionated radiotherapy. [2022]

9. Netherlands pubmed.ncbi.nlm.nih.gov

What are the minimal standards of radiotherapy planning and dosimetry for "hypofractionated" radiotherapy in breast cancer? [2018]

10. United States pubmed.ncbi.nlm.nih.gov

Hypofractionated radiation therapy in the treatment of early-stage breast cancer. [2021]

11. Switzerland pubmed.ncbi.nlm.nih.gov

Real-World Practice of Hypofractionated Radiotherapy in Patients With Invasive Breast Cancer. [2022]

12. United States pubmed.ncbi.nlm.nih.gov

Clinical experience using hypofractionated radiation schedules in breast cancer. [2022]