Hypofractionated Radiation for Breast Cancer

Recruiting in Palo Alto (17 mi)

+2 other locations

Overseen by Joshua T. Dilworth

Age: 18+

Sex: Female

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: William Beaumont Hospitals

Disqualifiers: T4 disease, Other malignancy, Radiation history, others

No Placebo Group

Approved in 3 Jurisdictions

Trial Summary

What is the purpose of this trial?

This is a prospective clinical trial designed to evaluate the efficacy and safety of hypofractionated regional nodal irradiation in breast cancer patients. After enrollment, participants will be stratified into 2 Groups based on the extent of axillary surgery. Participants will complete activities and assessments at baseline, and after completion of treatment at 1-2 weeks, 3 months, 6 months, 1 year, 2 year, and 3 years following completion of treatment.

Will I have to stop taking my current medications?

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 Radiation for Breast Cancer?

Research shows that hypofractionated radiation, which uses fewer but larger doses of radiation, has similar outcomes to traditional radiation for early-stage breast cancer. Studies have found it to be effective with acceptable short-term side effects, and ongoing trials are exploring its broader use. ^{1 2 3 4 5}

Is hypofractionated radiation therapy safe for humans?

Research shows that hypofractionated radiation therapy, used for breast cancer, is generally safe with long-term safety established, though some studies note potential for increased short-term side effects compared to traditional methods. ^{6 7 8 9 10}

How is hypofractionated radiation treatment different from other breast cancer treatments?

Hypofractionated radiation treatment for breast cancer uses fewer, larger doses of radiation over a shorter period compared to traditional radiation therapy, making it more convenient and potentially less costly while providing similar outcomes. ^{2 3 4 11 12}

Research Team

Joshua T. Dilworth

Principal Investigator

William Beaumont Hospitals

Eligibility Criteria

This trial is for women over 18 with breast cancer who have a life expectancy of more than 5 years and are in good physical condition. They must not be pregnant, breastfeeding, or refuse contraception if of child-bearing potential. Participants should have certain stages of tumor and node involvement but no history of radiation to the neck, breast, or thorax.

Inclusion Criteria

Life expectancy of >5 years

I am fully active and can carry on all my pre-disease activities without restriction.

My cancer has not spread to more than a few nearby lymph nodes.

Exclusion Criteria

My cancer has spread to nearby lymph nodes but not to distant parts of my body.

Pregnancy, active breast feeding, or refusal or inability to use highly effective means of contraception in participants of child-bearing potential

My scans show visible signs of cancer.

Treatment Details

Interventions

• Hypofractionated Radiation (Radiation)

Trial Overview The study tests hypofractionated regional nodal irradiation's effectiveness and safety in breast cancer patients post-surgery. It involves two groups based on axillary surgery extent, with follow-ups from 1-2 weeks up to 3 years after treatment completion.

Participant Groups

Group I: Group 2: axillary lymph node dissection Experimental Treatment 1 Intervention

Group 2: axillary lymph node dissection (with or without sentinel lymph node procedure). Patients who have more than 5 sentinel lymph nodes removed will be stratified into group 2.

Group II: Group 1: sentinel lymph node procedure with or without select removal of clipped lymph nodes Experimental Treatment 1 Intervention

Group 1: sentinel lymph node procedure with or without select removal of clipped (clinically involved) lymph nodes. Patients who have more than 5 sentinel lymph nodes removed will be stratified into group 2.

Hypofractionated Radiation is already approved in Canada for the following indications:

Approved in Canada as Hypofractionated Radiotherapy for:

• Endometrial cancer

Who Is Running the Clinical Trial?

William Beaumont Hospitals

Lead Sponsor

Trials

153

Recruited

113,000+

Dr. Benjamin Schwartz

William Beaumont Hospitals

Chief Medical Officer since 2021

MD from George Washington University School of Medicine and Health Sciences, Master in Healthcare Management from Harvard University

Tina Freese Decker

William Beaumont Hospitals

Chief Executive Officer since 2022

MBA from Stanford University

Findings from Research

Hypofractionated whole breast irradiation (WBI) has been shown to produce outcomes comparable to conventional radiation in early-stage breast cancer patients, suggesting it is a safe and effective treatment option.

Current trials, including a phase III study by the Radiation Therapy Oncology Group, are investigating the feasibility and effectiveness of adding a concurrent tumor bed boost to hypofractionated WBI, which may enhance treatment outcomes and broaden its use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Accelerated fractionation with a concurrent boost for early stage breast cancer. Freedman, GM., White, JR., Arthur, DW., et al.[2022]

Recent advancements in radiation therapy for non-metastatic breast cancer, particularly hypofractionation and partial breast irradiation, have led to optimized treatment approaches that consider both patient and tumor characteristics.

Despite strong level-1 evidence supporting hypofractionation, its adoption in routine practice has been slow, prompting the AIRO Breast Cancer Group to issue position statements aimed at standardizing postoperative radiation therapy practices based on current evidence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Italian Association for Radiotherapy and Clinical Oncology (AIRO) position statements for postoperative breast cancer radiation therapy volume, dose, and fractionation. Meattini, I., Palumbo, I., Becherini, C., et al.[2023]

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 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]

In a study involving 396 patients treated with ultra-hypofractionated breast radiotherapy, the five-year local-relapse free survival (LRFS) rate was an impressive 98.8%, indicating high efficacy in controlling breast cancer.

While ultra-hypofractionated radiotherapy showed excellent tumor control, certain regimens, particularly the 5.7 Gy weekly fraction and tumor bed boost, were linked to a higher risk of acute and late skin toxicities, highlighting the need for careful treatment planning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Large scale experience of two ultrahypofractionated 5 fractions regimes after breast conserving surgery from a single centre. Sauvage, LM., Loap, P., Vu-Bezin, J., et al.[2023]

In a study of 39 breast cancer patients treated with an accelerated hypofractionated radiotherapy schedule, no significant lung toxicity or adverse effects were observed after a median follow-up of 43 months, indicating the treatment's safety.

The radiotherapy regimen (34 Gy in 10 fractions plus an 8 Gy boost) was well-tolerated, with only minor skin changes noted in a few patients, suggesting it is a feasible option for adjuvant treatment without significant long-term side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Accelerated hypofractionated radiotherapy as adjuvant regimen after conserving surgery for early breast cancer: interim report of toxicity after a minimum follow up of 3 years. Pinnarò, P., Soriani, A., Landoni, V., et al.[2021]

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]

In a study involving 92 patients undergoing post-mastectomy radiation therapy (PMRT) with a hypofractionated regimen of 43.5 Gy over 15 days, the majority experienced mild skin toxicities, with 62% developing grade 2 dermatitis, which mostly resolved within three months.

The hypofractionated approach demonstrated a low incidence of significant acute toxicities, while effectively covering the target areas, although it resulted in a slightly higher dose to the ipsilateral lung compared to the heart.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hypofractionated radiotherapy in postmastectomy locally advanced breast cancer: an interim report on acute toxicities and dosimetry. Jamora, K., Cruz-Lim, EM., Cereno, RE., et al.[2023]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

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

2. Ireland pubmed.ncbi.nlm.nih.gov

Accelerated fractionation with a concurrent boost for early stage breast cancer. [2022]

3. Switzerland pubmed.ncbi.nlm.nih.gov

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

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

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

5. Italy pubmed.ncbi.nlm.nih.gov

The Italian Association for Radiotherapy and Clinical Oncology (AIRO) position statements for postoperative breast cancer radiation therapy volume, dose, and fractionation. [2023]

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. India pubmed.ncbi.nlm.nih.gov

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

8. England pubmed.ncbi.nlm.nih.gov

Large scale experience of two ultrahypofractionated 5 fractions regimes after breast conserving surgery from a single centre. [2023]

9. England pubmed.ncbi.nlm.nih.gov

Accelerated hypofractionated radiotherapy as adjuvant regimen after conserving surgery for early breast cancer: interim report of toxicity after a minimum follow up of 3 years. [2021]

10. Netherlands pubmed.ncbi.nlm.nih.gov

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

11. Poland pubmed.ncbi.nlm.nih.gov

Hypofractionated radiotherapy in postmastectomy locally advanced breast cancer: an interim report on acute toxicities and dosimetry. [2023]

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

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