Ultrahypofractionated Whole Breast Radiation Following Chemotherapy

March 13, 2025 updated by: MetroHealth Medical Center

Ultrahypofractionated Whole Breast Radiation Following Breast Conserving Surgery and Chemotherapy in Patients > 60 Years of Age With Clinically Low-Risk, Node-Negative Breast Cancer Who Have Received Prior Chemotherapy

This is a single institution, non-randomized, non-inferiority study comparing prospectively collected data for acute and late effects on the breast associated with ultrahypofractionated whole breast radiation (WBI) following breast conserving surgery (BCS) and chemotherapy to historical controls for breast cancer (BC) patients who receive hypofractionated RT following BCS and chemotherapy.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Standard treatment approaches for patients with localized BC includes BCS followed WBI [1], which has demonstrated equivalent local control and survival when compared to mastectomy [2,3]. Although conventionally fractionated radiotherapy (RT) (50 Gy 2 Gy per fraction) administered in 25 fractions in 5 weeks was historically used, moderate hypofractionation RT trials utilizing shorter treatment times and higher doses per session have resulted in favorable outcomes [4,5,6]. In addition, increased local control and reduced toxicity rates observed in moderate hypofractionation RT trials [5,6] have resulted in studies evaluating the use of ultrahypofractionated breast RT which further shorten the treatment time. The results of the FAST-Forward RT trial have shown that adjuvant RT using 26 Gy/5.2 Gy per fraction, over 5 fractions administered in 1 week, was not inferior to the standard 40.05 Gy/15 fx/3 weeks for local tumor control and is equally safe in terms of effects on normal tissue [7]. Side effects associated with RT can be more pronounced in patients when RT is combined with surgery and/or chemotherapy [9]. There are abundant data describing the safety of combining conventionally fractionated RT following chemotherapy. Similarly, there are several trials which have reported outcomes of patients who have received hypofractionated RT, including subsets of patients who also received chemotherapy demonstrating similar acute and late toxicity profiles compared to standard fractionation regimens [10, 11, 12, 13]. Although the FAST-Forward trial included patients who received neoadjuvant and adjuvant chemotherapy and estimates of 5-year cumulative incidence of any moderate or marked clinician-assessed normal tissue effects in the breast or chest wall were reported to be similar for 40 Gy 15 fraction hypofractionated vs the 26 Gy 5 fraction ultrahypofractionated RT regimen (26·8% v 28·5%, respectively), the study was not designed to detect differences for those who had received prior chemotherapy compared to those who did not [7]. Retrospective subgroup analysis did not identify differences in adverse effects related to prior chemotherapy, however confidence intervals overlapped, and the power for these retrospective subgroup analyses was low [19]. Hence, there is limited data evaluating the toxicity of ultrahypofractionated adjuvant breast RT in patients who have received prior chemotherapy. This study is designed to evaluate the acute and late effects on the breast of ultrahypofractionated WBI using the FAST-forward regimen (26 Gy, 5.2 Gy per fraction delivered in 1 week) in patients > 60 years of age with pathologically or clinically node-negative early-stage BC who undergo BCS and chemotherapy.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
213

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. Patients aged at least 60 years with invasive BC (T1-3) with clinically or pathologically negative axillary nodes following BCS who have a high-risk Mammaprint or Oncotype testing and receive chemotherapy. (If no axillary surgery planned, patients must have pre-operative negative axillary ultrasound)
  2. Invasive ductal, lobular, medullary, papillary, colloid (mucinous), or tubular histologies are allowed
  3. Any receptor status is allowed (ER/PR/Her2-neu)
  4. Patients with negative resection margins defined as 2 mm from ink, or a negative re-excision
  5. Bilateral BC is allowed, provided each cancer meets inclusion criteria
  6. Nodal RT is not allowed
  7. There must be no concern for distant metastatic disease
  8. Neoadjuvant or adjuvant chemotherapy is permitted provided pretreatment clinical and radiographic staging meets inclusion criteria. Specific adjuvant/neoadjuvant therapies are at the discretion of the treating Medical Oncologist. There are no systemic therapies that are not allowed on this study.
  9. Patients must be deemed fit to receive the prescribed systemic therapy
  10. Immunotherapy is allowed
  11. Targeted Her-2 neu therapy, including concurrent therapy is allowed
  12. Other targeted therapies are allowed (including but not limited to CDK inhibitors)
  13. Endocrine therapy, including concurrent therapy is allowed
  14. Participation in other non-RT clinical trial is allowed
  15. Must be able to sign informed consent

Exclusion Criteria:

  1. Patients with stage IV BC
  2. Surgical margins that cannot be microscopically assessed or are positive at pathologic evaluation. (If surgical margins are rendered free of disease by re-excision, the patient is eligible)
  3. Prior thoracic or breast RT

  4. The following RT methods and techniques are not permitted:

    • Brachytherapy or intraoperative RT (IORT)
    • Proton therapy
    • Regional nodal RT
    • Tumor bed boost
  5. Patients who have breast reconstruction with implant or expander
  6. Patients who have had a mastectomy for current BC
  7. Patients requiring a tumor bed boost
  8. Palpable or radiographic suspicious or contralateral lymph nodes or N2 disease
  9. Paget's disease of the nipple.
  10. Non-epithelial breast malignancies such as sarcoma or lymphoma
  11. History of non-breast malignancies (except for in situ cancers treated only by local excision and basal cell and squamous cell carcinomas of the skin) within 5 years prior to study entry
  12. Active collagen vascular disease, specifically dermatomyositis with a CPK level above normal or with an active skin rash, systemic lupus erythematosis, or scleroderma
  13. Pregnancy or lactation at the time of study entry/ or intention to become pregnant during treatment.
  14. Patients with serious medical illness or psychiatric illness that would interfere with the trial.
  15. Patients with active infection in the radiation treatment portal.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Sequential Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Treatment Arm
Radiation: Ultra-hypofractionated radiation
RT, delivered via external beam, 5.2 Gy per fraction for 5 fractions following BCS and neoadjuvant or adjuvant chemotherapy. Specific adjuvant/neoadjuvant therapies are at the discretion of the treating Medical Oncologist.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Primary(1)
Time Frame: up to 3 months
Incidence of acute toxicities during and up to 3 months following completion of RT in BC patients who receive ultrahypofractionated WBI in BC patients who have received prior chemotherapy compared to historic controls for BC patients who have received prior chemotherapy and hypofractionated RT
up to 3 months
Primary (2)
Time Frame: Up to 2 years
Incidence of late toxicities of the breast up to 2 years following completion of RT in BC patients who receive ultrahypofractionated WBI in BC patients who have received prior chemotherapy compared to historic controls for BC patients who have received prior chemotherapy and hypofractionated RT
Up to 2 years

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Secondary (1)
Time Frame: Up to 3 months
Incidence of acute toxicities during and up to 3 months following completion of RT for BC patients who received neoadjuvant chemotherapy vs adjuvant chemotherapy
Up to 3 months
Secondary (2)
Time Frame: Up to 2 years
Incidence of late toxicities of the breast up to 2 years following completion of RT in BC patients who received neoadjuvant chemotherapy vs adjuvant chemotherapy
Up to 2 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
MetroHealth Medical Center

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Suzanne Russo, MD, MetroHealth Medical Center

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
April 1, 2025

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 31, 2027

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 31, 2029

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
October 28, 2024

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 28, 2024

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
October 30, 2024

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
March 25, 2025

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
March 13, 2025

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
October 1, 2024

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • MHCI 24-01

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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