Early Detection of Cardiovascular Changes After Radiotherapy for Breast Cancer (EARLY-HEART)

November 6, 2023 updated by: Sophie JACOB, Institut de Radioprotection et de Surete Nucleaire

Early Detection of Cardiovascular Changes After Radiotherapy for Breast Cancer (EARLY HEART Study) in the Frame of the Implications of MEDIcal Low Dose RADiation Exposure (MEDIRAD) European Project

Breast cancer (BC) radiotherapy leads to coincidental radiation of the heart, resulting in increased risk of a variety of heart diseases. Identifying BC patients with the highest risk of radiation-induced cardiac complications is crucial for developing strategies for primary and secondary prevention. Little has been done on the relationship between dose distribution to different anatomical cardiac structures during radiotherapy and early cardiovascular changes that may lead to cardiac complications.

In the framework of the European project MEDIRAD, the EARLY-HEART multicenter prospective cohort was launched in August 2017, involving 5 investigating centers from France, Netherlands, Germany, Spain and Portugal. With 250 BC patients prospectively followed for 2 years, the main objective is to identify and validate the most important cardiac imaging (echocardiography, computed tomography coronary angiography, cardiac magnetic resonance imaging) and circulating biomarkers of radiation-induced cardiovascular changes arising in the first 2 years after BC radiotherapy.

Study Overview

Status

Completed

Detailed Description

EARLY-HEART is a multicentre prospective cohort study that will include 250 female primary breast cancer cases aged 40-75 years treated with postoperative radiotherapy (RT) alone after breast-conserving surgery using modern planning-CT based RT technologies and followed for 2 years after RT in one of the 5 participating hospitals. In addition to the standard follow-up, patients will need to give repeated blood samples and will undergo repeated cardiac imaging:

  • Functional and anatomical cardiac imaging biomarkers will be based on automated 2D-speckle-tracking echocardiography (ECHO-ST); Computed Tomography Coronary Angiography (CT) and cardiac magnetic resonance imaging (MRI).
  • Circulating biomarkers (BLOOD) will be based on a panel of multiple classical or novel blood-based biomarkers.

Imaging and circulating biomarkers measurements will be assessed at baseline before RT (ECHO, CT, MRI, BLOOD); at the end of RT (BLOOD); 6 months after RT (ECHO, MRI, BLOOD) and 24 months after RT (ECHO, CT, MRI, BLOOD).

Changes in functional and anatomical cardiac imaging and circulating biomarkers between unexposed status before RT and exposed status after RT at different time points will be first analysed to evaluate the effects of RT on the heart.

All relevant DICOM-data (including planning-CT scans and the ECHO, MRI and CT) will be centralized to the MEDIRAD-ENACT database managed by University of Groningen for automated segmentation of all cardiac substructures (including coronary arteries) to ensure uniformity of the segmentation procedure between centres. The RT planning CTs will be used to generate dose volume histograms and 3D dose maps of the heart and cardiac substructures in order to correlate the localization of any cardiovascular change with the anatomical dose distribution.

In the presence of a cardiac outcome, a multimetric Normal Tissue Complication Probability (NTCP) individual risk model will be constructed and an integrative clinical-biologic risk score will be developed for individual risk prediction.

Study Type

Interventional

Enrollment (Actual)

250

Phase

  • 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 Locations

      • Toulouse, France
        • IRSN - Clinique Pasteur
      • Munich, Germany
        • Klinikum rechts der Isar der Technischen Universität München
      • Groningen, Netherlands
        • Academisch Ziekenhuis Groningen
      • Lisbon, Portugal
        • Associação para Investigação e Desenvolvimento da Faculdade de Medicina
      • Girona, Spain
        • Institut Catala d'Oncologia

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

Ages Eligible for Study

40 years to 75 years (Adult, Older Adult)

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Female unilateral breast cancer patients
  • Treated with primary breast conserving surgery for stage I-III invasive adenocarcinoma of the breast or ductal carcinoma in situ (DCIS)
  • Age between 40-75 years at time of start radiotherapy
  • World Health Organisation (WHO) performance status 0-1
  • Planned for radiotherapy alone to the breast with or without the lymph node areas
  • Radiotherapy based on planning-CT scan using either three dimensional conformal radiation therapy (3D-CRT), Intensity-modulated radiotherapy (IMRT), or Volumetric Arc Therapy (VMAT/RapidArc)
  • Written Informed consent

Exclusion Criteria:

  • Male breast cancer patients
  • Neoadjuvant or adjuvant chemotherapy
  • M1 disease (metastatic breast cancer)
  • Medical history of coronary artery disease and/or myocardial infarction and/or atrial fibrillation
  • Previous thoracic or mediastinal radiation
  • Contraindications to injection of iodinated contrast such as allergy or renal failure
  • Pregnancy or lactation
  • Atrial fibrillation detected during electrocardiogram before radiotherapy
  • Abnormal echocardiography before radiotherapy defined as: Left Ventricular Ejection Fraction<50%; longitudinal strain ≤ -16%; longitudinal strain rate <-1%, and/or abnormal wall motion
  • Presence of myocardial infarction detected during MRI before radiotherapy
  • CT or MRI results before radiotherapy requiring revascularisation

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: Prevention
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: Breast cancer patients treated with RT

Cardiac imaging and circulating biomarkers measurements to evaluate:

  • myocardial dysfunction and deformation (ECHO-ST)
  • coronary artery lesions and coronary artery calcium score (CT)
  • myocardium including tissue abnormalities, cardiac morphology and function (MRI)
  • blood-based biomarkers of cardiovascular changes (BLOOD)
Automated 2D-speckle-tracking echocardiography (ECHO-ST); Computed tomography coronary angiography (CT); Cardiac magnetic resonance imaging (MRI); Blood samples for circulating biomarkers measurements (BLOOD)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of patients with decreased myocardial function assessed by echocardiography
Time Frame: 2 years after radiotherapy (baseline measurements performed before radiotherapy)
Number of patients with an increased of at least 2.5% in the Global Longitudinal Strain (GLS) between baseline and 2 years after radiotherapy
2 years after radiotherapy (baseline measurements performed before radiotherapy)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Changes in myocardial function measurements assessed by echocardiography
Time Frame: 6 months and 2 years after radiotherapy (baseline measurements performed before radiotherapy)
Increase of the segmental strain measurements (unit of measures:%)
6 months and 2 years after radiotherapy (baseline measurements performed before radiotherapy)
Anatomical changes in coronary arteries assessed by cardiac CT
Time Frame: 2 years after radiotherapy (baseline measurements performed before radiotherapy)
Increase of the number of coronary segments containing any plaque or increase of the calcium score
2 years after radiotherapy (baseline measurements performed before radiotherapy)
Myocardial tissue abnormalities assessed by cardiac MRI
Time Frame: 6 months and 2 years after radiotherapy (baseline measurements performed before radiotherapy)
Increase of the native mean myocardial T1 mapping value
6 months and 2 years after radiotherapy (baseline measurements performed before radiotherapy)
Changes in circulating biomarkers measurements
Time Frame: at the end of radiotherapy (through radiotherapy completion, an average of 5 weeks after starting date of radiotherapy), 6 months and 2 years after radiotherapy (baseline measurements performed before radiotherapy)

Significant increase or decrease in the following biomarkers:

classical biomarkers of cardiac injury (C-reactive protein, Troponin I, Troponin T, B-type natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-Pro BNP), beta2-Microglobulin, Galectin 3); Inflammatory cytokines; biomarkers of endothelial activation and dysfunction; Microparticles; MicroRNAs; circulating DNA methylation

at the end of radiotherapy (through radiotherapy completion, an average of 5 weeks after starting date of radiotherapy), 6 months and 2 years after radiotherapy (baseline measurements performed before radiotherapy)

Collaborators and Investigators

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

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

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 (Actual)

September 1, 2017

Primary Completion (Actual)

October 1, 2020

Study Completion (Actual)

May 31, 2021

Study Registration Dates

First Submitted

September 21, 2017

First Submitted That Met QC Criteria

September 28, 2017

First Posted (Actual)

September 29, 2017

Study Record Updates

Last Update Posted (Actual)

November 7, 2023

Last Update Submitted That Met QC Criteria

November 6, 2023

Last Verified

November 1, 2023

More Information

Terms related to this study

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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