II/III 期乳腺癌的质子放射治疗
需要全乳或胸壁淋巴结照射的 II/III 期局部区域非转移性乳腺癌患者术后保留心脏质子放射治疗的 II 期研究
The purpose of this study is to look at the rates of acute and long term adverse events of postoperative proton radiotherapy for complex loco-regional irradiation in women with loco-regionally advanced breast cancer. This study specifically includes longitudinal follow up to assess the incidence of cardiac mortality and second malignant neoplasms at 10 and 15 years following proton therapy(PT).
研究概览
详细说明
The proposed Phase II study is seeking to build clinical data as a continuation of the original dosimetric analysis published by Ares et al. performed at Paul-Scherrer Institute (PSI). That comparison demonstrated a benefit form proton planning for patients with non-metastatic breast cancer requiring complex, loco-regional, postoperative radiotherapy.1 The advantages of PT were improved target coverage compared to standard photon irradiation and reduced dose to heart, lungs and contralateral breast.
The study goal is to demonstrate a "meaningful benefit" of proton therapy for women with loco-regionally advanced breast cancer. The main clinical endpoints of this trial are the reduction of cardiac morbidity and mortality (coronary artery disease, myocardial infarction, cardiac insufficiency) and the reduction of contralateral, second breast cancer. Both adverse events are presently associated with external beam photon therapy. Both goals require longitudinal follow-up of minimum 5-10 years. Despite the logistical challenges of long term follow-up, the effort is needed in view of the compelling preclinical evidence of dose avoidance or even absence of radiation dose to heart and contralateral breast uniquely accomplishable by protons only.
研究类型
注册 (估计的)
阶段
- 阶段2
联系人和位置
学习地点
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Illinois
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Warrenville、Illinois、美国、60555
- Northwestern Medicine Chicago Proton Center
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Maryland
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Baltimore、Maryland、美国、21201
- Maryland Proton Treatment Center
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New Jersey
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Somerset、New Jersey、美国、08873
- Princeton ProCure Managment LLC
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Oklahoma
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Oklahoma City、Oklahoma、美国、73142
- Oklahoma Proton Center
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Virginia
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Hampton、Virginia、美国、23666
- Hampton University Proton Therapy Institute
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Must sign study-specific, IRB approved informed consent form prior to study entry. Note consent by legally authorized representative is not allowed for this trial.
- Must be > = 18 years of age.
- Must have a life expectancy of at least 10 years based on age and comorbidities but excluding diagnosis of breast cancer.
- Must have pathology proven breast cancer. Pathology must be invasive ductal or lobular
- Must meet stage II - III group criteria per AJCC Staging manual 7th edition.
- Must have had surgical treatment of the breast - either mastectomy or breast preserving surgery, such as lumpectomy. Re-excision of surgical margins is permitted.
- Note: Multicentric breast cancer and Paget's disease of the nipple are permitted.
Exclusion Criteria:
- Weight over 410 pounds.
- Non-epithelial breast malignancies such as sarcoma or lymphoma.
- 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).
- Breast size exceeding the technical limitation of daily set-up reproducibility. This may be center-specific and will be assessed at the discretion of the treating center.
- Women with post-surgical temporary breast expanders will require individual assessment. Depending on the manufacturing product and other treatment planning-specific details the patient may be eligible or may be deemed ineligible, as determined by treating investigator.
- Prior history of breast cancer.
- Prior radiation to the breast or thorax.
- Collagen vascular disease, specifically dermatomyositis with a CPK level above normal or with an active skin rash, systemic lupus erythematosis, or scleroderma.
- Pregnancy or lactation at the time of proposed study entry. Women of reproductive potential must agree to use an effective non-hormonal method of contraception during therapy such as an intrauterine device or condom with spermicide. (Note: Women of childbearing potential must have a negative serum pregnancy test within 3 weeks of study registration).
- Psychiatric or addictive disorders or other conditions that, in the opinion of the investigator, would preclude the patient from meeting the study requirements.
- Prior history of non-breast malignancies unless they have been disease free for 5 or more years and are deemed by their physician to be at low risk for recurrence. Further, patients who have the following cancers treated within the prior 5 years are permitted: carcinoma in situ of the cervix, carcinoma in situ of the colon, melanoma in situ, basal cell or squamous cell carcinoma of the skin.
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:不适用
- 介入模型:单组作业
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
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实验性的:Proton Radiotherapy
Proton Radiotherapy |
Radiation therapy will be given once a day. Minimum of 28 treatments and may receive 6-9 additional treatments as determined by protocol & physician. |
研究衡量的是什么?
主要结果指标
结果测量 |
大体时间 |
|---|---|
|
确定由质子治疗放射治疗引起的急性和晚期毒性(急性和晚期不良事件)的发生率。
大体时间:5年
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5年
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次要结果测量
结果测量 |
大体时间 |
|---|---|
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将 PT 计划的剂量体积直方图 (DVH) 与传统的外部光束计划(光子/电子强度调制放射治疗 (IMRT) 计划、3D 光子计划或 Tomotherapy 计划)进行剂量学比较。
大体时间:平均在治疗开始后 9 周
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平均在治疗开始后 9 周
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局部控制、区域控制、转移状态和无病总体生存的发生率。
大体时间:5年
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5年
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将 PT 计划的目标(D2、Dmean、Dmin、D95、V95、V110)和不同 OAR(如后所述)的不同 DVH 参数与 3D 适形放射治疗 (CRT)、IMRT 和断层放疗计划。
大体时间:平均在治疗开始后 9 周
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平均在治疗开始后 9 周
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确定质子治疗对冠状动脉、心脏、同侧和对侧肺以及对侧乳房的剂量分布。
大体时间:平均在治疗开始后 9 周
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平均在治疗开始后 9 周
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确定有临床症状的冠状动脉疾病的发病率、一般心脏病发病率和死亡率以及继发性恶性肿瘤(包括对侧乳腺癌)的发病率
大体时间:5年
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5年
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评估生活质量结果。
大体时间:5年
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5年
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合作者和调查者
调查人员
- 学习椅:Eugen Hug, MD、Proton Collaborative Group
研究记录日期
研究主要日期
学习开始
初级完成 (估计的)
研究完成 (估计的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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