Radiation Doses and Fractionation Schedules in Non-low Risk Ductal Carcinoma In Situ (DCIS) of the Breast

NCT ID: NCT00470236

Last Updated: 2023-03-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

1608 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-06-30

Study Completion Date

2024-06-30

Brief Summary

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Hypotheses:

1. The addition of tumour bed boost after BCS in women with non-low risk DCIS reduces the risk of local recurrence (invasive or intraductal recurrence in the ipsilateral breast).
2. The risk of local recurrence in the shorter fractionation arm is not worse than that for the standard fractionation arm.
3. A molecular signature predictive of invasive recurrence of DCIS will be detectable and the molecular signature may eventually have clinical utility for therapy individualization.

Overall Objectives:

1. To improve the outcome of women with non-low risk DCIS treated with breast conserving therapy.
2. To individualize treatment selection for women with DCIS to achieve long term disease control with minimal toxicity.

Detailed Description

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Specific objectives:

1. To evaluate time to local recurrence in women with DCIS treated with breast conserving surgery followed by:

* whole breast RT alone versus whole breast RT plus tumour bed boost;
* RT using the standard fractionation schedule versus the shorter schedule.
2. To evaluate time to disease recurrence and overall survival in women with DCIS treated with breast conserving surgery followed by:

* whole breast RT alone versus whole breast RT plus tumour bed boost;
* RT using the standard fractionation schedule versus the shorter schedule.
3. To compare the toxicity of:

* whole breast RT alone versus whole breast RT plus tumour bed boost;
* RT using the standard fractionation schedule versus the shorter schedule.
4. To compare the cosmetic outcome of:

* whole breast RT alone versus whole breast RT plus tumour bed boost;
* RT using the standard fractionation schedule versus the shorter schedule.
5. To identify a molecular signature predictive of invasive recurrence of DCIS to facilitate therapy individualization.
6. To assess inter-relationship of biomarkers and relationship between biomarker expression and specific histopathologic features of DCIS.
7. To evaluate the quality of life of women treated with:

* whole breast RT alone versus whole breast RT plus tumour bed boost;
* RT using the standard fractionation schedule versus the shorter schedule.

Conditions

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Carcinoma, Ductal, Breast

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Arm 1 (Standard WB Fractionation)

Whole Breast RT alone - Standard fractionation schedule (50GY/25 Fractions/35days)

Group Type ACTIVE_COMPARATOR

Standard WB fractionation

Intervention Type RADIATION

A total dose of 50 Gy in 25 fractions in 2-Gy daily fractions, 5 fractions per week (at least 9 fractions per fortnight).

Arm 2 (Shorter WB Fractionation)

Whole Breast RT alone - Shorter fractionation schedule (42.5 Gy/16 fractions/22 days)

Group Type EXPERIMENTAL

Shorter WB fractionation

Intervention Type RADIATION

A total dose of 42.5 Gy in 16 fractions in 2.656-Gy daily fractions, 5 fractions per week (at least 9 fractions per fortnight).

Arm 3 (Standard WB fractionation+Boost)

Whole Breast RT + tumor bed boost - Standard fractionation schedule (50 Gy/25 fractions/35 days; Boost 16 Gy/8 fractions/10 days)

Group Type ACTIVE_COMPARATOR

Standard WB fractionation+Boost

Intervention Type RADIATION

Whole Breast: A total dose of 50 Gy in 25 fractions in 2-Gy daily fractions, 5 fractions per week (at least 9 fractions per fortnight).

Tumour bed: A total dose of 10 Gy in 5 fractions in 2-Gy daily fractions, 5 fractions per week.

Arm 4 (Shorter WB fractionation + Boost)

Whole breast RT + tumour bed boost - Shorter fractionation schedule (42.5 Gy/16 fractions/22 days; Boost 16 Gy/8 fractions/10 days)

Group Type EXPERIMENTAL

Shorter WB fractionation + Boost

Intervention Type RADIATION

Whole breast: A total dose of 42.5 Gy in 16 fractions in 2.656-Gy daily fractions, 5 fractions per week (at least 9 fractions per fortnight).

Tumour bed: A total dose of 10 Gy in 4 fractions in 2.5-Gy daily fractions, 4 fractions per week.

Interventions

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Standard WB fractionation

A total dose of 50 Gy in 25 fractions in 2-Gy daily fractions, 5 fractions per week (at least 9 fractions per fortnight).

Intervention Type RADIATION

Shorter WB fractionation

A total dose of 42.5 Gy in 16 fractions in 2.656-Gy daily fractions, 5 fractions per week (at least 9 fractions per fortnight).

Intervention Type RADIATION

Standard WB fractionation+Boost

Whole Breast: A total dose of 50 Gy in 25 fractions in 2-Gy daily fractions, 5 fractions per week (at least 9 fractions per fortnight).

Tumour bed: A total dose of 10 Gy in 5 fractions in 2-Gy daily fractions, 5 fractions per week.

Intervention Type RADIATION

Shorter WB fractionation + Boost

Whole breast: A total dose of 42.5 Gy in 16 fractions in 2.656-Gy daily fractions, 5 fractions per week (at least 9 fractions per fortnight).

Tumour bed: A total dose of 10 Gy in 4 fractions in 2.5-Gy daily fractions, 4 fractions per week.

Intervention Type RADIATION

Other Intervention Names

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Radiation Radiation Radiation Radiation

Eligibility Criteria

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Inclusion Criteria

Patients must fulfill all of the following criteria for admission to study:

* Women ≥ 18 years.
* Histologically proven DCIS of the breast without an invasive component.
* Bilateral mammograms performed within 6 months prior to randomization.
* Clinically node-negative.
* Treated by breast conserving surgery (primary excision or re-excision) with complete microscopic excision and clear radial margins of ≥1 mm\* (\*Patients with superficial or deep resection margin of \<1 mm are eligible if surgery has removed all of the intervening breast tissue from the subcutaneous tissue to the pectoralis fascia).
* Women who are at high risk of local recurrence due to:

* Age \< 50 years; OR
* Age ≥ 50 years plus at least one of the following:

* Symptomatic presentation
* Palpable tumour
* Multifocal disease
* Microscopic tumour size ≥ 1.5 cm in maximum dimension
* Intermediate or high nuclear grade
* Central necrosis
* Comedo histology
* Radial\* surgical resection margin \< 10 mm. (\*Patients with superficial or deep resection margin of \< 10 mm are eligible if surgery has not removed all of the intervening breast tissue from the subcutaneous tissue to the pectoralis fascia.)
* Assessed by surgeon and radiation oncologist to be suitable for breast conserving therapy including whole breast RT.
* Ability to tolerate protocol treatment.
* Protocol RT should preferably commence within 8 weeks but must commence no later than 12 weeks from the last surgical procedure.
* ECOG performance status 0, 1 or 2.
* Patient's life expectancy \> 5 years.
* Availability for long-term follow-up.
* Written informed consent.

Exclusion Criteria

Patients who fulfill any of the following criteria are not eligible for admission to study:

* Multicentric disease or extensive microcalcifications that could not be completely excised by breast conserving surgery with radial margins of ≥1 mm\*.

\*Patients with superficial and/or deep margin of \<1 mm are eligible if surgery has removed all of the intervening breast tissue from the subcutaneous tissue to the pectoralis fascia.
* Presence of tumour cells in lymph nodes detected using H\&E or immunohistochemical examination (if lymph node biopsy or dissection has been performed).
* Locally recurrent breast cancer.
* Previous DCIS or invasive cancer of the contralateral breast.

* Bilateral DCIS of the breasts
* Synchronous invasive carcinoma of the contralateral breast
* Other concurrent or previous malignancies except:

* Non-melanomatous skin cancer;
* Carcinoma in situ of the cervix or endometrium; and
* Invasive carcinoma of the cervix, endometrium, colon, thyroid and melanoma treated at least five years prior to study admission without disease recurrence.
* Serious non-malignant disease that precludes definitive surgical or radiation treatment (e.g., scleroderma, systemic lupus erythematosus, cardiovascular/pulmonary/renal disease).
* ECOG performance status ≥ 3.
* Women who are pregnant or lactating.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Breast International Group

OTHER

Sponsor Role collaborator

NCIC Clinical Trials Group

NETWORK

Sponsor Role collaborator

Cancer Trials Ireland

NETWORK

Sponsor Role collaborator

Borstkanker Onderzoek Groep

NETWORK

Sponsor Role collaborator

ETOP IBCSG Partners Foundation

NETWORK

Sponsor Role collaborator

Scottish Cancer Trials Breast Group

UNKNOWN

Sponsor Role collaborator

European Organisation for Research and Treatment of Cancer - EORTC

NETWORK

Sponsor Role collaborator

Trans Tasman Radiation Oncology Group

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Boon Chua

Role: STUDY_CHAIR

Prince of Wales Hospital Randwick

Locations

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Campbelltown Hospital

Campbelltown, New South Wales, Australia

Site Status

Nepean Cancer Care Centre

Kingswood, New South Wales, Australia

Site Status

St George Hospital

Kogarah, New South Wales, Australia

Site Status

Liverpool Hospital

Liverpool, New South Wales, Australia

Site Status

Royal North Shore Hospital

St Leonards, New South Wales, Australia

Site Status

Riverina Cancer Care Centre

Wagga Wagga, New South Wales, Australia

Site Status

Calvary Mater Newcastle

Waratah, New South Wales, Australia

Site Status

Westmead Hospital

Wentworthville, New South Wales, Australia

Site Status

Premion - Wesley

Auchenflower, Queensland, Australia

Site Status

Royal Brisbane and Women's Hospital

Brisbane, Queensland, Australia

Site Status

Princess Alexandra Hospital

Brisbane, Queensland, Australia

Site Status

Genesis Cancer Care (previously Premion) - Nambour

Nambour, Queensland, Australia

Site Status

Radiation Oncology - Mater Centre

South Brisbane, Queensland, Australia

Site Status

Toowoomba Cancer Research Centre

Toowoomba, Queensland, Australia

Site Status

North Queensland Oncology Service

Townsville, Queensland, Australia

Site Status

Genesis Cancer Care (previously Premion) - Tugun

Tugun, Queensland, Australia

Site Status

Royal Adelaide Hospital

Adelaide, South Australia, Australia

Site Status

Royal Hobart Hospital

Hobart, Tasmania, Australia

Site Status

Launceston General Hospital

Launceston, Tasmania, Australia

Site Status

Barwon Health - Andrew Love Cancer Care Centre, Geelong Hospital

Geelong, Victoria, Australia

Site Status

Peter MacCallum Cancer Centre

Melbourne, Victoria, Australia

Site Status

Austin Hospital

Melbourne, Victoria, Australia

Site Status

William Buckland Radiotherapy Centre, Alfred Hospital

Melbourne, Victoria, Australia

Site Status

Sir Charles Gardiner Hospital

Nedlands, Western Australia, Australia

Site Status

Royal Perth Hospital

Perth, Western Australia, Australia

Site Status

Perth Radiation Oncology

Perth, Western Australia, Australia

Site Status

Onze Lieve Vrouw Ziekenhuis

Aalst, , Belgium

Site Status

ZNA Middelheim

Antwerp, , Belgium

Site Status

Cliniques Univeritaires St Luc

Brussels, , Belgium

Site Status

Universitair Zielenhusi

Brussels, , Belgium

Site Status

Hopital De Jolimont

Haine-Saint-Paul, , Belgium

Site Status

AZ Groeninghe - Campus Maria's Voorzienigheid

Kortrijk, , Belgium

Site Status

Algemeen Ziekenhis Sint-Augustinus

Wilrijk, , Belgium

Site Status

Nova Scotia Cancer Centre

Halifax, , Canada

Site Status

Jurvanski Cancer Centre

Hamilton, , Canada

Site Status

Notre Dame Hospital

Hearst, , Canada

Site Status

BCCA Southern Interior - CAVK

Kelowna, , Canada

Site Status

London Regional Cancer Program

London, , Canada

Site Status

Saint John Regional Hospital

Miramichi, , Canada

Site Status

Leon Richard Oncology Centre

Moncton, , Canada

Site Status

Hospital Maisonneuve-Rosemont

Montreal, , Canada

Site Status

Lakeridge Health

Oshawa, , Canada

Site Status

CHUQ L'Hotel-Dieu de Quebec

Québec, , Canada

Site Status

McGill University Department of Oncology

Sainte-Anne-de-Bellevue, , Canada

Site Status

Allan Blair Cancer Centre

Saskatoon, , Canada

Site Status

Saskatoon Cancer Centre

Saskatoon, , Canada

Site Status

Universite de Sherbrooke - CUGH

Sherbrooke, , Canada

Site Status

Thunder Bay Regional Health Sciences Centre

Thunder Bay, , Canada

Site Status

Odette Cancer Centre

Toronto, , Canada

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Princess Margaret Hospital

Toronto, , Canada

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BCCA Vancouver Centre

Victoria, , Canada

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Vancouver Island Cancer Centre

Victoria, , Canada

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Cancer Care Manitoba

Winnipeg, , Canada

Site Status

Chr De Grenoble - La Tronche

Grenoble, , France

Site Status

Centre Antine Lacassagne

Nice, , France

Site Status

Cork University Hospital

Cork, , Ireland

Site Status

University Hospital Galway

Galway, , Ireland

Site Status

SLRON (St Luke's Rad Onc Network)

Rathgar, , Ireland

Site Status

Centro Di Riferimento Oncologico - Aviano

Aviano, , Italy

Site Status

Fondazione Salvatore Maugeri

Pavia, , Italy

Site Status

Academisch Medisch Centrum

Amsterdam, , Netherlands

Site Status

Cancer Institute Antoni Van Leeuwenhoekziekenhuis

Amsterdam, , Netherlands

Site Status

Arnhem 'S Radiotherapeutisch Instituut

Arnhem, , Netherlands

Site Status

Reinier de Graaf Groep

Delft, , Netherlands

Site Status

University Medical Centre Groningen

Groningen, , Netherlands

Site Status

Leiden University Medical Centre

Leiden, , Netherlands

Site Status

Maastricht Radiation Oncology Maastro Clinic

Maastricht, , Netherlands

Site Status

Medisch Centrum Haaglanden

Westeinde, , Netherlands

Site Status

ISALA Klinieken

Zwolle, , Netherlands

Site Status

Auckland Hospital

Auckland, , New Zealand

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Christchurch Hospital

Christchurch, , New Zealand

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Waikato Hospital

Hamilton, , New Zealand

Site Status

National University Hospital

Singapore, , Singapore

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University Hospital Basel

Basel, , Switzerland

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IOSI

Bellinzona, , Switzerland

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Inselspital Bern

Bern, , Switzerland

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Kantonsspital Graubunden

Chur, , Switzerland

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Kantonsspital Munsterlingen

Münsterlingen, , Switzerland

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Kantonsspital St. Gallen

Sankt Gallen, , Switzerland

Site Status

Brust-Zentrum Zurich-Seefeld

Zurich, , Switzerland

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Klinik Hirslanden

Zurich, , Switzerland

Site Status

Gloucestershire Royal & Cheltenham General Hospitals

Cheltenham, Gloucestershire, United Kingdom

Site Status

Churchill Hospital

Oxford, Headington, United Kingdom

Site Status

Pilgram Hospital

Boston, Lincolnshire, United Kingdom

Site Status

Mount Vernon Cancer Centre

Northwood, Middlesex, United Kingdom

Site Status

Ealing Hospital

Southall, Middlesex, United Kingdom

Site Status

Kings Mill Hospital Nottingham

Sutton in Ashfield, Nottinghamshire, United Kingdom

Site Status

Musgrove Park Hospital

Taunton, Somerset, United Kingdom

Site Status

Queens Hospital Burton

Burton-on-Trent, Staffordshire, United Kingdom

Site Status

University of North Staffordshire

Stoke-on-Trent, Staffordshire, United Kingdom

Site Status

Aberdeen Royal Infirmary

Aberdeen, , United Kingdom

Site Status

Basildon University Hospital

Basildon, , United Kingdom

Site Status

Belfast City Hospital

Belfast, , United Kingdom

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Queen Elizabeth Hospital

Birmingham, , United Kingdom

Site Status

Sandwell and West Birmingham Hospitals NHS Trust

Birmingham, , United Kingdom

Site Status

Bristol Haematology & Oncology

Bristol, , United Kingdom

Site Status

Colchester Hospital

Colchester, , United Kingdom

Site Status

Coventry Arden Cancer Centre

Coventry, , United Kingdom

Site Status

Royal Derby Hospital

Derby, , United Kingdom

Site Status

Dumfries & Galloway Royal Infirmary

Dumfries, , United Kingdom

Site Status

Queen Margaret Hospital

Dunfermline, , United Kingdom

Site Status

Edinburgh Western General Hospital

Edinburgh, , United Kingdom

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The Beatson West of Scotland Cancer Centre

Glasgow, , United Kingdom

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Royal Surrey County Hospital

Guildford, , United Kingdom

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Ipswich Hospital

Ipswich, , United Kingdom

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Kidderminster Hospital

Kidderminster, , United Kingdom

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Leicester Royal Infirmary

Leicester, , United Kingdom

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Lincoln County Hospital

Lincoln, , United Kingdom

Site Status

Imperial College Healthcare Charing Cross

London, , United Kingdom

Site Status

James Cook University Hospital

Middlesbrough, , United Kingdom

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Nottingham University Hospitals

Nottingham, , United Kingdom

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Royal Alexandra Hospital

Paisley, , United Kingdom

Site Status

Alexandra Hospital

Redditch, , United Kingdom

Site Status

Weston Park Hospital

Sheffield, , United Kingdom

Site Status

The Shrewsbury and Telford Hospital NHS Trust

Shrewsbury, , United Kingdom

Site Status

Southend University Hopstial

Southend, , United Kingdom

Site Status

Stafford Hospital

Stafford, , United Kingdom

Site Status

Royal Marsden

Sutton, , United Kingdom

Site Status

Warwick Hospital

Warwick, , United Kingdom

Site Status

New Cross Hospital

Wolverhampton, , United Kingdom

Site Status

Countries

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Australia Belgium Canada France Ireland Italy Netherlands New Zealand Singapore Switzerland United Kingdom

References

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Chua BH, Link EK, Kunkler IH, Whelan TJ, Westenberg AH, Gruber G, Bryant G, Ahern V, Purohit K, Graham PH, Akra M, McArdle O, O'Brien P, Harvey JA, Kirkove C, Maduro JH, Campbell ID, Delaney GP, Martin JD, Vu TTT, Muanza TM, Neal A, Olivotto IA; BIG 3-07/TROG 07.01 trial investigators. Radiation doses and fractionation schedules in non-low-risk ductal carcinoma in situ in the breast (BIG 3-07/TROG 07.01): a randomised, factorial, multicentre, open-label, phase 3 study. Lancet. 2022 Aug 6;400(10350):431-440. doi: 10.1016/S0140-6736(22)01246-6.

Reference Type DERIVED
PMID: 35934006 (View on PubMed)

King MT, Link EK, Whelan TJ, Olivotto IA, Kunkler I, Westenberg AH, Gruber G, Schofield P, Chua BH; BIG 3-07/TROG 07.01 trial investigators. Quality of life after breast-conserving therapy and adjuvant radiotherapy for non-low-risk ductal carcinoma in situ (BIG 3-07/TROG 07.01): 2-year results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2020 May;21(5):685-698. doi: 10.1016/S1470-2045(20)30085-1. Epub 2020 Mar 20.

Reference Type DERIVED
PMID: 32203696 (View on PubMed)

Related Links

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http://www.trog.com.au

Click here for more information about this study on the TROG official website

Other Identifiers

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NHMRC 454390

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

BIG 3-07

Identifier Type: OTHER

Identifier Source: secondary_id

NCIC CTG MA.33

Identifier Type: OTHER

Identifier Source: secondary_id

BOOG 2009-03

Identifier Type: OTHER

Identifier Source: secondary_id

ICORG 10-06

Identifier Type: OTHER

Identifier Source: secondary_id

EORTC 22085-10083

Identifier Type: OTHER

Identifier Source: secondary_id

IBCSG 38-10

Identifier Type: OTHER

Identifier Source: secondary_id

SCTBG 2009MayPR55

Identifier Type: OTHER

Identifier Source: secondary_id

TROG 07.01

Identifier Type: -

Identifier Source: org_study_id

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