Safety and Efficacy Study of the Xoft® Axxent® eBx® IORT System®

NCT ID: NCT01644669

Last Updated: 2025-01-31

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

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

1200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-05-08

Study Completion Date

2029-12-31

Brief Summary

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The purpose of this trial is to assess the safety and efficacy of the Xoft Axxent eBx System when used for single-fraction IORT in early stage breast cancer. Hypothesis: IORT using the Xoft Axxent eBx System is no worse (non-inferior) than whole breast irradiation (WBI) when used as stand-alone radiation treatment in breast conserving therapy in women with early stage breast cancer.

Detailed Description

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The rationale for IORT as the sole radiation therapy is:

Favorable preliminary results in feasibility, safety and efficacy outcomes: Accelerated Partial Breast Irradiation (APBI) is an accepted alternative to whole breast irradiation following breast-conserving surgery for early stage breast cancer. Intra-Operative Radiation Therapy (IORT) is a form of APBI that allows radiation to be delivered directly to the open tumor bed following Breast Conservation Surgery (BCS). After 4 years of follow-up, IORT has shown equivalent disease control rates as whole breast irradiation.

Direct and timely radiation to the tumor bed: Radiation is delivered at to the target tissue (adjacent to the resection margins at the time of lumpectomy). It avoids treatment delays and eliminates weeks or months of post-surgical radiation therapy during which residual cancer cells might proliferate. An in vitro study showed that un-irradiated wound fluid stimulated the growth of breast cancer cells while irradiated wound fluid did not. Each month of delay in radiation treatment is associated with a 1% increase in the recurrence rate. Huang, et al., found a 5.8% recurrence rate in patients who received WBRT within 8 weeks of BCS compared with a 9.1% recurrence rate in patients who started radiotherapy 9-16 weeks after BCS.

Increased patient treatment compliance compared to conventional radiation therapy: Suitable early stage breast cancer patients are able to complete their breast cancer radiotherapy treatment at the time of BCS, which offers a convenient and potentially life-saving benefit to patients who might otherwise omit radiation therapy if it required lengthy travel or time commitments. In addition, healthcare resources, including both personnel and facilities, will be conserved by eliminating the overhead cost of multiple patient visits, eliminating waiting time for patients, and consolidating therapy to one visit combined with the surgical procedure.

Available Technology: The Xoft Axxent controller, x-ray source, and balloon applicator are cleared by the United States Food and Drug Administration (FDA) to deliver brachytherapy treatments using high dose rate x-ray radiation. The Xoft Axxent System has been used to treat breast cancer subjects using a multi-fraction APBI technique on an outpatient basis as part of two multi-center studies. The Xoft Axxent System enables the Radiation Oncologist to administer electronic brachytherapy without the use of a radioactive isotope in minimally shielded rooms. Characteristics of the Xoft System that make it well-suited for IORT include its portability and low energy photons, allowing for minimal shielding during the radiation therapy.

This protocol has been developed to further study the use of the Xoft Axxent eBx System in the delivery of IORT for subjects with early-stage breast cancer. The Xoft Axxent eBx System will be used according to the United States Food and Drug Administration (FDA) 510(k) cleared labeling; therefore, the use of the technology in this study is considered on-label and within the scope of the FDA cleared indication.

Conditions

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Invasive Ductal Carcinoma Ductal Carcinoma in Situ

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Single 20Gy dose of electronic brachytherapy (IORT)
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Intra-operative Radiation Therapy - IORT

Intra-operative Radiation Therapy

Group Type EXPERIMENTAL

Intra-operative Radiation Therapy - IORT

Intervention Type RADIATION

Single dose of 20 Gy

Interventions

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Intra-operative Radiation Therapy - IORT

Single dose of 20 Gy

Intervention Type RADIATION

Other Intervention Names

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Electronic Brachytherapy

Eligibility Criteria

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Inclusion Criteria

1. Subject must have provided written Informed Consent
2. Subject must have biopsy-proven invasive ductal carcinoma or ductal carcinoma in situ of the breast
3. Subject must be female ≥ 40 years of age
4. Subject's tumor(s) must be \< 3.0 cm in greatest diameter by pre-operative assessment
5. Subject's tumor(s) must meet AJCC Tumor Classification: Tis, T1 or T2 (\< 3 cm), N0, M0

Exclusion Criteria

7. Women of child-bearing potential must have a negative pregnancy test within one week of IORT treatment
8. Women of child-bearing potential must agree to use adequate contraceptive precautions (defined as oral contraceptives, intrauterine devices, surgical contraceptives or a combination of condom and spermicide) from the time of negative pregnancy test through completion of the radiation treatment period


1. Subject is pregnant or nursing
2. Subject has significant auto-immune disease
3. Subject has a pacemaker present in the field of radiation or quadrant of the breast cancer
4. Subject has biopsy-proven multifocal breast cancer
5. Subject has multi-centric breast cancer
6. Subject has known lympho-vascular invasion
7. Subject has invasive lobular cancer
8. Subject has undergone neo-adjuvant chemotherapy or neo-adjuvant endocrine therapy for current breast cancer
9. Subject has a history of recurrent breast cancer in the ipsilateral breast
10. Subject has had previous radiation exposure of the involved breast
11. Subject has BRCA 1 or 2 mutations. Note: Testing will only be required for Subjects presenting with bilateral breast cancer; testing is not required for unilateral cancers
12. Subject has contraindications for radiation
13. Subject considered by the Investigator to be high-risk for breast conservation surgery and/or intra-operative radiation therapy
14. Subject has participated in any other clinical investigation that is likely to confound study results or affect study outcome either at the time of IORT or for 3 months prior to IORT.
Minimum Eligible Age

40 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Icad, Inc.

INDUSTRY

Sponsor Role collaborator

Xoft, Inc.

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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A.M. Nisar Syed, MD

Role: PRINCIPAL_INVESTIGATOR

Long Beach Memorial Medical Center

Locations

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University of Arizona

Tucson, Arizona, United States

Site Status

City of Hope

Duarte, California, United States

Site Status

Long Beach Memorial Medical Center

Long Beach, California, United States

Site Status

UCLA

Los Angeles, California, United States

Site Status

Tri-City Medical Center

Oceanside, California, United States

Site Status

Diablo Valley Oncology Hematology Medical Group

Pleasant Hill, California, United States

Site Status

Western Surgical Care, PC

Denver, Colorado, United States

Site Status

Swedish Medical Center

Englewood, Colorado, United States

Site Status

Florida Hospital Celebration Health

Celebration, Florida, United States

Site Status

Doctors Hospital

Coral Gables, Florida, United States

Site Status

Martin Health System Center for Clinical Research

Stuart, Florida, United States

Site Status

Rush University

Chicago, Illinois, United States

Site Status

Lutheran Hospital of Indiana

Fort Wayne, Indiana, United States

Site Status

Greater Baltimore Medical Center

Baltimore, Maryland, United States

Site Status

MedStar Oncology Network - Good Samaritan Hospital

Baltimore, Maryland, United States

Site Status

MedStar Oncology Network - Franklin Square

Baltimore, Maryland, United States

Site Status

Exeter Hospital

Exeter, New Hampshire, United States

Site Status

Staten Island University Hospital

Staten Island, New York, United States

Site Status

University of Oklahoma

Oklahoma City, Oklahoma, United States

Site Status

Parkridge Medical Center

Chattanooga, Tennessee, United States

Site Status

Vanderbilt-Ingram Cancer Center

Nashville, Tennessee, United States

Site Status

Sentara Northern Virginia Medical Center

Woodbridge, Virginia, United States

Site Status

Monash Health / Peter MacCallum Cancer Centre

Clayton, Victoria, Australia

Site Status

Hospital CUF Porto

Porto, , Portugal

Site Status

Countries

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United States Australia Portugal

References

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Ivanov O, Dickler A, Lum BY, Pellicane JV, Francescatti DS. Twelve-month follow-up results of a trial utilizing Axxent electronic brachytherapy to deliver intraoperative radiation therapy for early-stage breast cancer. Ann Surg Oncol. 2011 Feb;18(2):453-8. doi: 10.1245/s10434-010-1283-x. Epub 2010 Aug 25.

Reference Type BACKGROUND
PMID: 20737219 (View on PubMed)

Dickler A, Ivanov O, Francescatti D. Intraoperative radiation therapy in the treatment of early-stage breast cancer utilizing xoft axxent electronic brachytherapy. World J Surg Oncol. 2009 Mar 2;7:24. doi: 10.1186/1477-7819-7-24.

Reference Type BACKGROUND
PMID: 19254369 (View on PubMed)

Related Links

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http://www.cancer.gov/cancertopics/factsheet/Therapy/radiation

National Cancer Institute Factsheet - Radiation Therapy for Cancer

Other Identifiers

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CTPR-0009

Identifier Type: -

Identifier Source: org_study_id

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