Hypofractionated LocoRegional Radiotherapy in Breast Cancer

NCT ID: NCT04228991

Last Updated: 2025-11-18

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

PHASE3

Total Enrollment

588 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-02-10

Study Completion Date

2030-12-31

Brief Summary

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The primary objective of this study is to determine if hypofractionated RT delivered over 1 week to the breast or chest wall and regional nodes (26Gy in 5 daily fractions) following BCS or mastectomy, is non-inferior to conventional fractionation to the breast or chest wall and regional nodes delivered over 3 weeks (40Gy in 15 daily fractions) in patients with node-positive breast cancer.

Detailed Description

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A multi-centre, randomized, non-inferior, phase III study comparing two radiation treatment modalities, conventional fractionation with hypofractionation for locoregional RT. Eligible, consenting patients with newly diagnosed and histologically confirmed invasive carcinoma of the breast without evidence of metastatic disease; treated with definitive surgery \[BCS or mastectomy with nodal staging using sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND)\] will be randomized in a 1:1 fashion to either conventional locoregional RT (control group) or hypofractionated locoregional RT (experimental group). Stratification factors include: body mass index, the performance of ALND, type of surgery (BCS or mastectomy) and clinical centre.

Study participants will be assessed for lymphedema, the primary outcome, by measuring arm volume. Arm mobility will be assessed by measuring arm movement. Study participants will be assessed for acute and late radiation toxicities, during and post RT. Study participants will be followed and assessed annually for breast cancer recurrence (BCR), new second cancers, quality of life (QOL) and overall survival. Cost effectiveness and cost utility will also be determined. The planned sample size is 588 study participants. The study will be conducted at clinical centres throughout Canada.

Conditions

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Breast Neoplasms Radiotherapy Lymphedema

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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Control

Conventional fractionation for locoregional radiotherapy

Group Type ACTIVE_COMPARATOR

Locoregional radiation treatment - Conventional fractionation

Intervention Type RADIATION

40 Gray in 15 daily fractions over 3 weeks

Experimental

Hypofractionation for locoregional radiotherapy

Group Type EXPERIMENTAL

Locoregional radiation treatment - Hypofractionation

Intervention Type RADIATION

26 Gray in 5 daily fractions over 1 week

Interventions

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Locoregional radiation treatment - Conventional fractionation

40 Gray in 15 daily fractions over 3 weeks

Intervention Type RADIATION

Locoregional radiation treatment - Hypofractionation

26 Gray in 5 daily fractions over 1 week

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

1. Newly diagnosed invasive carcinoma of the breast.
2. Treated with definitive surgery (BCS or mastectomy with nodal staging using SLNB or ALND) with clear margins of excision.\* Note: \*Patients with limited positive posterior margin where disease is resected to chest wall or limited positive anterior margin where disease is resected to dermis are eligible.
3. Candidate for locoregional radiotherapy: breast cancer stage after definitive surgery:

* Neoadjuvant chemotherapy was not administered: pathologic stage T3N0,T1-3 N1-2\*\*

\*\* patients with nodal micromets (N1mi) are eligible
* Neoadjuvant chemotherapy was administered: clinical stage T3N0, T1-3, N1-2 and pathologic stage T0-3, N0-2†

* Patients who are clinically N1-2 prior to chemotherapy should be confirmed histologically unless it is clear that they are node positive. Patients who are deemed node negative prior to chemotherapy but are node positive following chemotherapy are eligible. Patients who are node positive prior to chemotherapy and who have complete response in the lymph nodes are also eligible.
4. No evidence of metastatic disease.

Exclusion Criteria

1. Age \< 18 years.
2. Clinical stages T4 and/or N3.
3. Clinical lymphedema in the ipsilateral arm or breast/chest wall.
4. Any prior history, not including index cancer, of ipsilateral invasive breast cancer or ipsilateral DCIS treated with radiation therapy. (Patients with previous ipsilateral DCIS or LCIS not treated with radiation are eligible.)
5. Synchronous or previous contralateral breast cancer.(Patients with previous contralateral DCIS or LCIS not treated with radiation are eligible.)
6. History of non-breast malignancy within the last 5 years other than non-melanoma skin cancer or treated in-situ carcinoma.
7. Neoadjuvant endocrine therapy. (Extended neoadjuvant endocrine therapy is not permitted. Endocrine therapy exposure for 12 weeks or less prior to surgery is acceptable.)
8. Breast reconstruction.
9. Presence of known medical conditions that would preclude follow-up for 5 years.
10. Previous radiotherapy to the ipsilateral breast or chest wall or serious non-malignant disease e.g. scleroderma, severe lung or heart disease that would preclude radiotherapy.
11. Known pregnancy or currently lactating.
12. Geographic inaccessibility for follow-up.
13. Inability to provide informed consent.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ontario Clinical Oncology Group (OCOG)

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Timothy Whelan, MD

Role: PRINCIPAL_INVESTIGATOR

Juravinski Cancer Centre, McMaster University, Hamilton

Locations

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Tom Baker Cancer Centre

Calgary, Alberta, Canada

Site Status

Cross Cancer Institute

Edmonton, Alberta, Canada

Site Status

BC Cancer - Centre for the Southern Interior

Kelowna, British Columbia, Canada

Site Status

BC Cancer - Centre for the North

Prince George, British Columbia, Canada

Site Status

BC Cancer - Vancouver Centre

Vancouver, British Columbia, Canada

Site Status

BC Cancer - Vancouver Island Centre

Victoria, British Columbia, Canada

Site Status

Northeast Cancer Centre, Health Sciences North

Greater Sudbury, Ontario, Canada

Site Status

Juravinski Cancer Centre

Hamilton, Ontario, Canada

Site Status

London Regional Cancer Program

London, Ontario, Canada

Site Status

The Ottawa Hospital Regional Cancer Centre

Ottawa, Ontario, Canada

Site Status

Sunnybrook Health Sciences Centre - Odette Cancer Centre

Toronto, Ontario, Canada

Site Status

Princess Margaret Cancer Centre - UHN

Toronto, Ontario, Canada

Site Status

Hotel-Dieu de Lévis (CISSS CA)

Lévis, Quebec, Canada

Site Status

CIUSSS de l'Est-de-l'Île de Montréal, Hôpital, Maisonneuve-Rosemont

Montreal, Quebec, Canada

Site Status

McGill University Health Centre-Cedars Cancer Centre

Montreal, Quebec, Canada

Site Status

CHUM - Centre Hospitalier de L'Universite de Montreal

Montreal, Quebec, Canada

Site Status

CHU-de Québec-Université de Laval

Québec, Quebec, Canada

Site Status

Sherbrooke University Hospital Centre

Sherbrooke, Quebec, Canada

Site Status

Allan Blair Cancer Centre

Regina, Saskatchewan, Canada

Site Status

Saskatoon Cancer Centre

Saskatoon, Saskatchewan, Canada

Site Status

Countries

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Canada

Other Identifiers

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OCOG-2019-RHEAL

Identifier Type: -

Identifier Source: org_study_id

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