Hypofractionated Radiotherapy in Breast Cancer Patients With Prosthetic Reconstruction

NCT ID: NCT05491395

Last Updated: 2022-08-08

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

RECRUITING

Clinical Phase

NA

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-06-27

Study Completion Date

2029-05-01

Brief Summary

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RATIONALE:

Radiotherapy (RT) can be indicated to patients submitted to breast-conserving surgery, but, despite the benefits, adjuvant RT can cause contracture generated by tissue fibrosis in patients with immediate prosthetic reconstruction, which could cause prosthesis loss. The biological explanation of this outcome is not fully understood, but recent advances in the analysis of patient-derived blood can contribute to establishing a connection of molecular alterations related to this clinical outcome.

There is not a consensus about using hypofractionated RT schemes for patients with BCS and breast reconstruction since no studies had investigated the reasons why some patients lose the prosthesis.

PURPOSE: This study will evaluate G3 toxicity rate in breast cancer patients with immediate prosthetic reconstruction, submitted to hypofractionated radiotherapy, analyzing capsular contracture, leakage, infection, and bad positioning in order to demonstrate the noninferiority of Hypo-RT with the conventional RT. Additionally, the molecular profile of blood samples will be investigated in order to find biomarkers related to inflammations processes and response to treatment.

Detailed Description

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General aim: To evaluated if hypofractionated accelerated radiotherapy in patients with breast cancer undergoing immediate breast implant reconstruction surgery is non inferior to conventional radiotherapy.

Aim 1 (Primary objective): Assess the G3 toxicity rate - loss of the prosthesis (complication that requires surgical intervention: capsular contracture, leakage, infection, malpositioning).

Aim 2 (Specific secondary objectives):

* Compare local recurrence rate between two groups;
* Compare quality of life index between two groups using EORTC QLQ-C30 / EORTC QLQ-BR45 scales during treatment, after 6 and 12 months after treatment ending;
* Compare self-image differences between groups;
* Compare acute and late radiodermatitis rates by CTCAE 4.0;
* Analyse dosimetric planning differences considering the volumes of all breast and breast without prosthesis;
* Study inflammation molecular markers, which may indicate an increased risk of fibrosis;
* Evaluate the change in the profile of extracellular vesicles in patients treated with RT hypofractionated and conventional;
* Evaluate the change in EV collagen production after in vitro irradiation, using co-culture experiments with breast cells and fibroblasts.

Conditions

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Breast Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Arm Experimental: Post Mastectomy Hypofractionated Radiotherapy Arm No Intervention: Post Mastectomy Conventional Radiotherapy
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Post Mastectomy Hypofractionated Radiotherapy Arm

Post Mastectomy Hypofractionated Radiotherapy Arm

Group Type EXPERIMENTAL

Hypofractionation

Intervention Type RADIATION

Hypofractionation scheme will comprise 40 Gy in 15 fractions

Post Mastectomy Conventional Radiotherapy

Post Mastectomy Conventional Radiotherapy

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Hypofractionation

Hypofractionation scheme will comprise 40 Gy in 15 fractions

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

* Women with confirmed histological diagnosis of invasive ductal carcinoma and lobular breast carcinoma;
* Radical mastectomy with immediate reconstruction with a prosthesis;
* Patients indicated for adjuvant RT;
* Any lymph node status;
* With or without adjuvant chemotherapy;
* ECOG performance status from 0-2;
* \> 18 years old;
* Informed Consent Form applied before any study-specific procedure.

Exclusion Criteria

* Another histological diagnosis than invasive ductal carcinoma or lobular carcinoma;
* Previous history of neoplasm and/or radiotherapy and/ or quimiotherapy before this study;
* Distant metastatic disease;
* Palliative treatment;
* Patients with scleroderma / systemic lupus erythematosus.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Barretos Cancer Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Marcos D Mattos, MD, MS

Role: PRINCIPAL_INVESTIGATOR

Barretos Cancer Hospital

Gabriela B Salvador, BS

Role: STUDY_CHAIR

Barretos Cancer Hospital

Wanessa F Altei, PhD

Role: STUDY_CHAIR

Barretos Cancer Hospital

Lais L Almeida, MD

Role: STUDY_CHAIR

Barretos Cancer Hospital

Locations

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Radiation Oncology Department

Barretos, São Paulo, Brazil

Site Status RECRUITING

Countries

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Brazil

Central Contacts

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Marcos D Mattos, MD, MS

Role: CONTACT

+5517981140230

Alexandre A Jacinto, MD, PhD

Role: CONTACT

+5517974001314

Facility Contacts

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Marcos D Mattos, MD, MS

Role: primary

+5517981140230

Alexandre A Jacinto, MD, PhD

Role: backup

+551733216600 ext. 7342

References

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Reference Type BACKGROUND
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Veronesi U, Saccozzi R, Del Vecchio M, Banfi A, Clemente C, De Lena M, Gallus G, Greco M, Luini A, Marubini E, Muscolino G, Rilke F, Salvadori B, Zecchini A, Zucali R. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med. 1981 Jul 2;305(1):6-11. doi: 10.1056/NEJM198107023050102.

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Song SY, Chang JS, Fan KL, Kim MJ, Chang HP, Lew DH, Roh TS, Roh H, Kim YB, Lee DW. Hypofractionated Radiotherapy With Volumetric Modulated Arc Therapy Decreases Postoperative Complications in Prosthetic Breast Reconstructions: A Clinicopathologic Study. Front Oncol. 2020 Nov 17;10:577136. doi: 10.3389/fonc.2020.577136. eCollection 2020.

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Liu L, Yang Y, Guo Q, Ren B, Peng Q, Zou L, Zhu Y, Tian Y. Comparing hypofractionated to conventional fractionated radiotherapy in postmastectomy breast cancer: a meta-analysis and systematic review. Radiat Oncol. 2020 Jan 17;15(1):17. doi: 10.1186/s13014-020-1463-1.

Reference Type BACKGROUND
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SBRT, Brazilian Society of Radiotherapy; Freitas NMA, Rosa AA, Marta GN, Hanna SA, Hanriot RM, Borges ABB, Gondim GRM, Pellizzon ACA, Veras IM, Almeida Junior WJ, Fernandez CRSHW, Batalha Filho ES, Castilho MS, Kuhnen FQ, Najas RMXF, Affonso Junior RJ, Leite ACC, Ribeiro HLM, Freitas Junior R, Oliveira HF. Recommendations for hypofractionated whole-breast irradiation. Rev Assoc Med Bras (1992). 2018 Sep;64(9):770-777. doi: 10.1590/1806-9282.64.09.770.

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Nimeus-Malmstrom E, Krogh M, Malmstrom P, Strand C, Fredriksson I, Karlsson P, Nordenskjold B, Stal O, Ostberg G, Peterson C, Ferno M. Gene expression profiling in primary breast cancer distinguishes patients developing local recurrence after breast-conservation surgery, with or without postoperative radiotherapy. Breast Cancer Res. 2008;10(2):R34. doi: 10.1186/bcr1997. Epub 2008 Apr 22.

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Tramm T, Kyndi M, Myhre S, Nord S, Alsner J, Sorensen FB, Sorlie T, Overgaard J. Relationship between the prognostic and predictive value of the intrinsic subtypes and a validated gene profile predictive of loco-regional control and benefit from post-mastectomy radiotherapy in patients with high-risk breast cancer. Acta Oncol. 2014 Oct;53(10):1337-46. doi: 10.3109/0284186X.2014.925580. Epub 2014 Jun 24.

Reference Type BACKGROUND
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Kowal J, Arras G, Colombo M, Jouve M, Morath JP, Primdal-Bengtson B, Dingli F, Loew D, Tkach M, Thery C. Proteomic comparison defines novel markers to characterize heterogeneous populations of extracellular vesicle subtypes. Proc Natl Acad Sci U S A. 2016 Feb 23;113(8):E968-77. doi: 10.1073/pnas.1521230113. Epub 2016 Feb 8.

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Reference Type BACKGROUND
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Other Identifiers

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1

Identifier Type: -

Identifier Source: org_study_id

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