Accelerated Partial Breast Irradiation Using Intensity Modulated Radiotherapy Versus Whole Breast Irradiation
This trial is active, not recruiting.
|Treatments||accelerated partial breast irradiation (apbi), whole breast irradiation (wbi)|
|Sponsor||Azienda Ospedaliero-Universitaria Careggi|
|Start date||March 2005|
|End date||February 2014|
|Trial size||520 participants|
|Trial identifier||NCT02104895, APBI-IMRT-Florence|
The aim of this Phase 3 randomised trial is to compare the efficacy and safety of whole breast radiotherapy to accelerated partial breast irradiation using intensity-modulated radiotherapy technique in selected early breast cancer patients after breast conserving surgery.
|Endpoint classification||efficacy study|
|Intervention model||parallel assignment|
Ipsilateral breast tumor recurrence
time frame: 5-year
time frame: 5 years
Female participants at least 40 years old.
Inclusion Criteria: - Age at presentation >40 y - Tumor size <25 mm - Wide excision or quadrantectomy with clear margins (>5 mm) - Clips placed in tumor bed - Full informed consent from patient Exclusion Criteria: - Cardiac dysfunction - Forced expiratory volume in 1 second (FEV1) <1 L/m - Extensive intraductal carcinoma - Multifocal cancer - Psychiatric problems - Recurrent breast cancer
|Official title||Randomised Phase 3 Trial Of Accelerated Partial Breast Irradiation Using Intensity Modulated Radiotherapy Versus Whole Breast Irradiation|
|Principal investigator||Lorenzo Livi, Full Prof|
|Description||The surgeons were requested to place clips at the borders of the surgical bed, using a minimum of four clips. The presence of surgical clips was a selection criterion to avoid geographic misses. Computed tomography (CT) scanning was performed using 0.3-cm thick-slices and a slice spacing of 0.3 cm. In patients assigned to APBI arm, the clinical target volume (CTV) was drawn with a uniform 1-cm three-dimensional margin around the surgical clips. The CTV was limited to 3 mm from the skin surface and 3 mm from the lung-chest wall interface. A second uniform, three-dimensional 1-cm margin was added to the CTV to obtain the planning target volume (PTV). The PTV was allowed to extend 4 mm inside the ipsilateral lung and was limited to 3 mm from the skin. The ipsilateral and contralateral breast, ipsilateral and contralateral lung, heart, and spinal cord were contoured as organs at risk. All the regions of interest were contoured according to the International Commission on Radiation Units and Measurements reports 50 and 62 recommendations. No respiratory control was used. Concerning the experimental Arm (accelerated partial breast irradiation), a dose of 30 Gy in five fractions at 6 Gy/fraction was prescribed. The following constraints were adopted for plan optimization: PTV coverage: 100% of PTV covered by 95% of the prescribed dose (V28.5 = 100%); maximal dose to PTV <105% (31.5 Gy); minimal dose to PTV 28 Gy; uninvolved breast (i.e., ipsilateral breast without PTV): not >50% covered by a dose of >50% of the prescribed dose (V15 <50%); ipsilateral lung: not >20% covered by a dose >10 Gy (V10<20%); contralateral lung: not >10% covered by a dose >5 Gy (V5<10%); contralateral breast: maximal dose <1 Gy; heart: not >10% covered by a dose >3 Gy (V3 <10%).|
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