A Study of Accelerated 3 Fraction Photon,Proton or Brachytherapy for Early Invasive and Noninvasive Breast Ca
Condition: Breast Cancer
MeSH terms: Breast Neoplasms
Intervention: Brachytherapy APBI; 3D-CRT (photon) APBI; Proton APBI
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 170.0
Sex: Female
Minimum age: 50 Years
Healthy volunteers: No
Keywords: Proton; Brachytherapy; Partial Breast Irradiation; 3D Conformal Photon

Summary:

      This is an open label phase II study to determine the safety and efficacy of a novel 3
      fraction daily dosing regimen for accelerated partial breast irradiation (APBI) for early
      invasive and noninvasive breast cancer. The three techniques utilized are recognized as
      standard options for the delivery of APBI, and there is no evidence that either technique is
      superior or inferior to any other. The APBI technique utilized will be at the physician's
      discretion and will be based on technical considerations, availability at the treating
      radiation facility, insurance coverage, as well as patient preference.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Female Age ≥ 50 years at diagnosis

          -  Grade 1-3 invasive ductal, mucinous, tubular, colloidal, or pure ductal carcinoma in
             situ (DCIS) measuring ≤ 2cm (clinical stage T1).

          -  Estrogen Receptor (ER)+ (ER- DCIS meeting other eligibility criteria are eligible)

          -  Unicentric: Patients with microscopic multifocality are eligible as long as the total
             pathologic tumor size is <2cm.

          -  Surgical treatment of the breast must have been lumpectomy.

          -  The final margins of the resected specimen must be histologically free of tumor.

          -  Pathologically node negative Note: For patients with T1a, T1b, T1c invasive breast
             cancer (except T1mi), an axillary staging procedure should be performed (either
             sentinel lymph node biopsy alone or axillary dissection and the axillary node must be
             pathologically negative). Patients with N0 (i+) tumors on sentinel lymph node mapping
             or dissection (i.e., if the tumor deposit is 0.2mm or less as determined by
             immunohistochemistry or hematoxylin and eosin staining) will also be eligible.

          -  ECOG Performance Status of 0 or 1

          -  Negative pregnancy test done ≤7 days prior to registration, for women of childbearing
             potential only.

          -  Ability to complete questionnaire(s) by themselves or with assistance.

          -  Ability to elect radiotherapy care in conjunction with their physician

          -  Able and willing to provide written informed consent

          -  Willingness to return to enrolling institution for follow-up (during the Active
             Monitoring Phase of the study).

          -  Willing to provide tissue and blood samples for correlative research purposes

          -  Willing to sign consent onto the Mayo Clinic Radiotherapy Patient Outcomes Registry
             and Biobanking study, IRB number 15-000136

        Exclusion Criteria:

          -  Any of the following because this study involves therapy that has known genotoxic,
             mutagenic and teratogenic effects:

               -  Pregnant women

               -  Nursing women

               -  Women of childbearing potential who are unwilling to employ adequate
                  contraception

          -  Neoadjuvant chemotherapy

          -  Prior history of ipsilateral breast cancer

          -  Prior radiation therapy to the ipsilateral breast or thorax

          -  Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment
             of the investigator, would make the patient inappropriate for entry into this study or
             interfere significantly with the proper assessment of safety and toxicity of the
             prescribed regimens.

          -  Active collagen-vascular disease that, in the opinion of the treating physician, would
             make this protocol unreasonably hazardous for the patient.

          -  Paget's disease of the breast

          -  Proven multicentric carcinoma (DCIS or invasive) in more than one quadrant or
             separated by 4 or more centimeters or diffuse (>1 quadrant) suspicious calcifications

          -  Histologic evidence of angiolympatic invasion (ALI). Note: Cases termed focally
             suspicious for ALI but where no definitive ALI is found are eligible.

          -  Surgical margins that cannot be microscopically assessed or that are positive

          -  Pathologic tumor >2cm in size

          -  Metastatic disease

          -  Patients for whom the delivery of APBI is not feasible or any of the dosimetric
             treatment criteria in section 9.7 have not been met.

          -  BRCA 1/2 mutation Note: Patients are not required to undergo BRCA1 and BRCA2 or other
             genetic mutation tests in order to enroll on the study. However, in the event a
             patient is tested and is found to be a mutation carrier, she would be excluded from
             the study.

          -  Breast implants (patients who have had implants removed are eligible).

          -  Extensive intraductal component

          -  Active connective tissue disease

          -  Reduction mammoplasty if 3DCRT or proton APBI are planned

          -  Last surgery >10 weeks from enrollment