Breast-Conserving Surgery and Radiation Therapy in Patients With Multiple Ipsilateral Breast Cancer
Condition: Breast Cancer
MeSH terms: Breast Neoplasms
Intervention: therapeutic conventional surgery; whole breast irradiation
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 270.0
Sex: Female
Minimum age: 40 Years
Healthy volunteers: No
Keywords: stage IA breast cancer; stage IB breast cancer; stage II breast cancer; ductal breast carcinoma in situ; lobular breast carcinoma in situ

Summary:

      RATIONALE: Breast-conserving surgery is a less invasive type of surgery for breast cancer and
      may have fewer side effects and improve recovery. Radiation therapy uses high-energy x rays
      to kill tumor cells. Giving radiation therapy after surgery may kill any tumor cells that
      remain after surgery.

      PURPOSE: This phase II trial studies how well breast-conserving surgery and radiation therapy
      work in treating patients with multiple ipsilateral breast cancer
    

Eligibility criteria:

        Registration Inclusion Criteria:

          1. Age ≥ 40 years per National Comprehensive Cancer Network (NCCN) recommendations for
             breast conservation.

          2. Life Expectancy of at least 5 years, excluding diagnosis of breast cancer (Comorbid
             conditions should be taken into consideration, but breast cancer diagnosis is not a
             consideration)

          3. Female Gender - Men are excluded from this study. Male breast cancer is a rare event.

             Men are rarely candidates for breast conservation surgery due to small breast size.
             Men are less likely to be candidates for breast conservation surgery if found to have
             MIBC.

             Men are rarely candidates for breast conservation surgery due to small breast size.
             Men are less likely to be candidates for breast conservation surgery if found to have
             MIBC.

          4. Foci of Breast Cancer

             4.1 Upon clinical exam and pre-operative imaging by mammogram +/- MRI, two or three
             foci of biopsy proven breast cancer separated by > 2 cm of normal breast tissue.

             4.2 Foci must include at least one focus of invasive breast carcinoma with another
             focus of either invasive breast carcinoma or ductal carcinoma in situ (DCIS).

             No more than 2 quadrants with biopsy proven breast cancer.

             4.3 Note: The shortest distance between lesions must be reported on mammogram +/- MRI
             and eligibility criteria must be met on both, if both are obtained.

             4.4 Note: Patient is eligible for study if lesion is not visualized on all imaging
             modalities (i.e., any of the lesion(s) is/are visualized on MRI but not on mammogram
             OR visualized on mammogram but not on MRI).

             4.5 Ultrasound cannot be used to determine patient eligibility; eligibility to be
             determined by bilateral mammogram +/- MRI only.

             4.6 Fine needle aspirate of the second or third lesion to document malignancy is
             allowed if the first focus is shown to be invasive by core needle biopsy.

             4.7 Patient may remain on study if, upon pathological assessment, two or three lesions
             identified on pre-operative imaging represent one contiguous lesion.

          5. Patients may be registered AFTER surgery and PRIOR TO radiation therapy if either of
             the criteria is met:

             5.1 An area of atypia > 2cm from the index lesion excised at the time of cancer
             operation is upgraded to DCIS or invasive carcinoma thereby identifying MIBC. OR

             5.2 Patient underwent resection of two or three foci of malignancy by breast
             conservation surgery with a minimum of one invasive focus of breast cancer and a
             minimum of 2 cm of normal breast tissue between the lesions on final pathology.

          6. Mammogram Imaging - Bilateral mammogram ≤ 90 days prior to date of surgery.

             6.1 Note: For patients undergoing more than 1 breast operation, this is the date of
             the first breast surgery for breast cancer treatment.

          7. Staging of Cancer - cN0 or cN1 disease

          8. ECOG Performance Status (PS) - 0, 1, or 2.

          9. Ability to Complete Questionnaires - Ability to complete questionnaire(s) by
             themselves or with assistance

         10. Ability to Provide Written Informed Consent

         11. Willing to Return to Enrolling Institution - Willing to return to enrolling
             institution for follow-up during the Active Monitoring Phase (the active treatment and
             observation portions) of the study. Patients are encouraged to return to the enrolling
             institution; however, patients may receive radiation therapy at a different
             institution other than the enrolling institution.

        Registration Exclusion Criteria:

          1. Pregnancy, Nursing and Requirement for Contraception - Pregnant women, nursing women
             and women of childbearing potential who are unwilling to employ adequate contraception
             (as determined by the treating physician) are excluded from participation.

             This study involves radiation therapy (WBI) that has known genotoxic, mutagenic and
             teratogenic effects.

          2. Size of Single Focus of Disease on Preoperative Imaging - Largest single focus of
             disease > 5 centimeters by either mammogram or MRI or both. Note: Measurement of the
             largest single focus should include any satellite lesions within 1 centimeter of the
             index lesion.

          3. Prior Staging Procedure - Surgical axillary staging procedure prior to first
             definitive breast operation. Note: FNA or core needle biopsy of axillary node is
             permitted.

          4. Evidence of Metastatic Disease - Clinical or radiographic evidence of metastatic
             disease

          5. Prior History of Breast Cancer - Prior history of ipsilateral breast cancer [DCIS,
             LCIS (lobular cancer in situ) or invasive]

          6. Staging of Cancer - cNX, cN2, or cN3 disease

          7. Breast Implants - Breast implants at time of diagnosis. Note: Patients who have had
             implants previously removed prior to diagnosis are eligible.

          8. Systemic Illnesses or Concurrent Disease - Co-morbid systemic illnesses or other
             severe concurrent disease which, in the judgment of the investigator, would interfere
             significantly with whole breast irradiation (such as connective tissue disorders,
             lupus, scleroderma).

          9. Uncontrolled Intercurrent Illness - Uncontrolled intercurrent illness including, but
             not limited to, ongoing or active infection, symptomatic congestive heart failure,
             unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations
             that would limit compliance with study requirements.

         10. Bilateral Breast Cancer - Prior or current LCIS, DCIS or invasive breast cancer in the
             opposite breast (i.e., bilateral disease is not allowed).

         11. Disallowed Prior Treatments - Treatment including radiation therapy, chemotherapy,
             biotherapy, hormonal therapy for this cancer prior to surgery (i.e., any neoadjuvant
             chemotherapy or endocrine therapy is not allowed). Patients who undergo surgical
             resection with breast conservation and then are treated with adjuvant systemic therapy
             are eligible to enroll prior to the start of radiotherapy.

         12. Partial Breast Radiation - Planned partial breast radiation.

         13. Known BRCA Mutations - Patients with known BRCA mutations. Patients who are not tested
             or whose testing result is not returned at the time of registration are not excluded
             from registering to this study.

         14. Other Active Malignancies - Other active malignancy ≤ 5 years prior to registration.

        14.1 Exceptions: Non-melanotic skin cancer or carcinoma-in-situ of the cervix.

        14.2 Note: If there is a history of prior malignancy, they must not be receiving other
        specific treatment for their cancer.