A Prospective Study of Preoperative Tumor-bed Boost Followed by Oncoplastic Surgery and Adjuvant Whole Breast Radiotherapy for Early Stage Breast Cancer (BIRKIN)

Study Overview
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Brief Summary
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This study explores the feasibility of preoperative single-dose tumor-bed boost followed by oncoplastic breast-conserving surgery and ultra-hypofractionated postoperative radiotherapy in patients with early stage breast cancer. Patients less than 55 years old, who are diagnosed with breast cancer and are eligible to recieve breast-conserving surgery are enrolled. Patients who are older than 55 years, with suspected regional lymph node metastasis are excluded. The primary end point are the acute toxicities within 4 weeks after adjuvant radiation. The secondary endpoints are oncologic outcomes, surgical complications within 30 days, late toxicities, patients' quality of life and cosmetic outcomes.

Detailed Description
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This is a prospective, non-controlled, feasitility study. The tumor-bed boost part of the radiotherpay is put forward, 7-14 days before the definitive surgery. A single dose of 10Gy is prescribed to the tumor bed. In order to identify the tumor accurately, MRI guided radiotherapy is applied under the MR-linac. The breast surgery is planned after recovery from radiation induced acute toxicity, within 14 days. The surgeons would undertake lumpectomy only or an additional oncoplastic surgery, with axillary nodal evaluation with sentinal nodal biopsy or dissection. After wound healing, postoperative whole breast radiotherapy is administered, within 6 weeks following surgery. The dose is 26Gy/5.2Gy/5 fractions. Adjuvant systemic therapy is held until the end of the radiotherapy, no more than 12 weeks from surgery implementation.

Official Title
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A Prospective Study of Preoperative MRI Linac-based Tumor-bed Boost Followed by Breast-conservative Oncoplastic Surgery and Adjuvant Ultra-hypofractionated Whole Breast Radiotherapy for Early Stage Breast Cancer

Conditions
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Breast Neoplasms

Intervention / Treatment
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* Radiation: Preoperative MRI-guided tumor-bed boost and postopreative ultra-hypofractionated radiotherapy (26 Gy/5.2Gy/5)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients diagnosed with invasive breast cancer; cN0 based on clinical physical examination combined with at least two imaging tests, or axillary fine-needle biopsy proved pN0; Patients who plan to receive breast-conserving surgery or breast-conserving oncoplastic surgery; No distant metastasis; The primary tumour> 5mm from the skin, without invasion of the ribs or intercostal muscles; No neoadjuvant systemic therapy; Patients who can tolerate MRI; Life expectancy ≥5 years; Organ function is fine (Hemoglobin ≥100g/L, leukocyte ≥2×109/L, neutrophil ≥1×109/L, platelet ≥80×109/L; Creatinine 1.5 mg/dl or less; Alanine aminotransferase/aspartate aminotransferase ≤2.5×UNL.); Patients are willing to cooperate to follow up; Patients should sign the informed consent; Women of childbearing age need effective contraception. Exclusion Criteria: Concurrent active connective tissue disease; Patients who had radiotherapy to the ipsilateral breast or adjacent areas before; Other malignancies, which affect pateint life expectancy (except adequately treated basal cell carcinoma of the skin, carcinoma in situ of the cervix, superficial bladder neoplasms (no more than T1)); Severe comorbidities or active disease (Poorly controlled heart disease: New York Classification of Cardiac Function ≥ Grade 2, active coronary heart disease, unstable angina pectoris, arrhythmia requiring medical treatment/persistent refractory hypertension; Myocardial infarction, stroke within six months; Poorly controlled diabetes persists. Fasting blood glucose ≥ 10mmol/L, 2 hours postprandial blood glucose ≥ 13 mmol/L. Poorly controlled psychosis develops or worsens within six months; Active infection; Positive for antibodies to HIV).

Ages Eligible for Study
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Maximum Age: 55 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: preoperative tumor-bed boost<br>The participants receive preoperative tumor-bed boost, oncoplastic surgery and adjuvant WBRT±RNI. | Radiation: Preoperative MRI-guided tumor-bed boost and postopreative ultra-hypofractionated radiotherapy (26 Gy/5.2Gy/5)<br>* Preoperative tumor-bed boost was performed under MRI Linac, and a single dose of 10Gy is prescribed. The postoperative radiotherapy of 26Gy/5.2Gy/5 fractions is within 6 weeks following surgery. Adjuvant chemotherapy, targeted therapy and endocrine therapy are initiated no more than 12 weeks after surgery.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The rate of patients who develop radiation-associated acute toxicity (≥ 2 degree) | We will record the incidence of ≥ 2 degree radiation-associated acute toxicity, such as breast or chest wall oedema, acute dermatitis, breast pain,itch of breast skin. The incidence of all the above is the primary outcome. | until 4 weeks of postoperative radiotherapy | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Local recurrence rate | The incidence of recurrence of any invasive or non-invasive breast cancer in the ipsilateral breast. | Until 5 years after diagnosis. | 
| Local regional recurrence rate | The incidence of recurrence in the ipsilateral breast or the lymphatic nodal regions. | Until 5 years after diagnosis. | 
| Disease-free survival | The time interval from diagnosis to any event of recurrence or death. | Until 5 years after diagnosis. | 
| Overall survival | The time interval from diagnosis to death from any reason. | Until 5 years after diagnosis. | 
| Complications of surgery in the short term. | We will record the incidence of surgery assciated mobilidy events within 30 days, including bleeding, seroma, hematoma, wound dehiscence, flap necrosis, delayed wound healing, fat necrosis, wound infection, abscess and upper limb edema. | Until 30 days after the surgery. | 
| Quality of Life (according the outcomes of questionnaires to evaluate the quality of life) EORTC QLQ-C30 | European Organization Research and Treatment of Cancer Breast Cancer-Specific Quality of Life Questionnaire EORTC QLQ-C30 to record patients' quality of life in different time points. | Until 5 years after treatment. | 
| Quality of Life (according the outcomes of questionnaires to evaluate the quality of life) EORTC BR-23 | European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life Questionnaire EORTC BR-23 to record patients' quality of life in different time points. | Until 5 years after treatment. | 
| Cosmetic outcome Breast Cancer Treatment Outcome Scale (BCTOS) |  | Until 5 years after treatment. | 
| Cosmetic outcome Body Image Scale (BIS) |  | Until 5 years after treatment. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Breast cancer, MRI guided radiotherapy, Pre-operative radiotherapy, Ultra-hypofractionation