Node Negative, Invasive Breast Cancer Single Fraction IOERT

Study Overview
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Brief Summary
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The purpose of this study is to determine if lumpectomy followed by Intraoperative Electron Radiation Therapy (IOeRT) as a single, full dose partial breast irradiation will have as good or better results in preventing recurrence of local breast cancer, cosmetic appearance and early and late side effects.

Detailed Description
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See points VIII inclusion/exclusion criteria Operation: Lumpectomy, steninal node biopsy IOeRT After Surgery: Meet with a medical oncologist and discuss if chemotherapy and/or hormone therapy is recommended as part of your treatment course. In some cases, pathology results may indicate the need for removal of additional lymph nodes. The doctor will review pathology and discuss if additional surgery is required. Chemotherapy (if indicated) Hormone therapy (if indicated) Follow-Up Visits will be completed with the surgeon, radiation oncologist and research staff as the protocol indicates. Assessements of acute toxicity according to CTC-toxicity scoring system Assessments of late toxicity according to LENT-SOMA scoring systems Assessment of cosmetic outcome according to scoring system and photo documentation in standardized positions.

Official Title
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Lumpectomy Followed by Intraoperative Electron Radiation Therapy (IOERT) as a Single Full Dose Partial Breast Irradiation for Early Stage, Node Negative, Invasive Breast Cancer

Conditions
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Breast Cancer

Intervention / Treatment
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* Radiation: Single Fraction IOeRT


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient agrees to breast conservation therapy (segmental resection, partial mastectomy, and radiation therapy) as the treatment for their breast cancer Patient agrees to evaluation of the axilla with sentinel lymph node biopsy Post-menopausal women age > 60, defined as women who have experienced no menstrual period in the past 12 months. BRCA1 and 2 gene mutation negative, if tested. [genetic testing is NOT required based upon personal or family history] Unifocal (unicentric), invasive ductal carcinoma or favorable sub-types (mucinous, tubular, colloid) < 2.0 cm in diameter, primary T-stage of T1 (AJCC criteria) Grade 1, 2 acceptable Associated LCIS is allowed Estrogen receptor (ER) status of positive Negative margins at ink on gross pathologic examination Patient is node-negative, defined as N0 (i-) or N0 (i+) Patient must be deemed functionally and mentally competent to understand and sign the informed consent Exclusion Criteria: Prior breast malignancy or other malignancy if metastatic, or with expected survival of < 5 years Immuno-compromised status Pregnancy Women with an active connective tissue disorder (i.e. scleroderma, lupus and others) Breast cancer that involves the skin or chest wall, locally advanced breast cancer Pure DCIS, all grades Invasive lobular carcinoma Evidence of lymphovascular invasion (LVI) Invasive carcinoma with extensive intraductal component (EIC) Neoadjuvant chemotherapy indicated Patients with 1 or more positive lymph node determined during surgery with sentinel node and/or axillary dissection Not eligible for breast conserving management, i.e., prior whole breast radiation therapy Estrogen receptor negative Her2 positive Grade 3

Ages Eligible for Study
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Minimum Age: 60 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: Single Fraction IOeRT<br>A single dose of 21 Gy calculated such that the 90% isodose line encompasses the posterior of the tumor bed will be administered. | Radiation: Single Fraction IOeRT<br>* A single dose of 21 Gy calculated such that the 90% isodose line encompasses the posterior of the tumor bed will be administered.<br>* Other names: Intra-Operative electron radiation therapy;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients who are free of breast cancer. | Patients will be followed by standard of care breast imaging along with appointments with breast surgeon, radiation oncologist and medical oncologist if indicated. | 10 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Local recurrance rate with acute toxicity and cosmetic evaluations | AEs and Lent Soma will be assessed for acute toxicity. We will use a 20% toxicity cutoff, the protocol would be stopped if 2/10 were determined to have developed significant toxicities, grade 3 or greater, at the first 6-month follow-up visit. 2/10 patients at 6-months follow-up, 4/20 patients at 1-year follow-up, 6/30 at 18-months follow-up, 8/40 at 24-months follow-up, 10/50 at 30-months follow-up, 12/60 at 36-months follow-up, 14/70 at 42-months follow-up, 16/80 at 48-months follow-up, 18/90 at 54-months and 20/100 at 60-months follow-up. Cosmetic evaluations will be completed by the patient and radiation oncologist an via breast exams, questionnaires and breast photo documentation. | 10 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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IOERT, Radiation, Single fraction, Lumpectomy, Radiation therapy, Avera