ASHBY: Accelerated Super-Hypofractionated Breast Brachytherapy

Study Overview
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Brief Summary
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The purpose of this study is to compare any good and bad effects of giving radiation treatment for breast cancer in 3 treatments over about 2 days.

Detailed Description
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This phase 2, single-arm prospective study has been designed to determine the safety of delivering accelerated partial breast irradiation (APBI) with a multicatheter interstitial implant in a short course over 1.5 days

Official Title
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Accelerated Super-Hypofractionated Breast Brachytherapy - ASHBY Trial

Conditions
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Breast Cancer

Intervention / Treatment
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* Radiation: Accelerated partial breast irradiation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female New diagnosis of ductal carcinoma in situ (DCIS) and/or invasive breast carcinoma per histologic evaluation Age 45-79 at diagnosis Previous lumpectomy with surgical margins histologically free of invasive tumor and DCIS as determined by the pathologist. T stage of Tis, T1, or T2. T2 tumors must be ≤3 cm in maximum diameter If the tumor is human epidermal growth factor receptor 2 (HER2)-positive, the patient must receive HER2-directed therapy. For patients with invasive breast cancer, an axillary staging procedure must be performed (either sentinel node biopsy alone or axillary dissection [with a minimum of 6 axillary nodes removed]) and the axillary node[s] must be pathologically negative. Note: N0(i+) is not an exclusion criterion. Note: Patients meeting all of the following criteria are not required to undergo the axillary staging procedure: ≥70 years of age estrogen receptor, Her2 = human epidermal growth factor receptor 2, PR = progesterone receptor negative (ER+PR+HER2-) G1-2 Tumor ≤2 cm in size Agrees to comply with aromatase inhibitor recommendation Ability to understand and the willingness to sign a written informed consent document in English Exclusion Criteria: Pregnant or breastfeeding Active collagen-vascular disease Paget's disease of the breast History of DCIS or invasive breast cancer prior to the current diagnosis Prior breast or thoracic radiation therapy (RT) for any condition Multicentric carcinoma (DCIS or invasive) Synchronous bilateral invasive or non-invasive breast cancer Surgical margins that cannot be microscopically assessed or that are positive Excision cavity that cannot be clearly delineated per the treating investigator Any of the dosimetric treatment criteria defined in Section 6.1 have not been met. Patients who become ineligible due to inability to meet dosimetric criteria should not receive treatment as - defined in this protocol and will come off the study. Any subsequent adjuvant radiation will be delivered at the discretion of the treating physician Medical, psychological, or social condition that, in the opinion of the investigator, may increase the patient's risk or limit the patient's adherence with study requirements

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 79 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: Accelerated Partial Breast Irradiation (APBI)<br>7.5 gray (Gy) × 3 fractions via multicatheter brachytherapy | Radiation: Accelerated partial breast irradiation<br>* High Dose Rate treatment delivery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assess the toxicity (at 1 and 3 years) of a 1.5-day APBI treatment course | Determine the incidence of accelerated partial breast irradiation (APBI) related toxicities, adverse events, of interest occurring at grade ≥3 within 1 year and 3 years after APBI. The APBI-related toxicities specified in Section 10.1 will be explicitly evaluated at all follow-up appointments. All APBI-related toxicities of interest will be captured, regardless of grade, beginning with the start of study treatment and continuing until the patient is off study utilizing study-specific grading criteria in place of Common Terminology Criteria for Adverse Events (CTCAE) v5.0. | 1 year, and 5 years following irradiation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assess the rate of excellent or good cosmesis at baseline, 1, 3, and 5 years after a 1.5-day course of APBI utilizing the Breast Cancer Treatment Outcome Scale. | Cosmesis will be assessed utilizing the Breast Cancer Treatment Outcome Scale (BCTOS-12), a self-report instrument that evaluated the aesthetic outcome after breast conserving surgery (BCS). the Aesthetic Status, is composed of eight items referring to the breast. the new Aesthetic Status comprises eight items: (1) breast shape, (2) breast texture, (3) nipple appearance, (4) breast tenderness, (5) scar tissue, (6) breast swelling, (7) fit of bra, and (8) breast sensitivity. Patients are instructed to rate each item of the BCTOS questionnaire on a four-point rating scale evaluating the differences between the treated and untreated breast (1 = no difference to 4 = large difference). The score for each subscale is calculated as the mean of its items, with the score ranging from 1.00 to 4.00. A higher score reflects a poorer status. | Baseline, one year, three years, and five years following irradiation | 
| Assess the rate of excellent or good cosmesis at baseline, 1, 3, and 5 years after a 1.5-day course of APBI utilizing the Breast Cancer Treatment Outcome Scale. | Cosmesis will be assessed utilizing the Breast Cancer Treatment Outcome Scale (BCTOS-12), a self-report instrument that evaluated the functional outcome after breast conserving surgery (BCS). The questionnaire comprises 12 items and assesses various aspects of patients' subjective perception of the surgical result. The new Functional Status comprises four items: (1) arm heaviness, (2) shoulder discomfort, (3) arm discomfort, (4) arm swelling. Patients are instructed to rate each item of the BCTOS questionnaire on a four-point rating scale evaluating the differences between the treated and untreated breast (1 = no difference to 4 = large difference). The score for each subscale is calculated as the mean of its items, with the score ranging from 1.00 to 4.00. A higher score reflects a poorer status. | Baseline, one year, three years, and five years following irradiation | 
| Assess the rate of excellent or good cosmesis at baseline, 1, 3, and 5 years after a 1.5-day course of APBI utilizing the BREAST-Q©. | The radiation-specific module of this patient-reported outcome measure evaluates patient satisfaction with the cosmetic effects of radiation by utilizing the BREAST-Q© (intellectual property of Drs Andrea Pusic, Anne Klassen and Stefan Cano. The BREAST-Q© is owned by Memorial Sloan Kettering Cancer Center and The University of British Columbia (Copyright ©2012, Memorial Sloan Kettering Cancer Center and The University of British Columbia). There is no overall or total BREAST-Q© score, only scores for each independent scale. All BREAST-Q© scales are transformed into scores that range from 0-100. The scores are computed by adding the response items together and then converting the raw sum scale score to a score from 0-100. For all BREAST-Q© scales, a higher score means greater satisfaction or better QOL. | Baseline, one year, three years, and five years following irradiation | 
| Assess the rate of excellent or good cosmesis at baseline, 1, 3, and 5 years after a 1.5-day course of APBI utilizing the Harvard Cosmesis Scale | This physician-rated form will be used by the treating surgeon or radiation oncologist to score cosmesis at baseline and annually for 5 years, where Excellent= treated breast looks essentially the same as the contralateral breast as it relates to radiation effects. This includes patients with grade 1 punctate scarring. Good= minimal but identifiable radiation effects of the treated breast. This includes patients with grade 2 punctate scarring. Fair= significant radiation effects readily observable. Poor= severe sequelae of breast tissue secondary to radiation effect | Baseline, one year, three years, and five years following irradiation | 
| Determine the 3- and 5-year actuarial local control rate of breast cancer when treated with a 1.5-day course of APBI. | The number of participants that achieve complete responses, partial response, or relapse. Disease control will be assessed by physical examination and mammography. | up to three and five years after irradiation | 
| Assess cumulative treatment-related breast toxicities for up to 5 years after a 1.5-day course of APBI | The number of participants that have a reportable adverse event (AE) per protocol criteria. | up to five years after irradiation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Breast Cancer, Ductal Carcinoma in situ (DCIS), Irradiation