Description:
Women with BRCA germline mutations face a very high risk of developing breast cancer during
their lives. It was shown that for carrier patients, breast conservation, comprising of
lumpectomy followed by whole breast radiation, was not associated with increased risk of
ipsilateral breast cancer recurrence as compared with non carriers (10-15% over 10 years),
especially if they also underwent prophylactic oophorectomy. Yet their risk of subsequent
contralateral breast cancer was significantly increased, reported as high as 25-30% over 10
years and 40% over 15 years, as compared to 3% and 7% respectively in non carriers. The
reduction in ipsilateral disease was attributed to radiation of the affected breast. We
propose that for breast cancer patients with BRCA germline mutation that choose to have
breast-conserving therapy and refuse prophylactic contralateral mastectomy, prophylactic
radiation to the contralateral breast may reduce the rate of subsequent contralateral breast
cancer and offer an option for risk reduction.
Title
- Brief Title: Prophylactic Irradiation to the Contralateral Breast for BRCA Mutation Carriers Undergoing Treatment for Breast Cancer
- Official Title: Phase II Multicenter Clinical Trial of Prophylactic Irradiation to the Contralateral Breast for BRCA Mutation Carriers Undergoing Treatment for Breast Cancer
Clinical Trial IDs
- ORG STUDY ID:
102/07 (HT4351)
- NCT ID:
NCT00496288
Conditions
Purpose
Women with BRCA germline mutations face a very high risk of developing breast cancer during
their lives. It was shown that for carrier patients, breast conservation, comprising of
lumpectomy followed by whole breast radiation, was not associated with increased risk of
ipsilateral breast cancer recurrence as compared with non carriers (10-15% over 10 years),
especially if they also underwent prophylactic oophorectomy. Yet their risk of subsequent
contralateral breast cancer was significantly increased, reported as high as 25-30% over 10
years and 40% over 15 years, as compared to 3% and 7% respectively in non carriers. The
reduction in ipsilateral disease was attributed to radiation of the affected breast. We
propose that for breast cancer patients with BRCA germline mutation that choose to have
breast-conserving therapy and refuse prophylactic contralateral mastectomy, prophylactic
radiation to the contralateral breast may reduce the rate of subsequent contralateral breast
cancer and offer an option for risk reduction.
Detailed Description
Trial design and statistics:
This is a multi center- phase II open comparative trial. "Patients" - Those who choose
prophylactic contralateral breast irradiation. "Controls" - Those that do not opt for
prophylactic irradiation or mastectomy. Objective - to compare the rate of contralateral
breast cancer in "patients" versus "controls".
Assuming that 2/3 of the eligible carrier breast cancer patients refuse the procedure: To
detect a difference of 10% vs. 25% in the incidence of contralateral breast cancer with power
= 80%, alpha = 0.05, 80 patients and 160 controls need to be enrolled.
Treatment:
Chemotherapy, Hormonal therapy and XRT to the affected breast as per treating institution.
Radiation therapy:
Patients will undergo a pre-treatment planning CT with 5mm cuts in the treatment position, on
a breast board, with both arms extended above their head. The organs at risk (heart, lungs)
will be contoured on the CT scan.
The affected breast (with the index lesion) and associated lymphatic drainage will be treated
according to the treating physician decision. The contralateral breast will be treated with 2
tangent fields, using 1.8-2 Gy/fx to a total dose of 50-50.4 Gy. The whole breast will be
treated according to traditional guidelines and as described in the RTOG/NSABP B39 study. The
heart should be completely blocked for left sided breasts, included lung tissue should be
reduced to minimum. No overlapping field is allowed on the skin between the two breast fields
in the midline. Maximal dose should not exceed 110%.
Follow up:
The treating physician will follow the patient every 2 weeks during the radiation treatment.
Side effects will be scored and recorded in the patients chart according to the Common
Terminology Criteria for Adverse Events v3.0.
Subsequent follow-up schedule according to the treating institution and ASCO guidelines.
Patients will undergo annual mammogram and breasts US. Annual breasts MRI and bilateral
salpingo-oophorectomy will be recommended.
Ipsilateral and contralateral breast cancer will be recorded and reported. Any subsequent
malignancy other than breast cancer will be reported. Long-term radiation side effects will
be recorded.
Trial Arms
| Name | Type | Description | Interventions |
|---|
| prophylactic irradiation | Experimental | prophylactic contralateral breast irradiation | |
| controls | No Intervention | Those that do not opt for prophylactic irradiation or mastectomy | |
Eligibility Criteria
Inclusion Criteria:
1. Female patient diagnosed with stage I-III breast cancer (AJCC 6), undergoing breast
irradiation as part of her adjuvant therapy.
2. The patient must be a carrier of a deleterious mutation in BRCA 1/2.
3. Age above 30 years.
4. The patient may receive any regimen of adjuvant chemotherapy, according to the
treating physician. All cycles of chemotherapy must be completed at least 3 weeks
prior to the start of radiation therapy.
5. The patient may be treated with hormonal therapy before, during or after study entry,
according to the guidelines of her treating center.
6. The patient must have negative gadolinium based MRI of the contralateral breast, no
more than 6 months prior to study entry.
7. The patient refused prophylactic contralateral mastectomy.
8. The patient is aware that subsequent breast cancer in the irradiated breast will
probably mandate mastectomy.
9. The patient consent for contralateral prophylactic irradiation. -
Exclusion Criteria:
1. Metastatic breast cancer.
2. Previous irradiation of the breast or chest wall.
3. Pregnancy.
4. No concurrent chemotherapy is allowed
5. Patients with active connective tissue diseases are excluded due to the potential risk
of significant radiotherapy toxicity.
6. Patients who are unable to lie on their back and raise their arms above their heads in
the treatment planning position for radiotherapy are excluded -
| Maximum Eligible Age: | 90 Years |
| Minimum Eligible Age: | 30 Years |
| Eligible Gender: | Female |
| Healthy Volunteers: | No |
Primary Outcome Measures
| Measure: | Rate of contralateral breast cancer in carrier patients that received prophylactic radiation to the contralateral breast compared with carrier patients that did not receive that treatment. |
| Time Frame: | 15 years |
| Safety Issue: | |
| Description: | To compare the rate of contralateral breast cancer in carrier patients that received prophylactic radiation to the contralateral breast to the rate in carrier patients that did not receive that treatment |
Secondary Outcome Measures
| Measure: | Short and long term adverse effects of prophylactic contralateral breast irradiation. |
| Time Frame: | 15 years |
| Safety Issue: | |
| Description: | |
| Measure: | factors that influence patient's choice of treatment |
| Time Frame: | 15 years |
| Safety Issue: | |
| Description: | |
Details
| Phase: | Phase 2 |
| Primary Purpose: | Interventional |
| Overall Status: | Recruiting |
| Lead Sponsor: | Assaf-Harofeh Medical Center |
Trial Keywords
- BRCA mutation
- Breast cancer
- Prophylactic breast irradiation
- Prevention of contralateral breast cancer
Last Updated
April 5, 2011
