A Prospective Study of Preoperative Tumor-bed Boost Followed by Oncoplastic Surgery and Adjuvant Whole Breast Radiotherapy for Early Stage Breast Cancer (BIRKIN)
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.
Accepts Healthy Volunteers
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|Eligible Ages||N/A - 55 Years|
Inclusion Criteria:1. Patients diagnosed with invasive breast cancer; 2. cN0 based on clinical physical examination combined with at least two imaging tests, or axillary fine-needle biopsy proved pN0; 3. Patients who plan to receive breast-conserving surgery or breast-conserving oncoplastic surgery; 4. No distant metastasis; 5. The primary tumour> 5mm from the skin, without invasion of the ribs or intercostal muscles; 6. No neoadjuvant systemic therapy; 7. Patients who can tolerate MRI; 8. Life expectancy ≥5 years; 9. 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.); 10. Patients are willing to cooperate to follow up; 11. Patients should sign the informed consent; 12. Women of childbearing age need effective contraception.
Exclusion Criteria:1. Concurrent active connective tissue disease; 2. Patients who had radiotherapy to the ipsilateral breast or adjacent areas before; 3. 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)); 4. 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).
This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.
Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans.
Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data.
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The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.
|Cancer Institute and Hospital, Chinese Academy of Medical Sciences|
The person who is responsible for the scientific and technical direction of the entire clinical study.
|Jing Wang, M.D.Shu-lian Wang, M.D.Hao Jing, M.D.Xiang-yi Kong, M.D.|
|Principal Investigator Affiliation||Cancer Institute and Hospital, Chinese Academy of Medical SciencesCancer Institute and Hospital, Chinese Academy of Medical SciencesCancer Institute and Hospital, Chinese Academy of Medical SciencesCancer Institute and Hospital, Chinese Academy of Medical Sciences|
Category of organization(s) involved as sponsor (and collaborator) supporting the trial.
The disease, disorder, syndrome, illness, or injury that is being studied.
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.
Experimental: preoperative tumor-bed boost
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)
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.
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National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
Beijing, Beijing, 100021
Hao Jing, M.D.