Intensity Modulated Radiation Therapy or 3-Dimensional Conformal Radiation Therapy in Treating Patients With Lymph-Node Positive Breast Cancer

N/AActive Not RecruitingNCT03786354

Ohio State University Comprehensive Cancer Center61 enrolled

Overview

This phase II trial studies the shoulder morbidity in patients with lymph-node positive breast cancer receiving intensity modulated radiation therapy or 3-dimensional conformal radiation therapy. Intensity modulated radiation therapy may cause less shoulder/arm morbidity in patients with lymph-node positive breast cancer.

PRIMARY OBJECTIVES: I. To determine if intensity modulated radiation therapy (IMRT) reduces average 1-year patient-reported shoulder/arm morbidity in women receiving regional nodal irradiation (RNI) for lymph-node positive breast cancer as compared to historical data. SECONDARY OBJECTIVES: I. To measure patient-reported shoulder/arm morbidity in women receiving RNI with 3-dimensional conformal radiation therapy (3DCRT) for lymph-node positive breast cancer. II. To measure change in shoulder range of motion in women receiving RNI. III. To measures rates of ipsilateral upper extremity lymphedema in women receiving RNI. IV. To explore the dose volume parameters to the shoulder/neck/trunk musculature associated with worsening patient-reported shoulder/arm morbidity. V. To assess disease outcomes in patients treated with IMRT. VI. To measure long-term patient-reported shoulder/arm morbidity in women receiving RNI with IMRT or 3DCRT. OUTLINE: Patients are assigned to 1 of 2 arms. ARM A: Patients undergo IMRT over 5 weeks. ARM B: Patients undergo 3DCRT over 5 weeks. After completion study treatment, patients are followed up at 1, 6, and 12 months, and then annually for up to 5 years.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Eligibility

Sex: FEMALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Pathologically proven diagnosis of breast cancer * Patients that receive neoadjuvant systemic therapy (chemotherapy, anti-HER2 therapy, or endocrine therapy) are eligible * History/physical examination within 60 days prior to study entry * Patients who have undergone either a lumpectomy or mastectomy are eligible * Patients that have undergone any type of breast reconstruction are eligible * The interval between the date of last surgery or chemotherapy and registration must be =\< 84 days * Women of childbearing potential must have a negative urine or serum pregnancy test within 14 days of start of radiation therapy * Women of childbearing potential must be non-pregnant and non-lactating and willing to use medically acceptable form of contraception during radiation therapy * Patients must provide study specific informed consent prior to study entry Exclusion Criteria: * Clinical or radiologic evidence of distant metastases * Patients with known unresected disease in the axillary apex or supraclavicular fossa * Prior invasive or in-situ carcinoma of the breast (prior lobular breast carcinoma in situ \[LCIS\] is eligible) * Prior surgery to the ipsilateral shoulder for any condition * Baseline impaired mobility of the ipsilateral shoulder from a condition not related to the breast cancer surgery as determined by the treating physician * Non-epithelial breast malignancies such as sarcoma/lymphoma * Prior radiotherapy to the breast or prior radiation to the region of the ipsilateral breast that would result in overlap of radiation fields * Medical, psychiatric, or other conditions that would prevent the patient from receiving the protocol therapy or providing informed consent * Pregnancy or women of childbearing potential who are sexually active and not willing/able to use medically acceptable forms of contraception * Active systemic lupus, erythematosus, or any history of scleroderma, dermatomyositis with active rash

Outcomes

Primary Outcomes

Shoulder/arm morbidity assessed by Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in patients treated with intensity modulated radiation therapy (IMRT)

DASH questionnaire in patients treated with IMRT to assess shoulder/arm morbidity. Patients that have a DASH score of ≥15 at 1 year post-treatment will be considered as having persistent shoulder morbidity. The full scale range is 0-100.

Time frame: At 1 year

Secondary Outcomes

Shoulder/arm morbidity assessed by DASH questionnaire in patients treated with 3-dimensional conformal radiation therapy (3DCRT)

DASH questionnaire in patients treated with 3DCRT to assess shoulder/arm morbidity. Patients that have a DASH score of ≥15 at 1 year post-treatment will be considered as having persistent shoulder morbidity.

Time frame: At 1 year

Changes in shoulder range of motion for flexion, abduction, internal and external rotation using a goniometer as defined by the American Academy of Orthopedic Surgeons

Using a goniometer as defined by the American Academy of Orthopedic Surgeons to measure changes in shoulder range of motion for flexion, abduction, internal and external rotation

Time frame: At baseline, 1 month, 6 months and 12 months post-radiation

Measure rates of upper extremity lymphedema using arm circumference with a tape measure

Measure rates of upper extremity lymphedema using arm circumference using a tape measure

Time frame: At baseline, 1 month, 6 months and 12 months post-radiation

Measure rates of upper extremity lymphedema using a perometer

Measure rates of upper extremity lymphedema using arm circumference using a perometer

Time frame: At baseline, 1 month, 6 months and 12 months post-radiation

Dosimetric parameters associated with worse arm/shoulder morbidity as measured by the DASH

Dosimetric parameters (the volume of shoulder receiving 5-50 Gy) associated with worse arm/shoulder morbidity as measured by the DASH

Time frame: Up to 5 years

Rates of loco-regional control in patients treated with IMRT

Rates of loco-regional control, distant metastases, and overall survival in patients treated with IMRT

Time frame: At 5 years

Distant metastases in patients treated with IMRT

The cumulative incidence of distant metastases at 5 years in patients treated with IMRT control, distant metastases

Time frame: At 5 years

Overall survival in patients treated with IMRT

Kaplan-Meier method will be used to estimate the 5-year overall survival in patients treated with IMRT

Time frame: Up to 5 years

Shoulder/arm morbidity using the DASH questionnaire in patients treated with IMRT

DASH questionnaire in patients treated with IMRT to assess shoulder/arm morbidity using full scale range 0-100

Time frame: Up to 5 years

Shoulder/arm morbidity using the DASH questionnaire in patients treated with 3DCRT

DASH questionnaire in patients treated with 3DCRT to assess shoulder/arm morbidity

Time frame: Up to 5 years

Intensity Modulated Radiation Therapy or 3-Dimensional Conformal Radiation Therapy in Treating Patients With Lymph-Node Positive Breast Cancer

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes