CARA Treatment Pilot Study for Breast Positioning

British Columbia Cancer Agency20 enrolled

Overview

CARA is a novel Carbon-fibre Adjustable and Re-usable Accessory for supine breast positioning during radiation therapy. CARA was developed at BC Cancer. In this study, twenty patients will be planned and treated with CARA positioning to establish safety and workflow measures of this novel device. The device is designed to remove the infra-mammary skin fold and lateral breast droop which can lead to unwanted dose to normal tissue.

This pilot study will investigate the safety and potential benefits of CARA breast positioning by treating 20 patients using the device. Patients will be planned with CARA positioning and standard of care positioning. CARA plans will be evaluated to ensure all treatment planning goals are met and patients will proceed to treatment with CARA positioning. This pilot study will ensure that patients can be safely treated with the CARA and provide us with valuable information from therapists, oncologists and patients about the performance of the current design. This will also inform the direction of design improvements and the production of educational materials for training practitioners in the use of the device. Overall, this will prepare us for a randomized clinical trial of the CARA positioning technique versus current standard of practice to assess whether reduced toxicity can be achieved using the CARA technique.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Breast Cancer Side Effect

Interventions

CARA - carbon fibre adjustable re-usable accessory for breast positioningDEVICE

Breast positioning to alleviate infra-mammary fold and lateral breast sag

Eligibility

Sex: ALLMin age: 19 Years

Medical Language ↔ Plain English

Inclusion Criteria: Patients diagnosed with completely excised stage I or II invasive breast cancer, or ductal carcinoma in situ (DCIS), who have undergone breast-conserving surgery and are scheduled to undergo adjuvant breast radiotherapy; Any breast size with a skin fold of depth 1 cm or greater at the infra-mammary crease at the time of radiation treatment planning, or brassiere cup size equal to or larger than D; Patients undergoing nodal radiotherapy are eligible if the above criteria are met; Patients undergoing boost radiotherapy are eligible if the above criteria are met, but only if the surgical scar does not extend inferior to the nipple line of the breast; Language is not a barrier if there are interpreters/family members to translate; Patients having had chemotherapy are eligible for this study; Exclusion Criteria: Inability to give informed consent or comply with requirements of the trial; Failure of healing of the surgical scar or significant post-operative wound infection; Prior radiotherapy to either breast or to the chest; Presence of significant connective tissue disease (e.g. systemic sclerosis); known radiation hypersensitivity phenotype (e.g. ataxia telangiectasia); Inability to return for assessment at both one week and two weeks following completion of radiotherapy; Breast reconstruction; Use of Mepitel® wound dressing product.

Locations (1)

BC Cancer

Vancouver, British Columbia, Canada

Outcomes

Primary Outcomes

Number of participants for whom dose volume treatment planning constraints are not met using CARA support for breast setup

Treatment planning dose constraints are: \>=95% of the prescribed dose covering \>=98% of the breast target tissue, including internal mammary chain when requested by the treating oncologist volume of ipsi-lateral lung receiving \>= 20Gy should be \<=35% volume of heart receiving \>=25Gy should be \<=5% maximum dose to any point in the body \<=110% of the prescribed dose volume of breast receiving \>=107% of prescribed dose should be \<=22 cm\^3

Time frame: 12 months

Number of participants having measured breast skin dose => 110% of the prescribed dose to an area of skin => 1 cm^2

Skin dose is measured on the breast surface under the carbon fibre device using radio-chromic film. The area of skin receiving 70% of the prescribed dose up to the maximum absorbed dose is measured in 5% dose increments to an accuracy of 0.5 cm\^2. If any participant receives =\> 110% of the prescribed dose to \>=1 cm\^2 area of skin, the study will be stopped.

Time frame: 12 months

Number of participants scoring =>6 on the CTCAE Version 4.0 skin assessment

Participants will undergo a detailed breast skin assessment at baseline, one week prior to RT completion, last week of RT, and one and two weeks post RT using the CTCAE Version 4 skin assessment scoring system as well as examination of the infra-mammary fold for any moist desquamation. The dimensions and location of moist desquamation will be recorded. In the event that a skin reaction of ≥ 6 (indicating ulceration, hemorrhage or necrosis) on the CTCAE V 4.0 scale is reported, the trial will be stopped.

Time frame: 12 months

Secondary Outcomes

Workflow measures

Measured time to accomplish set up and treatment with CARA positioning

Time frame: 12 months

Setup reproducability

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.