An explanatory study comparing complementary treatment to breast conservative surgery with radiation therapy DCIS, T1-T2 N0 M0 (AJCC v8) 1 week schedule vs 3.1 weeks standard schedule, in order to determine the equivalence of local tumor control, survival, acute and chronic toxicity. Shorter curse of radiation therapy may lead to similar local control of tumor cells and lower rates of toxicity than 3.1 standard treatment.
PRIMARY OBJECTIVE: I. Compare the effectiveness of hypofractionated radiotherapy (1 week) with standard treatment (3.1 weeks) in the local control of breast cancer treated with conservative surgery. SECONDARY OBJECTIVES: I. Identify the histological lineage of the tumor. II. Identify the degree of differentiation of tumor cells. III. Identify the presence and type of receptors (estrogen, progesterone, HER-2NEU) through immunohistochemistry. IV. Measure the frequency of progression or recurrence. V. Identify the site of progression or recurrence. VI. Measure the frequency of toxicity in both groups. VII. Classify toxicity according to its severity. VIII. Classify toxicity according to chronological presentation, acute, subacute, or chronic. IX. Measure quality of life in both groups according to the European Organization for Research and Treatment Cancer scale, Breast Cancer-Specific Quality of Life Questionnaire, (EORTC, QLQ-BR23). X. Measure quality of life in both groups according to the Eastern Collaborative Oncology Group (ECOG) performance scale. XI. Measure 5-year survival. OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: will receive radiotherapy treatment with high hypofractionation, 26 Gy in 5 fractions to the whole breast. ARM II: will receive radiotherapy treatment with standard hypofractionation, 42.5 Gy in 16 fractions with simultaneous integrated increase of 5.5 Gy to the tumor bed in high-risk patients. After completion of treatments, patients will be followed: 2 weeks after final fraction, 6 weeks after final fraction, every 4 months for the next 5 years
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
72
Ultra hypofractionated 26 Gy in 5 fractions applied once with daily port film.
Unidad Medica de Alta Especialidad
Mérida, Yucatán, Mexico
RECRUITINGIdentify the progression timing.
Quantify the time to progression through follow up in both groups
Time frame: 5 years
Identify the recurrence timing.
Quantify the time to recurrence through follow up in both groups
Time frame: 5 years
Identify the histological lineage of the tumor
Carcinoma InSitu or Invasive Carcinoma; 1. \- Adenocarcinoma 2. \- Other
Time frame: 14 Months
Identify the degree of differentiation of tumor cells
Histologic grade identification using Scarff-Bloom-Richardson (SBR) scale 1. Grade 1: 3-5 points 2. Grade 2: 6-7 points 3. Grade 3: 8-9 points
Time frame: 14 months
Identify the presence and type of receptors (estrogen, progesterone, HER-2NEU) through immunohistochemistry
Number of participants with presence of Luminal A, B, HER-2NEU enriched or triple negative immunohistochemistry subtype. 1. Luminal A: RE (+), RP \>20%, Ki67 \<20% y HER 2 NEU (-) 2. Luminal B: RE (+), RP \<20%, Ki67 \>20% y HER 2 NEU (+/-) 3. HER-2 Enriched: RE (-), RP (-),Ki67 any, HER 2 NEU (+) 4. Triple Negative: RE (-), RP (-), Ki67 any, HER-2 (-)
Time frame: 14 months
Measure the frequency of toxicity in both groups.
Quantify the presence of toxicity categorized by CTCAE version 5 system. 1. Grade 1: characterized by the presence of a mild adverse event that does not require treatment 2. Grade 2: considers a moderate adverse event that may require medical treatment on an outpatient basis 3. Grade 3: is a serious adverse event that should receive medical treatment, and even hospital treatment. 4. Grade 4: is an adverse event with risk of death or disability that requires specialized medical management and hospitalization. 5. Grade 5: considers the presence of death associated with an adverse event.
Time frame: 5 years
Classify toxicity according to its severity.
Quantify toxicity according to its severity categorized by CTCAE version 5 system. 1. Dry skin: A disorder characterized by flaky and dull skin; the pores are generally fine, the texture is a papery thin texture \- Grade 1 to 3 2. Eczema: A disorder characterized by skin which becomes itchy, red, inflamed, crusty, thick, scaly, and/or forms blisters. \- Grade 1 to 3 3. Skin hyperpigmentation: A disorder characterized by darkening of the skin due to excessive melanin deposition. \- Grade 1 to 2 4. Dysphagia: A disorder characterized by difficulty in swallowing. \- Grade 1 to 4 5. Cough: A disorder characterized by sudden, often repetitive, spasmodic contraction of the thoracic cavity, resulting in violent release of air from the lungs and usually accompanied by a distinctive sound. \- Grade 1 to 3 6. Pneumonitis: A disorder characterized by inflammation focally or diffusely affecting the lung parenchyma. * Grade 1 to 5
Time frame: 5 years
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