BreastcancerHAI-5-IIINCT03121248
Outcome of 15 Versus 5 Fractions in Adjuvant Breast Radiotherapy in Women Over 65 Years
A study testing WBI 5 fractions, WBI 15 fractions and LNI 5 fractions in people with Breastcancer, run by University Hospital, Ghent at 1 site in Belgium.
Trial summary
This study will evaluate the effect of highly accelerated external beam radiotherapy (EBRT) in 5 fractions over 10 days compared to 15 fractions over 3 weeks for early as well as locally-advanced stage breast cancer. Primary endpoint will be chronic toxicity (breast deformation and retraction). Read more about this study
- Who is it for?
- Ages 65 years and older, women only
- Conditions the study is for
- Breastcancer
- What is being tested?
- WBI 5 fractions, WBI 15 fractions and LNI 5 fractions
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 144 participants
- Where
- 1 siteBelgium
- Study dates
- 15 Feb 2017to 15 Nov 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 65 years and older
- Women only
- No healthy volunteers
- Older adult
Who may be able to join
- breast conserving surgery or mastectomy for breast carcinoma
- multidisciplinary decision of adjuvant irradiation
- absence of distant metastases
- informed consent obtained, signed and dated before specific protocol procedures
Who cannot join
- History of previous radiation treatment to the same region
- Bilateral breast irradiation
- Life expectancy of less than 2 years
- Planned reconstructive breast surgery
- Condition making toxicity evaluation difficult, e.g. skin disorders, pre-existing brachial plexus injury, …
- Inability to respect constraints on skin, heart, lungs, esophagus, ribs, brachial plexus or any other organ at risk
- Mental condition rendering the patient unable to understand the nature, scope and possible consequences of the study
- Patient unlikely to comply with the protocol; i.e. uncooperative attitude, inability to return for follow-up visits or unlikely to complete the study
Trial locations and contacts
1 site in 1 country.
Belgium1 site
Ghent University Hospital, Dept. Radiotherapy-Oncology
Ghent, 9000
About this study
Official title: A Partially Randomized Patient Preference Trial, Comparing Adjuvant Hypofractionated Radiotherapy in 15 Versus 5 Fractions After Breast Conserving Surgery or Mastectomy for Early or Locally Advanced Breast Cancer in Women Above 65 Years
This study will evaluate the effect of highly accelerated external beam radiotherapy (EBRT) in 5 fractions over 10 days compared to 15 fractions over 3 weeks for early as well as locally-advanced stage breast cancer.
Primary endpoint will be chronic toxicity (breast deformation and retraction). Secondary endpoints are acute toxicity, loco-regional and distant tumor control, patient reported QoL and cosmetic satisfaction. Patients with lymph node irradiation will be closely monitored for radiation induced plexopathy.
Read the detailed description
Over the age of 65, uptake of adjuvant radiotherapy after surgery for breast cancer declines, even in women with poor prognostic stage or adverse tumor characteristics.
Lowering the number of fractions may reduce reluctancy for radiotherapy in this age group.
In a preceding prospective phase I-II trial, evaluating EBRT over 10 days, results on technical feasibility and acute toxicity were positively evaluated.
However, data on the chronic effects of breast irradiation using high doses per fraction are still sparse.
This trial is developed to compare standard hypo-fractionation in 15 fractions (if needed with simultaneously integrated boost - SIB) with highly accelerated radiotherapy in 5 fractions.
Patients referred for adjuvant radiotherapy after breast conserving surgery will preferably be randomized, depending on the indication, to a study-arm with whole breast irradiation (WBI) +/- SIB or to a study-arm with WBI+/- SIB and lymph node irradiation (LNI).
If patients after breast conserving surgery (BCS) have a strong preference for 5 or 15 fractions, they will be invited to enter the parallel observational arm (patient preference).
Patients referred for adjuvant radiotherapy after mastectomy +/- LNI accepting to participate, can choose a 5 or 15-fraction schedule. No randomization is foreseen in this last observational group.
- Conditions
- Breastcancer
- Being tested
- WBI 5 fractions, WBI 15 fractions, LNI 5 fractions, LNI 15 fractions, SIB 5 fractions if needed
- Keywords
- Accelerated radiotherapy, Older women, Hypo-fractonation
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
WBI 5 fractionsRadiation
External beam radiotherapy in 5 fractions of 5,7Gy
WBI 15 fractionsRadiation
External beam radiotherapy in 15 fractions of 2,67Gy
LNI 5 fractionsRadiation
External beam radiotherapy in 5 fractions of 5,4Gy
LNI 15 fractionsRadiation
External beam radiotherapy in 15 fractions of 2,67Gy
SIB 5 fractions if neededRadiation
Simultaneous boost of 5 x 6,2Gy (6,5Gy in case of involved resection margins) if needed
SIB 15 fractions if neededRadiation
Simultaneous boost of 15x3,12Gy (3,33Gy in case of involved resection margins) if needed
TWI 5 fractionsRadiation
External beam radiotherapy in 5 fractions of 5,7Gy
TWI 15 fractionsRadiation
External beam radiotherapy in 15 fractions of 2,67Gy
| Study group | Role | What they receive |
|---|---|---|
| WBI - randomized - 5 | Experimental | WBI 5 fractions SIB 5 fractions if needed Receives: Radiation: WBI 5 fractions; Radiation: SIB 5 fractions if needed |
| WBI - randomized - 15 | Active comparator | WBI 15 fractions SIB 15 fractions if needed Receives: Radiation: WBI 15 fractions; Radiation: SIB 15 fractions if needed |
| WBI - observational - 5 | Experimental | WBI 5 fractions SIB 5 fractions if needed Receives: Radiation: WBI 5 fractions; Radiation: SIB 5 fractions if needed |
| WBI - observational - 15 | Active comparator | WBI 15 fractions SIB 15 fractions if needed Receives: Radiation: WBI 15 fractions; Radiation: SIB 15 fractions if needed |
| WBI + LNI - randomized - 5 | Experimental | WBI 5 fractions SIB 5 fractions if needed LNI 5 fractions Receives: Radiation: WBI 5 fractions; Radiation: LNI 5 fractions; Radiation: SIB 5 fractions if needed |
| WBI + LNI - randomized - 15 | Active comparator | WBI 15 fractions SIB 15 fractions if needed LNI 15 fractions Receives: Radiation: WBI 15 fractions; Radiation: LNI 15 fractions; Radiation: SIB 15 fractions if needed |
| WBI with LNI - observational - 5 | Experimental | WBI 5 fractions SIB 5 fractions if needed LNI 5 fractions Receives: Radiation: WBI 5 fractions; Radiation: LNI 5 fractions; Radiation: SIB 5 fractions if needed |
| WBI with LNI - observational - 15 | Active comparator | WBI 15 fractions SIB 15 fractions if needed LNI 15 fractions Receives: Radiation: WBI 15 fractions; Radiation: LNI 15 fractions; Radiation: SIB 15 fractions if needed |
| thoracic wall irradiation (TWI) +/- LNI - observational - 5 | Experimental | TWI 5 fractions SIB 5 fractions if needed LNI 5 fractions Receives: Radiation: LNI 5 fractions; Radiation: TWI 5 fractions |
| TWI +/- LNI - observational - 15 | Active comparator | TWI 15 fractions SIB 15 fractions if needed LNI 15 fractions Receives: Radiation: LNI 15 fractions; Radiation: TWI 15 fractions |
What is being measured
The primary outcome is the main question the study is designed to answer.
Breast retraction (LENTSOMA)
Breast Cancer Conservative treatment.core (BCCT.core) objective measurement
Measured: 2-5 years
Secondary outcomes (16)
Acute toxicity: number of patients with clinical relevant dermatitis (CTCAE v. 4.0)
Assessment of grade of dermatitis
Measured: 1-8 weeks
Acute toxicity: number of patients with moist desquamation
CTCAE v. 4.0 (grade 3)
Measured: 1-8 weeks
Acute toxicity: number of patients with pain (CTCAE v. 4.0)
Grade 1: mild; Grade 2: moderate, limiting activity of daily living (ADL); grade 3: severe, limiting ADL
Measured: 1-8 weeks
Acute toxicity: number of patients with pruritus (CTCAE v. 4.0)
Grade 1: mild, localized topical intervention; Grade 2: intense, oral intervention, skin changes
Measured: 1-8 weeks
Acute toxicity: number of patients with fatigue (MFI-20)
Questionnaire (20 questions)
Measured: 1-8 weeks
Chronic toxicity: measurement of patient satisfaction with breast esthetic outcome
BREAST-Q questionnaire: Patient reported outcome, evaluating satisfaction with esthetic outcome.
Measured: Before radiotherapy and after 2 and 5 years
Chronic toxicity: prevalence of fibrosis
LENT Soma: fibrosis (score 0-3)
Measured: 2 and 5 years
Chronic toxicity: prevalence of pain
LENT Soma: score 0-4
Measured: 2 and 5 years
Chronic toxicity: prevalence of telangiectasia
LENT Soma: Score 0-3
Measured: 2 and 5 years
Chronic toxicity: prevalence of lymphedema
LENT Soma: score 0-4
Measured: 2 and 5 years
Chronic toxicity: prevalence of fatigue (MFI-20)
Questionnaire (20 questions)
Measured: 2 and 5 years
Chronic toxicity - prevalence of radiation induced brachial plexopathy (RIBP) (standardized screening questionnaire), confirmed by electromyogram (EMG)
If a screening reveals unilateral pain, loss of function or muscular atrophy in the ipsilateral arm, an EMG will be performed to confirm/exclude RIBP
Measured: 2 and 5 years
Loco-regional tumor control
Ipsilateral or regional breast recurrence
Measured: 2 and 5 years
Distant tumor control
Distant metastases free survival
Measured: 2 and 5 years
Breast cancer specific survival
Number of patients alive and without breast cancer recurrence at 2 and 5 years after adjuvant radiotherapy
Measured: 2 and 5 years
Overall survival
Number of patients alive, 2 and 5 years after adjuvant radiotherapy
Measured: 2 and 5 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted20 Apr 2017
- Study start15 Feb 2017
- Primary completion15 Nov 2021
- Study completion15 Nov 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for BreastcancerStudies of the same condition, open and under way.
- More trials run by University Hospital, GhentThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 144 participants (actual)
Sponsor and investigators
- Lead sponsor
- University Hospital, Ghent
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Liv Veldeman, M.D., PhD, Principal investigator, Ghent University Hospital, Dept. Radiotherapy-Oncology
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03121248
- Sponsor's protocol ID
- EC/2016/1386
- Acronym
- HAI-5-III
- Status last verified
- Dec 2023
- First submitted
- 13 Jan 2017
- Last updated
- 22 Dec 2023
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 22 Dec 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Partially Randomized Patient Preference Trial, Comparing Adjuvant Hypofractionated Radiotherapy in 15 Versus 5 Fractions After Breast Conserving Surgery or Mastectomy for Early or Locally Advanced Breast Cancer in Women Above 65 Years
- ClinicalTrials.gov ID
- NCT03121248
- Acronym / sponsor ID
- HAI-5-III / EC/2016/1386
- Conditions
- Breastcancer
- Keywords
- Accelerated radiotherapy, Older women, Hypo-fractonation
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 144 participants (actual)
- Lead sponsor
- University Hospital, GhentUniversity, hospital or other
- Study start
- 15 Feb 2017 (actual)
- Primary completion
- 15 Nov 2021 (actual)
- Study completion
- 15 Nov 2026 (estimated)
- First posted
- 20 Apr 2017 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study will evaluate the effect of highly accelerated external beam radiotherapy (EBRT) in 5 fractions over 10 days compared to 15 fractions over 3 weeks for early as well as locally-advanced stage breast cancer.
Primary endpoint will be chronic toxicity (breast deformation and retraction). Secondary endpoints are acute toxicity, loco-regional and distant tumor control, patient reported QoL and cosmetic satisfaction. Patients with lymph node irradiation will be closely monitored for radiation induced plexopathy.
Detailed description
Over the age of 65, uptake of adjuvant radiotherapy after surgery for breast cancer declines, even in women with poor prognostic stage or adverse tumor characteristics.
Lowering the number of fractions may reduce reluctancy for radiotherapy in this age group.
In a preceding prospective phase I-II trial, evaluating EBRT over 10 days, results on technical feasibility and acute toxicity were positively evaluated.
However, data on the chronic effects of breast irradiation using high doses per fraction are still sparse.
This trial is developed to compare standard hypo-fractionation in 15 fractions (if needed with simultaneously integrated boost - SIB) with highly accelerated radiotherapy in 5 fractions.
Patients referred for adjuvant radiotherapy after breast conserving surgery will preferably be randomized, depending on the indication, to a study-arm with whole breast irradiation (WBI) +/- SIB or to a study-arm with WBI+/- SIB and lymph node irradiation (LNI).
If patients after breast conserving surgery (BCS) have a strong preference for 5 or 15 fractions, they will be invited to enter the parallel observational arm (patient preference).
Patients referred for adjuvant radiotherapy after mastectomy +/- LNI accepting to participate, can choose a 5 or 15-fraction schedule. No randomization is foreseen in this last observational group.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 10
| Arm | Type | Receives |
|---|---|---|
| WBI - randomized - 5 | Experimental | Radiation: WBI 5 fractions, Radiation: SIB 5 fractions if neededWBI 5 fractions SIB 5 fractions if needed |
| WBI - randomized - 15 | Active comparator | Radiation: WBI 15 fractions, Radiation: SIB 15 fractions if neededWBI 15 fractions SIB 15 fractions if needed |
| WBI - observational - 5 | Experimental | Radiation: WBI 5 fractions, Radiation: SIB 5 fractions if neededWBI 5 fractions SIB 5 fractions if needed |
| WBI - observational - 15 | Active comparator | Radiation: WBI 15 fractions, Radiation: SIB 15 fractions if neededWBI 15 fractions SIB 15 fractions if needed |
| WBI + LNI - randomized - 5 | Experimental | Radiation: WBI 5 fractions, Radiation: LNI 5 fractions, Radiation: SIB 5 fractions if neededWBI 5 fractions SIB 5 fractions if needed LNI 5 fractions |
| WBI + LNI - randomized - 15 | Active comparator | Radiation: WBI 15 fractions, Radiation: LNI 15 fractions, Radiation: SIB 15 fractions if neededWBI 15 fractions SIB 15 fractions if needed LNI 15 fractions |
| WBI with LNI - observational - 5 | Experimental | Radiation: WBI 5 fractions, Radiation: LNI 5 fractions, Radiation: SIB 5 fractions if neededWBI 5 fractions SIB 5 fractions if needed LNI 5 fractions |
| WBI with LNI - observational - 15 | Active comparator | Radiation: WBI 15 fractions, Radiation: LNI 15 fractions, Radiation: SIB 15 fractions if neededWBI 15 fractions SIB 15 fractions if needed LNI 15 fractions |
| thoracic wall irradiation (TWI) +/- LNI - observational - 5 | Experimental | Radiation: LNI 5 fractions, Radiation: TWI 5 fractionsTWI 5 fractions SIB 5 fractions if needed LNI 5 fractions |
| TWI +/- LNI - observational - 15 | Active comparator | Radiation: LNI 15 fractions, Radiation: TWI 15 fractionsTWI 15 fractions SIB 15 fractions if needed LNI 15 fractions |
Who may qualify
- Ages
- 65 years and older
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Older adult
Key inclusion criteria (4 listed)
- breast conserving surgery or mastectomy for breast carcinoma
- multidisciplinary decision of adjuvant irradiation
- absence of distant metastases
- informed consent obtained, signed and dated before specific protocol procedures
Key exclusion criteria (8 listed)
- History of previous radiation treatment to the same region
- Bilateral breast irradiation
- Life expectancy of less than 2 years
- Planned reconstructive breast surgery
- Condition making toxicity evaluation difficult, e.g. skin disorders, pre-existing brachial plexus injury, …
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| WBI 5 fractionsExternal beam radiotherapy in 5 fractions of 5,7Gy | Radiation | WBI + LNI - randomized - 5, WBI - observational - 5, WBI - randomized - 5, WBI with LNI - observational - 5 |
| WBI 15 fractionsExternal beam radiotherapy in 15 fractions of 2,67Gy | Radiation | WBI + LNI - randomized - 15, WBI - observational - 15, WBI - randomized - 15, WBI with LNI - observational - 15 |
| LNI 5 fractionsExternal beam radiotherapy in 5 fractions of 5,4Gy | Radiation | WBI + LNI - randomized - 5, WBI with LNI - observational - 5, thoracic wall irradiation (TWI) +/- LNI - observational - 5 |
| LNI 15 fractionsExternal beam radiotherapy in 15 fractions of 2,67Gy | Radiation | TWI +/- LNI - observational - 15, WBI + LNI - randomized - 15, WBI with LNI - observational - 15 |
| SIB 5 fractions if neededSimultaneous boost of 5 x 6,2Gy (6,5Gy in case of involved resection margins) if needed | Radiation | WBI + LNI - randomized - 5, WBI - observational - 5, WBI - randomized - 5, WBI with LNI - observational - 5 |
| SIB 15 fractions if neededSimultaneous boost of 15x3,12Gy (3,33Gy in case of involved resection margins) if needed | Radiation | WBI + LNI - randomized - 15, WBI - observational - 15, WBI - randomized - 15, WBI with LNI - observational - 15 |
| TWI 5 fractionsExternal beam radiotherapy in 5 fractions of 5,7Gy | Radiation | thoracic wall irradiation (TWI) +/- LNI - observational - 5 |
| TWI 15 fractionsExternal beam radiotherapy in 15 fractions of 2,67Gy | Radiation | TWI +/- LNI - observational - 15 |
Primary outcome
Breast retraction (LENTSOMA)
Time frame: 2-5 years
Breast Cancer Conservative treatment.core (BCCT.core) objective measurement
16 secondary outcomes
Acute toxicity: number of patients with clinical relevant dermatitis (CTCAE v. 4.0)
Time frame: 1-8 weeks
Acute toxicity: number of patients with moist desquamation
Time frame: 1-8 weeks
Acute toxicity: number of patients with pain (CTCAE v. 4.0)
Time frame: 1-8 weeks
Acute toxicity: number of patients with pruritus (CTCAE v. 4.0)
Time frame: 1-8 weeks
Acute toxicity: number of patients with fatigue (MFI-20)
Time frame: 1-8 weeks
Chronic toxicity: measurement of patient satisfaction with breast esthetic outcome
Time frame: Before radiotherapy and after 2 and 5 years
Chronic toxicity: prevalence of fibrosis
Time frame: 2 and 5 years
Chronic toxicity: prevalence of pain
Time frame: 2 and 5 years
Chronic toxicity: prevalence of telangiectasia
Time frame: 2 and 5 years
Chronic toxicity: prevalence of lymphedema
Time frame: 2 and 5 years
Chronic toxicity: prevalence of fatigue (MFI-20)
Time frame: 2 and 5 years
Chronic toxicity - prevalence of radiation induced brachial plexopathy (RIBP) (standardized screening questionnaire), confirmed by electromyogram (EMG)
Time frame: 2 and 5 years
Loco-regional tumor control
Time frame: 2 and 5 years
Distant tumor control
Time frame: 2 and 5 years
Breast cancer specific survival
Time frame: 2 and 5 years
Overall survival
Time frame: 2 and 5 years
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 22 Dec 2023.
- HAI-5 feasilibility trial: results acute toxicityLink provided by the sponsor.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Liv Veldeman, M.D., PhD principal investigator
Ghent University Hospital, Dept. Radiotherapy-Oncology
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing WBI 5 fractions, WBI 15 fractions and LNI 5 fractions in people with Breastcancer, run by University Hospital, Ghent at 1 site in Belgium.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 22 Dec 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Belgium. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Breast retraction (LENTSOMA) (time frame: 2-5 years). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Dec 2023.