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II期单剂量与超分割照射用于及时获得部分乳腺放疗(SHIFT-PB)

Phase II single vs hypofractionated irradiation for timely access to partial breast radiotherapy (SHIFT-PB).

作者信息

Olson Robert, Cua Marjorie, Matthews Quinn, Laing Jordanna, Narinesingh Dylan, Nichol Alan, Berrang Tanya, Koulis Theodora, Karan Tania, Chng Nick

机构信息

University of British Columbia, Vancouver, Canada.

University of Northern British Columbia, Prince George, Canada.

出版信息

BMC Cancer. 2025 Aug 8;25(1):1285. doi: 10.1186/s12885-025-14720-w.


DOI:10.1186/s12885-025-14720-w
PMID:40781619
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12333179/
Abstract

BACKGROUND: Breast cancer is the leading cause of global cancer incidence. In early-stage disease, standard treatment with breast-conserving surgery followed by whole breast irradiation (WBI) is associated with excellent outcomes. Multiple studies with extensive follow-up periods have demonstrated the comparative efficacy and toxicity outcomes of partial breast irradiation (PBI) in contrast to WBI. Various dose fractionation schedules for PBI have been recommended in clinical practice guidelines. In British Columbia (BC), a dose of 26 Gy in 5 fractions has been adopted. Early studies on single-fraction (SF) radiation for PBI have investigated its safety and effect on cosmetic outcomes, with promising initial results. In the context of the ongoing health care crisis, single-fraction PBI has the potential to reduce wait times and improve access to radiation. This study will therefore investigate a single-fraction PBI dose of 13 Gy. METHODS: This is a phase II randomized controlled trial, with a primary objective of testing the feasibility of randomizing participants to 1 vs. 5 fractions of PBI for early stage, node negative, breast cancer. The primary endpoint is the ability to accrue 60 participants at 4 of the 6 BC Cancer centres over a 2- year period and to randomize them to 1 vs. 5 fractions of radiotherapy for PBI. Its secondary endpoints are time from CT simulation to partial breast radiotherapy, local control rates, quality of life as measured by Prospective Outcomes and Support Initiative (POSI)-Breast, rates of provider-rated toxicities as measured by Common Terminology Criteria for Adverse Events (CTCAE), rates of participant-reported toxicities as measured by participant reported outcome version of CTCAE (PRO-CTCAE), overall survival, and progression-free survival. DISCUSSION: One of the trial's objectives is testing the feasibility of randomizing participants to single vs. multiple fractions for PBI. If successful, it will lead to a phase III non-inferiority trial with the potential to inform breast cancer treatment guidelines. Ultimately, if found to be non-inferior, a single-fraction PBI can reduce wait times, facilitate access to radiation, and improve patient convenience, particularly for those in rural and remote communities who must travel long distances to receive high-quality cancer care. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT06885671. Date of Registration: 14 March 2025.

摘要

背景:乳腺癌是全球癌症发病率的主要原因。在早期疾病中,保乳手术加全乳照射(WBI)的标准治疗效果良好。多项长期随访研究对比了部分乳腺照射(PBI)与WBI的疗效和毒性结果。临床实践指南推荐了多种PBI剂量分割方案。在不列颠哥伦比亚省(BC),采用了5次分割给予26 Gy的剂量。早期关于PBI单次分割(SF)放疗的研究探讨了其安全性和对美容效果的影响,初步结果令人鼓舞。在当前的医疗保健危机背景下,单次分割PBI有可能减少等待时间并改善放疗可及性。因此,本研究将探讨13 Gy的单次分割PBI剂量。 方法:这是一项II期随机对照试验,主要目的是测试将早期、淋巴结阴性乳腺癌患者随机分为PBI 1次分割与5次分割的可行性。主要终点是在2年内在BC癌症中心的6个中心中的4个中心招募60名参与者,并将他们随机分为PBI放疗的1次分割与5次分割。次要终点包括从CT模拟到部分乳腺放疗的时间、局部控制率、通过前瞻性结局与支持倡议(POSI)-乳腺测量的生活质量、通过不良事件通用术语标准(CTCAE)测量的医生评定毒性发生率、通过CTCAE参与者报告结局版本(PRO-CTCAE)测量的参与者报告毒性发生率、总生存期和无进展生存期。 讨论:该试验的目标之一是测试将参与者随机分为PBI单次分割与多次分割的可行性。如果成功,将开展III期非劣效性试验,有可能为乳腺癌治疗指南提供依据。最终,如果发现单次分割PBI非劣效,它可以减少等待时间,便于接受放疗,并提高患者便利性,特别是对于那些必须长途跋涉才能获得高质量癌症治疗的农村和偏远社区患者。 试验注册:Clinicaltrials.gov标识符:NCT06885671。注册日期:2025年3月14日。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25b3/12333179/2f497bcb98b5/12885_2025_14720_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25b3/12333179/2f497bcb98b5/12885_2025_14720_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/25b3/12333179/2f497bcb98b5/12885_2025_14720_Fig1_HTML.jpg

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[1]
Phase II single vs hypofractionated irradiation for timely access to partial breast radiotherapy (SHIFT-PB).

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[2]
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[9]
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本文引用的文献

[1]
Partial Breast Irradiation for Patients With Early-Stage Invasive Breast Cancer or Ductal Carcinoma In Situ: An ASTRO Clinical Practice Guideline.

Pract Radiat Oncol. 2024

[2]
Novel Form of Breast Intraoperative Radiation Therapy with CT-Guided High-Dose-Rate Brachytherapy: Interim Results of a Prospective Phase-II Clinical Trial.

J Am Coll Surg. 2024-1-1

[3]
Partial Breast Irradiation Versus Whole Breast Irradiation for Early Breast Cancer Patients in a Randomized Phase III Trial: The Danish Breast Cancer Group Partial Breast Irradiation Trial.

J Clin Oncol. 2022-12-20

[4]
From 25 Fractions to Five: How Hypofractionation has Revolutionised Adjuvant Breast Radiotherapy.

Clin Oncol (R Coll Radiol). 2022-5

[5]
Preliminary Results of Multi-Institutional Phase 1 Dose Escalation Trial Using Single-Fraction Stereotactic Partial Breast Irradiation for Early Stage Breast Cancer.

Int J Radiat Oncol Biol Phys. 2022-3-1

[6]
Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.

CA Cancer J Clin. 2021-5

[7]
Accelerated Partial-Breast Irradiation Compared With Whole-Breast Irradiation for Early Breast Cancer: Long-Term Results of the Randomized Phase III APBI-IMRT-Florence Trial.

J Clin Oncol. 2020-12-10

[8]
Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial.

Lancet. 2020-4-28

[9]
Single-Institution Phase 1/2 Prospective Clinical Trial of Single-Fraction, High-Gradient Adjuvant Partial-Breast Irradiation for Hormone Sensitive Stage 0-I Breast Cancer.

Int J Radiat Oncol Biol Phys. 2020-6-1

[10]
External beam accelerated partial breast irradiation versus whole breast irradiation after breast conserving surgery in women with ductal carcinoma in situ and node-negative breast cancer (RAPID): a randomised controlled trial.

Lancet. 2019-12-5

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