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Brief Title: Safety and Efficacy Study of the Xoft® Axxent® eBx® IORT System®
Official Title: A Safety and Efficacy Study of Intra-Operative Radiation Therapy (IORT) Using the Xoft® Axxent® eBx® System® at the Time of Breast Conservation Surgery for Early Stage Breast Cancer
Study ID: NCT01644669
Brief Summary: The purpose of this trial is to assess the safety and efficacy of the Xoft Axxent eBx System when used for single-fraction IORT in early stage breast cancer. Hypothesis: IORT using the Xoft Axxent eBx System is no worse (non-inferior) than whole breast irradiation (WBI) when used as stand-alone radiation treatment in breast conserving therapy in women with early stage breast cancer.
Detailed Description: The rationale for IORT as the sole radiation therapy is: Favorable preliminary results in feasibility, safety and efficacy outcomes: Accelerated Partial Breast Irradiation (APBI) is an accepted alternative to whole breast irradiation following breast-conserving surgery for early stage breast cancer. Intra-Operative Radiation Therapy (IORT) is a form of APBI that allows radiation to be delivered directly to the open tumor bed following Breast Conservation Surgery (BCS). After 4 years of follow-up, IORT has shown equivalent disease control rates as whole breast irradiation. Direct and timely radiation to the tumor bed: Radiation is delivered at to the target tissue (adjacent to the resection margins at the time of lumpectomy). It avoids treatment delays and eliminates weeks or months of post-surgical radiation therapy during which residual cancer cells might proliferate. An in vitro study showed that un-irradiated wound fluid stimulated the growth of breast cancer cells while irradiated wound fluid did not. Each month of delay in radiation treatment is associated with a 1% increase in the recurrence rate. Huang, et al., found a 5.8% recurrence rate in patients who received WBRT within 8 weeks of BCS compared with a 9.1% recurrence rate in patients who started radiotherapy 9-16 weeks after BCS. Increased patient treatment compliance compared to conventional radiation therapy: Suitable early stage breast cancer patients are able to complete their breast cancer radiotherapy treatment at the time of BCS, which offers a convenient and potentially life-saving benefit to patients who might otherwise omit radiation therapy if it required lengthy travel or time commitments. In addition, healthcare resources, including both personnel and facilities, will be conserved by eliminating the overhead cost of multiple patient visits, eliminating waiting time for patients, and consolidating therapy to one visit combined with the surgical procedure. Available Technology: The Xoft Axxent controller, x-ray source, and balloon applicator are cleared by the United States Food and Drug Administration (FDA) to deliver brachytherapy treatments using high dose rate x-ray radiation. The Xoft Axxent System has been used to treat breast cancer subjects using a multi-fraction APBI technique on an outpatient basis as part of two multi-center studies. The Xoft Axxent System enables the Radiation Oncologist to administer electronic brachytherapy without the use of a radioactive isotope in minimally shielded rooms. Characteristics of the Xoft System that make it well-suited for IORT include its portability and low energy photons, allowing for minimal shielding during the radiation therapy. This protocol has been developed to further study the use of the Xoft Axxent eBx System in the delivery of IORT for subjects with early-stage breast cancer. The Xoft Axxent eBx System will be used according to the United States Food and Drug Administration (FDA) 510(k) cleared labeling; therefore, the use of the technology in this study is considered on-label and within the scope of the FDA cleared indication.
Minimum Age: 40 Years
Eligible Ages: ADULT, OLDER_ADULT
Sex: FEMALE
Healthy Volunteers: No
University of Arizona, Tucson, Arizona, United States
City of Hope, Duarte, California, United States
Long Beach Memorial Medical Center, Long Beach, California, United States
UCLA, Los Angeles, California, United States
Tri-City Medical Center, Oceanside, California, United States
Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, California, United States
Western Surgical Care, PC, Denver, Colorado, United States
Swedish Medical Center, Englewood, Colorado, United States
Florida Hospital Celebration Health, Celebration, Florida, United States
Doctors Hospital, Coral Gables, Florida, United States
Martin Health System Center for Clinical Research, Stuart, Florida, United States
Rush University, Chicago, Illinois, United States
Lutheran Hospital of Indiana, Fort Wayne, Indiana, United States
Greater Baltimore Medical Center, Baltimore, Maryland, United States
MedStar Oncology Network - Good Samaritan Hospital, Baltimore, Maryland, United States
MedStar Oncology Network - Franklin Square, Baltimore, Maryland, United States
Exeter Hospital, Exeter, New Hampshire, United States
Staten Island University Hospital, Staten Island, New York, United States
University of Oklahoma, Oklahoma City, Oklahoma, United States
Parkridge Medical Center, Chattanooga, Tennessee, United States
Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, United States
Sentara Northern Virginia Medical Center, Woodbridge, Virginia, United States
Monash Health / Peter MacCallum Cancer Centre, Clayton, Victoria, Australia
Hospital CUF Porto, Porto, , Portugal
Name: A.M. Nisar Syed, MD
Affiliation: Long Beach Memorial Medical Center
Role: PRINCIPAL_INVESTIGATOR