SBRT for Breast Cancer

(SBRT BREAST Trial)

Overseen By Pushpa Talanki

Age: 18+

Sex: Any

Trial Phase: Phase < 1

Sponsor: Stony Brook University

Disqualifiers: Pregnancy, Breastfeeding, Breast implant, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 4 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

15 Participants Needed

Trial Summary

Do I need to stop my current medications for the SBRT breast cancer trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the study team or your doctor.

What data supports the effectiveness of the treatment Stereotactic Body Radiation Therapy (SBRT) for breast cancer?

Research shows that Stereotactic Body Radiation Therapy (SBRT) is effective in treating early-stage lung cancer by precisely targeting tumors with high doses of radiation, which suggests it may also be beneficial for other cancers like breast cancer. ^{1 2 3 4 5}

Is SBRT generally safe for humans?

SBRT has been used safely in patients with lung cancer and other conditions, showing an excellent safety profile with some known side effects like lung and chest wall issues. However, specific adverse effects like vertebral fractures have been noted in certain cases. ^{6 7 8 9 10}

How is the treatment SBRT for breast cancer different from other treatments?

SBRT (Stereotactic Body Radiation Therapy) for breast cancer is unique because it delivers highly precise radiation doses to the tumor, potentially allowing patients who might not qualify for breast-conserving surgery to receive effective treatment. It is minimally invasive and can be combined with chemotherapy before surgery to determine the maximum safe dose, offering a novel approach compared to traditional radiation therapies. ^{10 11 12 13 14}

What is the purpose of this trial?

This trial is testing a focused radiation treatment for breast cancer patients who don't have surgery. It aims to see if this treatment is safe and effective by giving high doses of radiation in a few sessions. The study will follow patients over several years to monitor results. The treatment is being explored for its effectiveness in delaying the switch to other treatments in breast cancer patients.

Research Team

Alexander M. Stessin

Principal Investigator

Stony Brook Cancer Center

Eligibility Criteria

This trial is for adults with invasive breast cancer that can't be removed by surgery or who aren't good candidates for surgery. Participants must have a life expectancy over 6 months, understand and sign consent, and women of childbearing age must use contraception. It's not for those with breast implants in the affected area, life expectancy under 6 months, inadequate imaging, body habitus issues preventing treatment planning, pregnant or breastfeeding women, or those unable to follow study requirements.

Inclusion Criteria

Patient is to be treated at Stony Brook University Hospital

I am not post-menopausal, have a negative pregnancy test, and agree to use contraception during the study.

My breast cancer is in stages T1 to T4.

Exclusion Criteria

Inability to understand or unwillingness to sign a written consent document

I am not pregnant, breastfeeding, and if able to become pregnant, I am using or willing to use birth control during the study.

I do not have any severe illnesses or social situations that would stop me from following the study's requirements.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Radiation

Participants receive stereotactic body radiation therapy (SBRT) to a dose of 40 Gy over the course of 5 fractions

1-2 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

5 years

Treatment Details

Interventions

• Stereotactic Body Radiation Therapy (SBRT)

Trial Overview The trial tests Stereotactic Body Radiation Therapy (SBRT) as an alternative to surgery for treating breast cancer. Fifteen patients will receive a total radiation dose of 40 Gy in five sessions at Stony Brook University Hospital and will be monitored over five years to assess safety and effectiveness.

Participant Groups

Group I: Active Experimental Treatment 1 Intervention

Stereotactic Body Radiation Therapy (SBRT) is already approved in United States, European Union, Canada, Japan for the following indications:

Approved in United States as Stereotactic Body Radiation Therapy for:

• Prostate cancer
• Lung cancer
• Liver cancer
• Pancreatic cancer
• Spinal tumors

Approved in European Union as Stereotactic Body Radiation Therapy for:

• Prostate cancer
• Lung cancer
• Liver cancer
• Pancreatic cancer
• Spinal tumors

Approved in Canada as Stereotactic Body Radiation Therapy for:

• Prostate cancer
• Lung cancer
• Liver cancer
• Pancreatic cancer
• Spinal tumors

Approved in Japan as Stereotactic Body Radiation Therapy for:

• Prostate cancer
• Lung cancer
• Liver cancer
• Pancreatic cancer
• Spinal tumors

Who Is Running the Clinical Trial?

Stony Brook University

Lead Sponsor

Trials

225

Recruited

41,700+

Findings from Research

In a study of 92 patients with early-stage non-small cell lung cancer (NSCLC) tumors measuring ≥5 cm, stereotactic body radiotherapy (SBRT) demonstrated high local control rates of 95.7% at 1 year and 73.2% at 2 years, indicating its efficacy for larger tumors.

The treatment was found to be safe, with only 1% of patients experiencing grade 3 dermatitis and 4% experiencing grade 3 radiation pneumonitis, suggesting that serious side effects are relatively rare.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multi-institutional experience of stereotactic body radiotherapy for large (≥5 centimeters) non-small cell lung tumors. Verma, V., Shostrom, VK., Kumar, SS., et al.[2018]

Stereotactic body radiotherapy (SBRT) is an effective treatment for patients with stage I non-small cell lung cancer (NSCLC) who cannot undergo surgery, with a median overall survival of 30 months for T1 tumors and 26 months for T2 tumors based on a study of 723 patients.

Higher biological equivalent doses (BED10) of SBRT significantly improve local control rates for T2 tumors, with a local failure rate dropping from 32% to 8% as the BED10 increases from <105 Gy to ≥150 Gy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stereotactic body radiotherapy for early-stage non-small cell lung cancer: clinical outcomes from a National Patient Registry. Davis, JN., Medbery, C., Sharma, S., et al.[2022]

Lung stereotactic body radiation therapy (SBRT) is an effective treatment option for early-stage non-small cell lung cancer (NSCLC) and is increasingly being used for more advanced cases.

The review highlights current treatment recommendations and planning for SBRT, indicating its growing role in managing lung cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lung Stereotactic Body Radiation Therapy. Rehman, S., Roach, MC., Bradley, JD., et al.[2018]

Stereotactic body radiation therapy (SBRT) for early-stage lung cancer showed a high local control rate of 98% at 1 year and 95% at 5 years, indicating its effectiveness in managing tumors non-invasively.

The treatment was well tolerated, with only one severe toxicity (Grade 4 pneumonitis) reported among 28 recorded toxicities, suggesting a favorable safety profile for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Local control and survival after stereotactic body radiation therapy of early-stage lung cancer patients in Slovenia. Stanic, K., But-Hadzic, J., Zagar, J., et al.[2023]

Stereotactic body radiation therapy (SBRT) demonstrated a 3-year overall survival rate of 59.9% for inoperable patients and 76.5% for operable patients with T1N0M0 non-small cell lung cancer, indicating its efficacy as a treatment option.

The treatment was associated with low rates of severe toxicities, with only 10 patients experiencing grade 3 and 2 patients experiencing grade 4 toxicities, suggesting that SBRT is a safe alternative to surgery for early-stage lung cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prospective Trial of Stereotactic Body Radiation Therapy for Both Operable and Inoperable T1N0M0 Non-Small Cell Lung Cancer: Japan Clinical Oncology Group Study JCOG0403. Nagata, Y., Hiraoka, M., Shibata, T., et al.[2022]

In a study of 145 patients with multiple pulmonary metastases treated with stereotactic body radiotherapy (SBRT), the overall survival (OS) was 23.5 months, indicating that SBRT is effective for this condition.

The study found no increase in the risk of early death or severe toxicity (grade 4 or 5) associated with multiple SBRT treatments, suggesting a strong safety profile for this approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stereotactic body radiotherapy (SBRT) for multiple pulmonary oligometastases: Analysis of number and timing of repeat SBRT as impact factors on treatment safety and efficacy. Klement, RJ., Hoerner-Rieber, J., Adebahr, S., et al.[2018]

In a study of 145 patients with early-stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT), the treatment demonstrated a high local control rate with only 24.1% experiencing disease recurrence over a median follow-up of 65.6 months.

SBRT was associated with low toxicity, as only 3.4% of patients experienced grade 3 adverse events, and no patients suffered from severe (grade 4 or 5) toxicities, indicating that it is a safe treatment option for this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Five-year follow-up after stereotactic body radiotherapy for medically inoperable early-stage non-small cell lung cancer: a multicenter study. Guo, Y., Zhu, Y., Zhang, R., et al.[2023]

A 68-year-old woman treated with stereotactic body radiation therapy (SBRT) for lung metastases experienced pathological vertebral fractures ten months post-treatment, highlighting a previously unreported adverse effect of SBRT.

Despite achieving a complete response of the metastatic disease without signs of radiation pneumonitis, the case emphasizes the need for oncologists to consider the risk of bone toxicity, particularly in older patients with potential low bone mineral density (BMD).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pathological vertebral fracture after stereotactic body radiation therapy for lung metastases. Case report and literature review. Rodríguez-Ruiz, ME., San Miguel, I., Gil-Bazo, I., et al.[2022]

In a review of stereotactic body radiotherapy (SBRT) plans from 17 centers, it was found that 29% of patient plans compromised target volume coverage to meet organ-at-risk tolerances, highlighting the need for better plan quality metrics that do not rely solely on target coverage.

The study established that the prescription dose spillage (PDS) and modified gradient index (MGI) metrics provide updated guidance for evaluating SBRT plan quality, with PDS values aligning well with existing clinical trial constraints, while MGI values indicated discrepancies that need addressing for optimal treatment planning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multi-center evaluation of dose conformity in stereotactic body radiotherapy. Lee, J., Dean, C., Patel, R., et al.[2022]

Stereotactic body radiation therapy (SBRT) is a preferred treatment for early-stage non-small cell lung cancer (NSCLC) patients who cannot undergo surgery, but accurate lymph node staging is crucial for optimal patient selection.

Current staging methods like PET/CT and EBUS have limited sensitivity in detecting lymph node metastases, which can lead to undetected cancer spread and poorer outcomes; thus, invasive staging procedures are often necessary to improve detection and potentially enhance survival with adjuvant therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Undetected lymph node metastases in presumed early stage NSCLC SABR patients. Cerra-Franco, A., Diab, K., Lautenschlaeger, T.[2017]

References

1. United States pubmed.ncbi.nlm.nih.gov

SU-E-T-456: Potential Optimization of Stereotactic Body Radation Therapy (SBRT) from a Simple Field Timing Rearrangement. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Multi-institutional experience of stereotactic body radiotherapy for large (≥5 centimeters) non-small cell lung tumors. [2018]

3. Germany pubmed.ncbi.nlm.nih.gov

Stereotactic body radiotherapy for early-stage non-small cell lung cancer: clinical outcomes from a National Patient Registry. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Lung Stereotactic Body Radiation Therapy. [2018]

5. Poland pubmed.ncbi.nlm.nih.gov

Local control and survival after stereotactic body radiation therapy of early-stage lung cancer patients in Slovenia. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

Stereotactic body radiation therapy for patients with lung cancer previously treated with thoracic radiation. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Prospective Trial of Stereotactic Body Radiation Therapy for Both Operable and Inoperable T1N0M0 Non-Small Cell Lung Cancer: Japan Clinical Oncology Group Study JCOG0403. [2022]

8. Ireland pubmed.ncbi.nlm.nih.gov

Stereotactic body radiotherapy (SBRT) for multiple pulmonary oligometastases: Analysis of number and timing of repeat SBRT as impact factors on treatment safety and efficacy. [2018]

9. China pubmed.ncbi.nlm.nih.gov

Five-year follow-up after stereotactic body radiotherapy for medically inoperable early-stage non-small cell lung cancer: a multicenter study. [2023]

10. England pubmed.ncbi.nlm.nih.gov

Pathological vertebral fracture after stereotactic body radiation therapy for lung metastases. Case report and literature review. [2022]

11. Netherlands pubmed.ncbi.nlm.nih.gov

Multi-center evaluation of dose conformity in stereotactic body radiotherapy. [2022]

12. United States pubmed.ncbi.nlm.nih.gov

Phase 1 clinical trial of stereotactic body radiation therapy concomitant with neoadjuvant chemotherapy for breast cancer. [2022]

13. England pubmed.ncbi.nlm.nih.gov

Undetected lymph node metastases in presumed early stage NSCLC SABR patients. [2017]

14. Poland pubmed.ncbi.nlm.nih.gov

The role of SBRT in oligometastatic patients with liver metastases from breast cancer. [2020]