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NCT Number: NCT07135661

Ultra-Hypofractionated vs. Moderately Hypofractionated Proton Therapy for Early Breast Cancer After Lumpectomy

Breast-conserving surgery (BCS) followed by whole-breast irradiation (WBI) remains the standard therapeutic approach for early-stage breast cancer. Long-term follow-up data from the FAST trial (10-year analysis) demonstrated that the 28.5 Gy/5-fraction regimen exhibited comparable adverse effects to the conventional 50 Gy/25-fraction regimen, with no statistically significant differences in photographic cosmetic assessments at 2 and 5 years post-treatment. The FAST-Forward trial demonstrated comparable 5-year ipsilateral breast tumor recurrence rates (IBTR) and incidence of radiation-related toxicities between ultra-hypofractionated whole-breast irradiation (UH-WBI; 26 Gy in 5 fractions over 1 week) and moderately hypofractionated whole-breast irradiation (MH-WBI; 40 Gy in 15 fractions over 3 weeks). Additionally, no statistically significant difference in cosmetic outcomes was observed between the two regimens at the 2-year follow-up.

Proton radiotherapy enables precise dose delivery to tumor targets while minimizing radiation exposure to surrounding normal tissues, thereby reducing treatment-related toxicities. However, current clinical protocols predominantly employ conventional fractionation for proton therapy, with a paucity of robust evidence evaluating the efficacy and safety of ultra-hypofractionated proton radiotherapy in breast cancer patients. This prospective randomized controlled trial aims to establish high-level scientific evidence for the clinical application of ultra-hypofractionated proton radiotherapy following BCS, ensuring non-inferiority in oncologic control, toxicity profiles, and cosmetic preservation compared to standard regimens.

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Key information

Conditions

Breast Cancer Breast Diseases Breast Neoplasms Neoplasms Neoplasms by Site Proton Therapy Skin Diseases Skin and Connective Tissue Diseases

Age range

40 year and older

Sex eligibility

Female

Study type

Interventional

Phase

Not applicable

Primary location

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age ≥ 40 years
  • Pathologically (cytologically or histologically) confirmed unilateral primary invasive breast carcinoma
  • Breast conserving surgery + sentinel lymph node biopsy/axillary lymph node dissection, pathological stage pT1-2N0M0，negative margins (≥ 2 mm)
  • No distant metastasis confirmed by CT, MRI, bone scan, and PET/CT
  • No prior radiation therapy to the ipsilateral chest or breast
  • ECOG 0 ~ 2 or KPS ≥ 70

Exclusion criteria

  • Without pathology diagnosis
  • Positive margins or close margins (< 2mm)
  • Lymph nodes or distant metastasis
  • Bilateral breast cancer or patients with a history of contralateral breast cancer
  • Prior radiation therapy to the ipsilateral chest or breast
  • Pregnancy (confirmed by serum or urine β-HCG test) or lactation

Treatment and study plan

moderate hypofractionated proton radiotherapy

Radiation

moderate hypofractionated proton radiotherapy: Whole Breast Irradiation, at 40 Gy(RBE) in 15 fractions, tumor bed SIB to 48Gy(RBE)

ultra-hypofractionated proton radiotherapy

Radiation

Ultra-hypofractionated proton radiotherapy:Whole breast radiotherapy, 26 Gy(RBE) in 5 fractions，tumor bed boost with 10Gy(RBE) in 2 fractions.

Primary outcomes

  1. Cosmetic Outcomes

    Time frame: 2 years

    Cosmetic outcomes will be assessed at 2 years after radiotherapy. Changes in breast appearance compared to baseline will be evaluated using the Breast Cancer Treatment Outcome Scale (BCTOS), independently completed by the patient, the treating physician, and a trained research assistant at each follow-up visit. Standardized photographs of the treated breast will be taken at each assessment time point and analyzed using BCCT.core software for objective cosmetic scoring.

Secondary outcomes

  1. Acute and late toxicities

    Time frame: 5 years

    Acute radiation-induced toxicities will be assessed from the start of radiotherapy to three months after its completion. Evaluations will be performed weekly during radiotherapy and at 1 and 3 months after treatment. Late radiation-induced toxicities will be assessed every 3 months for first 2 years, every 6 months from the 3rd to the 4th year, and annually thereafter. The toxicities will be graded using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 and radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC).

  2. Locoregional recurrence (LRR)

    Time frame: 5 years

    Any first recurrence confirmed by histology or cytology within the ipsilateral breast and/or regional nodes area (including supraclavicular, infraclavicular, axillary, or internal mammary lymph nodes)

  3. Disease-free survival (DFS)

    Time frame: 5 years

    The duration from the date of enrollment to the first occurrence of local recurrence, distant metastases, tumor-related death, death without prior progression, or end of follow-up.

  4. Overall survival (OS)

    Time frame: 5 years

    The duration from the date of enrollment to the date of death from any cause or the last follow-up.

Other outcomes

  1. Quality of Life, as measured by EORTC QLQ-BR23 questionnaire

    Time frame: 1 years

    To compare quality of life at 1 year after radiotherapy measured by the EORTC QLQ-BR45. Raw scores are linearly converted to a 0-100 scale with higher symptom scales reflecting increased levels of symptom burden.

Study contacts

Contact information is provided by the study sponsor or research team.

Ping Li

CONTACT

[email protected]

+86 02138296666

Sponsors and collaborators

Lead sponsor

Shanghai Proton and Heavy Ion Center

Other

Registry information

Official study title

A Prospective Phase II Randomized Controlled Trial Comparing Ultra-Hypofractionated and Moderately Hypofractionated Proton Radiotherapy Following Breast-Conserving Surgery in Early-Stage Breast Cancer（UPH-BC）

Acronym: UPH-BC

Important dates

Study start
2024
Primary completion
2027
Study completion
2029
First posted
Aug 22, 2025
Registry last updated
Aug 22, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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