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Breast CancerPPTOX-BCNCT07537712

Proton vs Photon IMRT Toxicity in Breast Cancer

An observational study of Breast Cancer, run by Ruijin Hospital at 1 site in China.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

This study aims to compare the differences in acute and long-term toxicities between intensity-modulated proton therapy (IMPT) and intensity-modulated photon radiotherapy (IMRT/VMAT) in postoperative breast cancer patients, with a focus on evaluating their impact on critical organs, including the heart, lungs, skin… Read more about this study

Who is it for?
Ages 18 years and older, women only
Conditions the study is for
Breast Cancer
What is being tested?
Intensity-modulated photon radiotherapy (IMRT/VMAT) and Intensity-modulated proton therapy (IMPT)
Type of treatment
Surgery or procedure
How many people
750 participants
Where
1 siteChina
Study dates
Apr 2026to Dec 2027
Phase
Observational
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 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Study population: Breast cancer patients aged ≥18 years with histologically confirmed disease and indications for postoperative radiotherapy as determined by the treating physician, who are willing to receive radiotherapy using IMPT or IMRT.

Who may be able to join

  • Female patients aged ≥18 years.
  • Pathological diagnosis of invasive breast cancer or ductal carcinoma in situ.
  • Undergone breast-conserving surgery or total mastectomy, with or without stage I breast reconstruction.
  • For invasive carcinoma, sentinel lymph node biopsy, axillary lymph node sampling, or axillary lymph node dissection was performed.
  • Required postoperative adjuvant radiotherapy.
  • Karnofsky Performance Status (KPS) score ≥ 70.
  • The estimated life expectancy of greater than 5 years .
  • Planned to receive photon intensity-modulated radiotherapy (IMRT) or proton IMRT, with written informed consent obtained.

Who cannot join

  • Prior history of chest radiotherapy.
  • Severe cardiopulmonary dysfunction or other conditions that contraindicate radiotherapy.
  • Pregnancy or breastfeeding.
  • Concurrent active malignancies.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

China1 site
  • Ruijin Hospital, Shanghai Jiaotong University School of Medicine

    Shanghai, Shanghai 200025

    Lu Cao, PhD, 86-021-64370045, cl11879@rjh.com.cn

Other trials in China

About this study

Official title: Comparative Toxicity of Postoperative Proton Versus Photon Intensity-Modulated Radiotherapy(IMRT) in Breast Cancer: A Multicenter, Prospective, Observational Study

This study aims to compare the differences in acute and long-term toxicities between intensity-modulated proton therapy (IMPT) and intensity-modulated photon radiotherapy (IMRT/VMAT) in postoperative breast cancer patients, with a focus on evaluating their impact on critical organs, including the heart, lungs, skin, esophagus, thyroid, and lymphatic tissues. Eligible patients will be followed for at least one year to assess the incidence and severity of both acute and late toxicities, as well as differences in patient-reported outcomes (PROs), cosmetic outcomes following breast-conserving surgery, and overall quality of life.

Read the detailed description

Eligible breast cancer patients will receive either 4005 cGy (RBE) in 15 fractions once daily or 4256 cGy (RBE) in 16 fractions once daily, five times per week. The radiation dose will be delivered to the ipsilateral chest wall or whole breast, with or without regional nodal irradiation, including the ipsilateral supraclavicular, infraclavicular, and high-risk axillary lymph node regions, and optionally the internal mammary lymph node regions. The decision to administer a tumor bed boost will be made by the treating physician. The boost may be delivered either sequentially (10-12.5 Gy (RBE) in 4-5 fractions) or concurrently (48-49.5 Gy (RBE) in 15-16 fractions). The treating physician will evaluate clinical indications to determine the necessity of regional nodal irradiation and whether the internal mammary nodes should be included in the regional nodal clinical target volume (CTV). All patients will undergo intensity-modulated radiation therapy (IMRT) or intensity-modulated proton therapy (IMPT).

The primary endpoint is a composite of toxicity events, including grade ≥2 ipsilateral arm lymphedema within one year post-radiotherapy, grade ≥2 lymphopenia within three months post-treatment, or grade ≥1 cardiac toxicity within one year post-treatment. Patients will be followed for at least one year to assess acute and late toxicities, cosmetic outcomes (patient-reported) in those undergoing breast-conserving surgery, and quality of life.

Due to the greater difficulty in enrolling patients for IMPT compared to IMRT, the study employs an unbalanced 2:1 allocation ratio (IMRT : IMPT = 2:1). Based on an alpha level of 0.05, 80% power, a 2:1 allocation ratio, an assumed 11% difference in toxicity rates between conventional radiotherapy and IMPT during and within one year post-treatment, and a 6.4% anticipated loss-to-follow-up rate, the estimated total sample size is 750 patients (500 in the IMRT/VMAT group and 250 in the IMPT group).

Conditions
Breast Cancer
Being tested
Intensity-modulated photon radiotherapy (IMRT/VMAT), Intensity-modulated proton therapy (IMPT)
Keywords
Breast Cancer, Intensity-modulated proton therapy, Intensity-modulated radiation therapy, Toxicity profile
Medical subject headings
Breast Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Intensity-modulated photon radiotherapy (IMRT/VMAT)Radiation

    Participants will receive photon intensity-modulated radiation therapy (IMRT) targeting the whole breast or chest wall, with or without regional lymph node irradiation (including the ipsilateral supraclavicular, infraclavicular, and high-risk axillary lymph node regions, and optionally the internal mammary lymph node regions). The prescribed dose is either 4005 cGy in 15 fractions once daily, or 4256 cGy in 16 fractions once daily. For patients undergoing breast-conserving surgery with high-risk features, the decision to deliver a tumor bed boost will be determined by the treating clinician. The tumor bed boost may be administered either sequentially (10-12.5 Gy in 4-5 fractions) or concurrently (48-49.5 Gy in 15-16 fractions). The attending physician will assess clinical indications to determine the need for regional lymph node irradiation and whether to include the internal mammary lymph nodes within the clinical target volume (CTV) of the regional nodal field.

  • Intensity-modulated proton therapy (IMPT)Radiation

    Participants will receive photon Intensity-modulated proton therapy (IMPT) targeting the whole breast or chest wall, with or without regional lymph node irradiation (including the ipsilateral supraclavicular, infraclavicular, and high-risk axillary lymph node regions, and optionally the internal mammary lymph node regions). The prescribed dose is either 4005 cGy (RBE) in 15 fractions once daily, or 4256 cGy (RBE) in 16 fractions once daily. For patients undergoing breast-conserving surgery with high-risk features, the decision to deliver a tumor bed boost will be determined by the treating clinician. The tumor bed boost may be administered either sequentially (10-12.5 Gy (RBE) in 4-5 fractions) or concurrently (48-49.5 Gy (RBE) in 15-16 fractions). The attending physician will assess clinical indications to determine the need for regional lymph node irradiation and whether to include the internal mammary lymph nodes within the clinical target volume (CTV) of the regional nodal field.

Study groups in NCT07537712
Study groupRoleWhat they receive
Intensity-modulated photon radiotherapy (IMRT/VMAT)Participants will receive photon intensity-modulated radiation therapy (IMRT) targeting the whole breast or chest wall, with or without regional lymph node irradiation (including the ipsilateral supraclavicular, infraclavicular, and high-risk axillary lymph node regions, and optionally the internal mammary lymph node regions).
Receives: Radiation: Intensity-modulated photon radiotherapy (IMRT/VMAT)
Intensity-modulated proton therapy (IMPT)Participants will receive photon Intensity-modulated proton therapy (IMPT) targeting the whole breast or chest wall, with or without regional lymph node irradiation (including the ipsilateral supraclavicular, infraclavicular, and high-risk axillary lymph node regions, and optionally the internal mammary lymph node regions).
Receives: Radiation: Intensity-modulated proton therapy (IMPT)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Composite Toxicity Event

    Definition: The composite toxicity endpoint is a binary outcome (yes/no), defined as the occurrence of at least one of the following events from the start of radiotherapy up to 1 year post-treatment:

    Event A (Lymphedema): Development of ≥ Grade 2 upper limb lymphedema;Event B (Lymphopenia): Development of ≥ Grade 2 lymphopenia within 3 months after completion of treatment;Event C (Cardiotoxicity): Development of ≥ Grade 1 cardiotoxicity within 1 year post-treatment. All assessed according to CTCAE v5.0.This primary outcome measure will report the proportion (%) of subjects who experience at least one composite toxicity event.

    Measured: 1 year

Secondary outcomes (11)
  1. Acute Radiation-Induced Cardiac Toxicity (RTOG/EORTC)

    The incidence and grade of acute radiation-induced cardiac morbidities (e.g., EKG changes or pericardial abnormalities) will be assessed using the Radiation Therapy Oncology Group (RTOG)/European Organisation for Research and Treatment of Cancer (EORTC) Acute Radiation Morbidity Scoring Criteria. Assessments will be conducted weekly during treatment, and at 4 weeks and 3 months post-treatment.

    Measured: 3 months

  2. Acute Radiation-Induced Non-Cardiac Toxicity (CTCAE v5.0)

    The incidence and severity of other acute toxicities will be graded using CTCAE v5.0, including fatigue , malaise, radiation dermatitis, and esophageal pain,Esophagitis,Breast infection,pneumonia,Cough and blood system disorder. Assessments will follow the same schedule as above.

    Measured: 3 months

  3. Chronic Radiation-Induced Skin and Cardiac Toxicity (RTOG/EORTC)

    The incidence and grade of chronic radiation-induced Other skin and cardiac toxicities will be assessed at 6 and 12 months post-treatment using the RTOG/EORTC Late Radiation Morbidity Scoring Criteria. Specific assessments include: Chronic radiation dermatitis (Late skin toxicity) and Chronic cardiac injury (e.g., pericardial effusion, constrictive pericarditis, cardiomyopathy)

    Measured: 1 year

  4. Chronic Radiation-Induced Toxicity - Multi-System (CTCAE v5.0)

    The incidence and severity of chronic radiation-induced toxicities will be assessed at 6 and 12 months post-treatment completion. Evaluations will employ the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, assessing the following specific adverse events: chest wall necrosis (soft tissue necrosis);hyperpigmentation ;hypopigmentation;radiation pneumonitis (lung toxicity);breast atrophy;nipple deformity;breast infection;hyperparathyroidism;hyperthyroidism;lib fracture, brachial plexopathy and joint range of motion decreased.

    Measured: 1 year

  5. Late Radiation-Induced Breast Toxicity (LENT-SOMA)

    The incidence and severity of late radiation-induced breast toxicities will be assessed at 6 and 12 months post-treatment using the Late Effects of Normal Tissue-Subjective, Objective, Management, Analytic (LENT-SOMA) scoring system. Specific assessments include: Telangiectasia;Fibrosis; breast/chest edema; ulceration and arm lymphedema.

    Measured: 1 year

  6. Breast Cosmetic Outcome

    Assessed via patient self-assessment and physician photographic review using the Harvard/NSABP/RTOG Breast Cosmesis Grading Scale. This scale rates cosmetic outcome on a 4-point scale: Excellent, Good, Fair, or Poor, where higher grades indicate worse cosmetic outcomes.

    Measured: 1 year

  7. Patient-Reported Outcomes (PROs)

    Assessed using the PRO-CTCAE (Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events). This is a patient-reported outcome measurement system developed by the National Cancer Institute to evaluate symptomatic adverse events in cancer clinical trials. Each symptom is rated on a 5-point scale ranging from 0 to 4, where higher scores indicate worse symptoms (0=None, 1=Mild, 2=Moderate, 3=Severe, 4=Very severe).

    Measured: 3, 6, 12, 18, 24, 36,48, 60 months

  8. Health-Related Quality of Life (HRQoL)

    Assessed using the breast cancer specific EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30) questionnaires. This is a 30-item questionnaire assessing functional scales (physical, role, emotional, cognitive, social functioning) and symptom scales. Scores range from 0 to 100. For functional scales, higher scores indicate better quality of life; for symptom scales, higher scores indicate worse symptoms.

    Measured: 3, 6, 12, 24, 60 months

  9. Dose-volume parameters of the Planning treatment volume (PTV)

    Target coverage of the PTV, defined by V95% (the percentage of the PTV receiving at least 95% of the prescribed dose).PTV coverage as measured by V90%, and high-dose volume as measured by V105% and V110%.

    Measured: Upon completion of radiotherapy treatment planning, prior to the first fraction of treatment.

  10. Dose-volume parameters of the organs at risk (OARs)

    The dose-volume histograms (DVHs) of OARs will be analyzed. The evaluation will cover:Cardiac Structures: Mean dose, D1cc, and V2-V30 for the heart and left ventricle (LV), along with D0.1cc for the left anterior descending artery (LAD).Lungs: Mean dose, D0.1cc, and V5-V25 for the ipsilateral lung, and V2 and V4 for the contralateral lung.Serial Organs: Maximum dose for the spinal cord (Dmax), D0.1cc for the ipsilateral brachial plexus, and D1cc for the esophagus.

    Other Structures: Contralateral breast, and thyroid gland.

    Measured: From CT simulation through completion of all treatment fractions (approximately 4 weeks per patient)

  11. Health-Related Quality of Life (HRQoL)

    Assessed using the breast cancer specific EORTC QLQ-BR 23 questionnaire. This is a 23-item breast cancer specific module assessing functional scales(body image, sexual functioning, sexual enjoyment, future perspective) and symptom scales (systemic therapy side effects, breast symptoms, arm symptoms, upset by hair loss). Scores range from 0 to 100. For functional scales, higher scores indicate better functioning; for symptom scales, higher scores indicate worse symptoms.

    Measured: 3, 6, 12, 24, 60 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Apr 2026
  2. Study startApr 2026 (estimated)
  3. Primary completionDec 2027 (estimated)
  4. Study completionDec 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Other
Time perspective
Prospective
Enrolment
750 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07537712
Sponsor's protocol ID
RJBC-PPTOX-BC
Other IDs
PPTOX-BC
Acronym
PPTOX-BC
Status last verified
Apr 2026
First submitted
6 Apr 2026
Last updated
17 Apr 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

An observational study of Breast Cancer, run by Ruijin Hospital at 1 site in China.

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 8 inclusion and 4 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: opening soon, as of the sponsor's last update on 17 Apr 2026. 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 China. 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?

Contact Lu Cao, PhD (+86-021-64370045, cl11879@rjh.com.cn), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Composite Toxicity Event (time frame: 1 year). 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 17 Apr 2026; AzTrials last refreshed its copy on 6 Nov 2026.

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