Breast Cancer Radiotherapy Group

HeartSpare Plus: Chief Investigator

This study aims to identify and evaluate optimal radiotherapy techniques for treating locoregional lymph nodes in women with lymph-node positive breast cancer whilst limiting the dose to normal tissues, in order to reduce the risks of radiation-induced heart disease and second cancers.

CORE Trial: Breast Lead Co-Investigator

This trial is evaluating the role of stereotactic radiotherapy in treating small-volume metastatic disease.

Quartus Study: Principal Investigator

This study is using novel ultrasound techniques to evaluate patients who develop breast swelling and hardness following breast radiotherapy.

PRADA Study: Co-Investigator

The PRADA study is investigating whether reversing the order of mastectomy with immediate DIEP flap reconstruction and adjuvant radiotherapy is safe, with a view to improving cosmetic outcomes in women requiring breast radiotherapy and DIEP flap reconstruction.

IMPORT Trials>: Chief Clinical Co-Ordinator

These trials are evaluating partial breast irradiation and simultaneous integrated boost in women at low and high risk of relapse respectively.

BRITER Study: Principal Investigator

A Randomised Clinical Trial comparing the use of dark ink and fluorescent (“invisible”) tattoos

External funding

Cancer Research UK

National Institute for Health Research “Research for Patient Benefit” Programme

The Breast Cancer Radiotherapy Group evaluates novel radiotherapy techniques that improve the accuracy of radiation delivery and reduce the risk of side-effects of treatment.

A principal research theme is the development of heart-sparing breast radiotherapy, which the group has led nationally via the UK HeartSpare Study, a series of three clinical trials that have begun to change national practice. The HeartSpare Plus study is currently combining the breath-hold techniques developed in HeartSpare with newer technologies – including volumetric-modulated arc therapy – and aims to minimise the risk of late side-effects including heart disease and a second cancer.

Another key research theme is the evaluation and implementation of novel technologies. Dr Kirby chairs the breast tumour site working group for the international MR Linac consortium. This group is evaluating the use of MRI-guided radiotherapy to treat patients pre-operatively with radiotherapy, and to escalate dose in women with heavily lymph-node positive breast cancer. In addition, Dr Kirby is Breast Lead Investigator on the UK CORE trial investigating the role of stereotactic radiotherapy in treating patients with small-volume metastatic disease.

Dr Kirby also works on the optimisation of cosmetic outcomes following breast radiotherapy. The group is collaborating with colleagues in physics to optimise the assessment of post-radiotherapy toxicity and to improve our understanding of the underlying pathological processes using novel ultrasound techniques (the Quartus Study). Surgical collaborations include projects assessing cosmetic outcomes using 3D-photography, and reversing the order of surgery and radiotherapy in order to minimise the impact of radiotherapy on long-term cosmetic outcomes following breast reconstruction (the PRADA study). Finally, analysis of long-term outcomes in large national breast radiotherapy trials led by the ICR Clinical Trials and Statistics Unit (ICR-CTSU) will help to inform the relationship between surgical factors, radiotherapy doses and long-term side-effects.

Axial CT slices of one patient taken during free breathing, voluntary breath-hold (v_DIBH) and active-breathing-controlled breath-hold (ABC_DIBH). Heart, left anterior descending coronary artery (LAD) and LAD with 1 cm margin have been outlined. Key: magenta – heart, orange – LAD, dark green – LAD plus 1 cm margin.