Dunlop, A., Colgan, R., Kirby, A., Ranger, A. & Blasiak-Wal, I.
(2019). Evaluation of organ motion-based robust optimisation for VMAT planning for breast and internal mammary chain radiotherapy. Clinical and translational radiation oncology,
Kaidar-Person, O., Vrou Offersen, B., Hol, S., Arenas, M., Aristei, C., Bourgier, C., Cardoso, M.J., Chua, B., Coles, C.E., Engberg Damsgaard, T., et al.
(2019). ESTRO ACROP consensus guideline for target volume delineation in the setting of postmastectomy radiation therapy after implant-based immediate reconstruction for early stage breast cancer. Radiotherapy and oncology,
Ranger, A., Dunlop, A., Hutchinson, K., Convery, H., Maclennan, M.K., Chantler, H., Twyman, N., Rose, C., McQuaid, D., Amos, R.A., et al.
(2018). A Dosimetric Comparison of Breast Radiotherapy Techniques to Treat Locoregional Lymph Nodes Including the Internal Mammary Chain. Clinical oncology,
O’Connell, R.L., Di Micco, R., Khabra, K., Kirby, A.M., Harris, P.A., James, S.E., Power, K., Ramsey, K.W. & Rusby, J.E.
(2018). Comparison of Immediate versus Delayed DIEP Flap Reconstruction in Women Who Require Postmastectomy Radiotherapy. Plastic and reconstructive surgery,
O'Leary, B., Alarcon, L., Mallon, E. & Kirby, A.
(2017). Radiotherapy-associated Pemphigus – a Rare Cause of Grade 4 Skin Toxicity. Clinical oncology,
Mitchell, R.A., Wai, P., Colgan, R., Kirby, A.M. & Donovan, E.M.
(2017). Improving the efficiency of breast radiotherapy treatment planning using a semi-automated approach. Journal of applied clinical medical physics,
Bartlett, F.R., Donovan, E.M., McNair, H.A., Corsini, L.A., Colgan, R.M., Evans, P.M., Maynard, L., Griffin, C., Haviland, J.S., Yarnold, J.R., et al.
(2017). The UK HeartSpare Study (Stage II): Multicentre Evaluation of a Voluntary Breath-hold Technique in Patients Receiving Breast Radiotherapy. Clinical oncology,
O'Connell, R.L., Di Micco, R., Khabra, K., Wolf, L., deSouza, N., Roche, N., Barry, P.A., Kirby, A.M. & Rusby, J.E.
(2017). The potential role of three-dimensional surface imaging as a tool to evaluate aesthetic outcome after Breast Conserving Therapy (BCT). Breast cancer research and treatment,
Coles, C.E., Griffin, C.L., Kirby, A.M., Titley, J., Agrawal, R.K., Alhasso, A., Bhattacharya, I.S., Brunt, A.M., Ciurlionis, L., Chan, C., et al.
(2017). Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. The lancet,
Harris, E.J., Mukesh, M.B., Donovan, E.M., Kirby, A.M., Haviland, J.S., Jena, R., Yarnold, J., Baker, A., Dean, J., Eagle, S., et al.
(2016). A multicentre study of the evidence for customized margins in photon breast boost radiotherapy. The british journal of radiology,
Dunkerley, N., Bartlett, F.R., Kirby, A.M., Evans, P.M. & Donovan, E.M.
(2016). Mean heart dose variation over a course of breath-holding breast cancer radiotherapy. The british journal of radiology,
O’Connell, R.L., DiMicco, R., Khabra, K., O’Flynn, E.A., deSouza, N., Roche, N., Barry, P.A., Kirby, A.M. & Rusby, J.E.
(2016). Initial experience of the BREAST-Q breast-conserving therapy module. Breast cancer research and treatment,
Landeg, S.J., Kirby, A.M., Lee, S.F., Bartlett, F., Titmarsh, K., Donovan, E., Griffin, C.L., Gothard, L., Locke, I. & McNair, H.A., et al.
(2016). A randomized control trial evaluating fluorescent ink versus dark ink tattoos for breast radiotherapy. Br j radiol,
OBJECTIVE: The purpose of this UK study was to evaluate interfraction reproducibility and body image score when using ultraviolet (UV) tattoos (not visible in ambient lighting) for external references during breast/chest wall radiotherapy and compare with conventional dark ink. METHODS: In this non-blinded, single-centre, parallel group, randomized control trial, patients were allocated to receive either conventional dark ink or UV ink tattoos using computer-generated random blocks. Participant assignment was not masked. Systematic (∑) and random (σ) setup errors were determined using electronic portal images. Body image questionnaires were completed at pre-treatment, 1 month and 6 months to determine the impact of tattoo type on body image. The primary end point was to determine that UV tattoo random error (σsetup) was no less accurate than with conventional dark ink tattoos, i.e. <2.8 mm. RESULTS: 46 patients were randomized to receive conventional dark or UV ink tattoos. 45 patients completed treatment (UV: n = 23, dark: n = 22). σsetup for the UV tattoo group was <2.8 mm in the u and v directions (p = 0.001 and p = 0.009, respectively). A larger proportion of patients reported improvement in body image score in the UV tattoo group compared with the dark ink group at 1 month [56% (13/23) vs 14% (3/22), respectively] and 6 months [52% (11/21) vs 38% (8/21), respectively]. CONCLUSION: UV tattoos were associated with interfraction setup reproducibility comparable with conventional dark ink. Patients reported a more favourable change in body image score up to 6 months following treatment. Advances in knowledge: This study is the first to evaluate UV tattoo external references in a randomized control trial..
Bartlett, F.R., Colgan, R.M., Donovan, E.M., McNair, H.A., Carr, K., Evans, P.M., Griffin, C., Locke, I., Haviland, J.S., Yarnold, J.R., et al.
(2015). The UK HeartSpare Study (Stage IB): Randomised comparison of a voluntary breath-hold technique and prone radiotherapy after breast conserving surgery. Radiotherapy and oncology,
Hanna, G.G. & Kirby, A.M.
(2015). Intraoperative radiotherapy in early stage breast cancer: potential indications and evidence to date. The british journal of radiology,
Kirby, A., Hanna, G., Wilcox, M. & MacKenzie, M.
(2015). In Regard to Vaidya et al. International journal of radiation oncology*biology*physics,
Colgan, R., James, M., Bartlett, F.R., Kirby, A.M. & Donovan, E.M.
(2015). Voluntary breath-holding for breast cancer radiotherapy is consistent and stable. The british journal of radiology,
Taylor, C.W. & Kirby, A.M.
(2015). Cardiac Side-effects From Breast Cancer Radiotherapy. Clinical oncology,
Tsang, Y., Ciurlionis, L., Kirby, A.M., Locke, I., Venables, K., Yarnold, J.R., Titley, J., Bliss, J. & Coles, C.E.
(2015). Clinical impact of IMPORT HIGH trial (CRUK/06/003) on breast radiotherapy practices in the United Kingdom. The british journal of radiology,
Harris, E.J., Mukesh, M., Jena, R., Baker, A., Bartelink, H., Brooks, C., Dean, J., Donovan, E.M., Collette, S., Eagle, S., et al.
(2014). A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique. Efficacy and mechanism evaluation,
Bartlett, F.R., Yarnold, J.R. & Kirby, A.M.
(2014). Response to D Woolf and M Keshtgar's reply to: breast radiotherapy and heart disease - where are we now?. Clin oncol (r coll radiol),
Bartlett, F.R., Colgan, R.M., Donovan, E.M., Carr, K., Landeg, S., Clements, N., McNair, H.A., Locke, I., Evans, P.M., Haviland, J.S., et al.
(2014). Voluntary breath-hold technique for reducing heart dose in left breast radiotherapy. J vis exp,
Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these techniques, patients hold their breath while radiotherapy is delivered, pushing the heart down and away from the radiotherapy field. Despite clear dosimetric benefits, these techniques are not yet in widespread use. One reason for this is that commercially available solutions require specialist equipment, necessitating not only significant capital investment, but often also incurring ongoing costs such as a need for daily disposable mouthpieces. The voluntary breath-hold technique described here does not require any additional specialist equipment. All breath-holding techniques require a surrogate to monitor breath-hold consistency and whether breath-hold is maintained. Voluntary breath-hold uses the distance moved by the anterior and lateral reference marks (tattoos) away from the treatment room lasers in breath-hold to monitor consistency at CT-planning and treatment setup. Light fields are then used to monitor breath-hold consistency prior to and during radiotherapy delivery. .
Phillips, I., Locke, I., Kirby, A. & Rahman, F.
(2014). Palliative External Beam Radiotherapy for Painful Bone Metastases. Clinical oncology,
Kirby, A.N., Jena, R., Harris, E.J., Evans, P.M., Crowley, C., Gregory, D.L. & Coles, C.E.
(2013). Tumour bed delineation for partial breast/breast boost radiotherapy: what is the optimal number of implanted markers?. Radiother oncol,
PURPOSE: International consensus has not been reached regarding the optimal number of implanted tumour bed (TB) markers for partial breast/breast boost radiotherapy target volume delineation. Four common methods are: insertion of 6 clips (4 radial, 1 deep and 1 superficial), 5 clips (4 radial and 1 deep), 1 clip at the chest wall, and no clips. We compared TB volumes delineated using 6, 5, 1 and 0 clips in women who have undergone wide-local excision (WLE) of breast cancer (BC) with full-thickness closure of the excision cavity, in order to determine the additional margin required for breast boost or partial breast irradiation (PBI) when fewer than 6 clips are used. METHODS: Ten patients with invasive ductal BC who had undergone WLE followed by implantation of six fiducial markers (titanium clips) each underwent CT imaging for radiotherapy planning purposes. Retrospective processing of the DICOM image datasets was performed to remove markers and associated imaging artefacts, using an in-house software algorithm. Four observers outlined TB volumes on four different datasets for each case: (1) all markers present (CT6M); (2) the superficial marker removed (CT(5M)); (3) all but the chest wall marker removed (CTCW); (4) all markers removed (CT(0M)). For each observer, the additional margin required around each of TB(0M), TBCW, and TB(5M) in order to encompass TB(6M) was calculated. The conformity level index (CLI) and differences in centre-of-mass (COM) between observers were quantified for CT(0M), CTCW, CT(5M), CT(6M). RESULTS: The overall median additional margins required to encompass TB(6M) were 8mm (range 0-28 mm) for TB(0M), 5mm (range 1-13 mm) for TBCW, and 2mm (range 0-7 mm) for TB(5M). CLI were higher for TB volumes delineated using CT(6M) (0.31) CT(5M) (0.32) than for CTCW (0.19) and CT(0M) (0.15). CONCLUSIONS: In women who have undergone WLE of breast cancer with full-thickness closure of the excision cavity and who are proceeding to PBI or breast boost RT, target volume delineation based on 0 or 1 implanted markers is not recommended as large additional margins are required to account for uncertainty over true TB location. Five implanted markers (one deep and four radial) are likely to be adequate assuming the addition of a standard 10-15 mm TB-CTV margin. Low CLI values for all TB volumes reflect the sensitivity of low volumes to small differences in delineation and are unlikely to be clinically significant for TB(5M) and TB(6M) in the context of adequate TB-CTV margins..
Bartlett, F.R., Colgan, R.M., Carr, K., Donovan, E.M., McNair, H.A., Locke, I., Evans, P.M., Haviland, J.S., Yarnold, J.R. & Kirby, A.M., et al.
(2013). The UK HeartSpare Study: randomised evaluation of voluntary deep-inspiratory breath-hold in women undergoing breast radiotherapy. Radiother oncol,
PURPOSE: To determine whether voluntary deep-inspiratory breath-hold (v_DIBH) and deep-inspiratory breath-hold with the active breathing coordinator™ (ABC_DIBH) in patients undergoing left breast radiotherapy are comparable in terms of normal-tissue sparing, positional reproducibility and feasibility of delivery. METHODS: Following surgery for early breast cancer, patients underwent planning-CT scans in v_DIBH and ABC_DIBH. Patients were randomised to receive one technique for fractions 1-7 and the second technique for fractions 8-15 (40 Gy/15 fractions total). Daily electronic portal imaging (EPI) was performed and matched to digitally-reconstructed radiographs. Cone-beam CT (CBCT) images were acquired for 6/15 fractions and matched to planning-CT data. Population systematic (Σ) and random errors (σ) were estimated. Heart, left-anterior-descending coronary artery, and lung doses were calculated. Patient comfort, radiographer satisfaction and scanning/treatment times were recorded. Within-patient comparisons between the two techniques used the paired t-test or Wilcoxon signed-rank test. RESULTS: Twenty-three patients were recruited. All completed treatment with both techniques. EPI-derived Σ were ≤ 1.8mm (v_DIBH) and ≤ 2.0mm (ABC_DIBH) and σ ≤ 2.5mm (v_DIBH) and ≤ 2.2mm (ABC_DIBH) (all p non-significant). CBCT-derived Σ were ≤ 3.9 mm (v_DIBH) and ≤ 4.9 mm (ABC_DIBH) and σ ≤ 4.1mm (v_DIBH) and ≤ 3.8mm (ABC_DIBH). There was no significant difference between techniques in terms of normal-tissue doses (all p non-significant). Patients and radiographers preferred v_DIBH (p=0.007, p=0.03, respectively). Scanning/treatment setup times were shorter for v_DIBH (p=0.02, p=0.04, respectively). CONCLUSIONS: v_DIBH and ABC_DIBH are comparable in terms of positional reproducibility and normal tissue sparing. v_DIBH is preferred by patients and radiographers, takes less time to deliver, and is cheaper than ABC_DIBH..
Bartlett, F.R., Yarnold, J.R. & Kirby, A.M.
(2013). Breast radiotherapy and heart disease - where are we now?. Clin oncol (r coll radiol),
Bartlett, F.R., Yarnold, J.R., Donovan, E.M., Evans, P.M., Locke, I. & Kirby, A.M.
(2013). Multileaf collimation cardiac shielding in breast radiotherapy: Cardiac doses are reduced, but at what cost?. Clin oncol (r coll radiol),
AIMS: To measure cardiac tissue doses in left-sided breast cancer patients receiving supine tangential field radiotherapy with multileaf collimation (MLC) cardiac shielding of the heart and to assess the effect on target volume coverage. MATERIALS AND METHODS: Sixty-seven consecutive patients who underwent adjuvant radiotherapy to the left breast (n = 48) or chest wall (n = 19) in 2009/2010 were analysed. The heart, left anterior descending coronary artery (LAD), whole breast and partial breast clinical target volumes (WBCTV and PBCTV) were outlined retrospectively (the latter only in patients who had undergone breast-conserving surgery [BCS]). The mean heart and LAD NTDmean and maximum LAD doses (LADmax) were calculated for all patients (NTDmean is a biologically weighted mean dose normalised to 2 Gy fractions using a standard linear quadratic model). Coverage of WBCTV and PBCTV by the 95% isodose was assessed (BCS patients only). RESULTS: The mean heart NTDmean (standard deviation) was 0.8 (0.3) Gy, the mean LAD NTDmean 6.7 (4.3) Gy and the mean LADmax 40.3 (10.1) Gy. Coverage of the WBCTV by 95% isodose was <90% in one in three patients and PBCTV coverage <95% (range 78-94%) in one in 10 BCS patients. CONCLUSION: The use of MLC cardiac shielding reduces doses to cardiac tissues at the expense of target tissue coverage. Formal target volume delineation in combination with an assessment of the likelihood of local relapse is recommended in order to aid decisions regarding field and MLC placement..
Yates, L., Kirby, A., Crichton, S., Gillett, C., Cane, P., Fentiman, I. & Sawyer, E.
(2012). RISK FACTORS FOR REGIONAL NODAL RELAPSE IN BREAST CANCER PATIENTS WITH ONE TO THREE POSITIVE AXILLARY NODES. International journal of radiation oncology biology physics,
Juneja, P., Harris, E.J., Kirby, A.M. & Evans, P.M.
(2012). Adaptive breast radiation therapy using modeling of tissue mechanics: a breast tissue segmentation study. Int j radiat oncol biol phys,
PURPOSE: To validate and compare the accuracy of breast tissue segmentation methods applied to computed tomography (CT) scans used for radiation therapy planning and to study the effect of tissue distribution on the segmentation accuracy for the purpose of developing models for use in adaptive breast radiation therapy. METHODS AND MATERIALS: Twenty-four patients receiving postlumpectomy radiation therapy for breast cancer underwent CT imaging in prone and supine positions. The whole-breast clinical target volume was outlined. Clinical target volumes were segmented into fibroglandular and fatty tissue using the following algorithms: physical density thresholding; interactive thresholding; fuzzy c-means with 3 classes (FCM3) and 4 classes (FCM4); and k-means. The segmentation algorithms were evaluated in 2 stages: first, an approach based on the assumption that the breast composition should be the same in both prone and supine position; and second, comparison of segmentation with tissue outlines from 3 experts using the Dice similarity coefficient (DSC). Breast datasets were grouped into nonsparse and sparse fibroglandular tissue distributions according to expert assessment and used to assess the accuracy of the segmentation methods and the agreement between experts. RESULTS: Prone and supine breast composition analysis showed differences between the methods. Validation against expert outlines found significant differences (P<.001) between FCM3 and FCM4. Fuzzy c-means with 3 classes generated segmentation results (mean DSC = 0.70) closest to the experts' outlines. There was good agreement (mean DSC = 0.85) among experts for breast tissue outlining. Segmentation accuracy and expert agreement was significantly higher (P<.005) in the nonsparse group than in the sparse group. CONCLUSIONS: The FCM3 gave the most accurate segmentation of breast tissues on CT data and could therefore be used in adaptive radiation therapy-based on tissue modeling. Breast tissue segmentation methods should be used with caution in patients with sparse fibroglandular tissue distribution..
Kirby, A.M., Evans, P.M., Helyer, S.J., Donovan, E.M., Convery, H.M. & Yarnold, J.R.
(2011). A randomised trial of supine versus prone breast radiotherapy (SuPr study): comparing set-up errors and respiratory motion. Radiother oncol,
PURPOSE: To test a prone position against the international-standard supine position in women undergoing whole-breast-radiotherapy (WBRT) after wide-local-excision (WLE) of early breast cancer (BC) in terms of feasibility, set-up errors, and respiratory motion. METHODS: Following WLE of BC with insertion of tumour-bed clips, patients underwent 4D-CT for WBRT-planning in supine and prone positions (the latter using an in-house-designed platform). Patients were randomised to undergo WBRT fractions 1-7 in one position, switching to the alternate position for fractions 8-15 (40Gy/15-fractions total). Cone-beam CT-images (CBCT) were acquired prior to fractions 1, 4, 7, 8, 11 and 14. CBCT data were matched to planning-CT data using (i) chest-wall and (ii) clips. Systematic and random errors were calculated. Maximal displacement of chest-wall and clips with respiration was measured on 4D-CT. Clinical- to planning-target-volume (CTV-PTV) margins were calculated. Patient-comfort-scores and treatment-times were evaluated. RESULTS: Twenty-five patients were randomized. 192/192 (100%) planned supine fractions and 173/192 (90%) prone fractions were completed. 3D population systematic errors were 1.3-1.9mm (supine) and 3.1-4.3mm (prone) (p=0.02) and random errors 2.6-3.2mm (supine) and 3.8-5.4mm (prone) (p=0.02). Prone positioning reduced chest-wall and clip motion (0.5±0.2mm (prone) versus 2.7±0.5mm (supine) (p<0.001)) with respiration. Calculated CTV-PTV margins were greater for prone (12-16mm) than for supine treatment (10mm). Patient-comfort-scores and treatment times were comparable (p=0.06). CONCLUSIONS: Set-up errors were greater using our prone technique than for our standard supine technique, resulting in the need for larger CTV-PTV margins in the prone position. Further work is required to optimize the prone treatment-platform and technique before it can become a standard treatment option at our institution..
Barton, S.R., Smith, I.E., Kirby, A.M., Ashley, S., Walsh, G. & Parton, M.
(2011). The role of ipsilateral breast radiotherapy in management of occult primary breast cancer presenting as axillary lymphadenopathy. Eur j cancer,
AIM: To assess the role of ipsilateral breast radiotherapy (IBR) in women with occult primary breast cancer presenting with axillary metastases (OPBC). METHODS: Patients with axillary nodal metastases and histological diagnosis of breast cancer without palpable, mammographic or ultrasonographic evidence of a breast primary were identified from a prospectively maintained single institution database. Imaging, surgery, radiotherapy, recurrence and survival data were collected. Patients whose breast cancer primary was detected on MRI (but occult on clinical examination and other imaging) were excluded from the analyses of IBR and outcome, but were included in other exploratory analyses. RESULTS: Fifty-five patients were included between 1975 and 2009. Median follow up was 68 months. Twenty patients had breast magnetic resonance imaging (MRI) in addition to other imaging. A primary breast cancer was detected in 7 of these 20. 48/55 patients had no detectable breast primary. 35/48 patients (73%) were treated with radiotherapy to the conserved breast, and 13/48 (27%) with observation. Patients who had IBR had better 5 year local recurrence free survival (LRFS) (84% versus 34%, p<0.001), and relapse free survival (RFS) (64% versus 34%, p=0.05), but no difference in overall survival (OS) (84% versus 85%, p=0.2). There was no difference in 5 year LRFS (80% versus 90%: p=0.3) between patients who received radiation of 50 Gy in 25 fractions versus ≥60 Gy. CONCLUSION: Patients with OPBC should be managed with IBR and breast conservation, or mastectomy. Our data suggest it is not necessary to irradiate the breast to more than 50 Gy in 25 fractions..
Kirby, A.M., Coles, C.E. & Yarnold, J.R.
(2010). Target volume definition for external beam partial breast radiotherapy: clinical, pathological and technical studies informing current approaches. Radiother oncol,
Partial breast irradiation (PBI) is currently under investigation in several phase III trials and, following a recent consensus statement, its use off-study may increase despite ongoing uncertainty regarding optimal target volume definition. We review the clinical, pathological and technical evidence for target volume definition in external beam partial breast irradiation (EB-PBI). The optimal method of tumour bed (TB) delineation requires X-ray CT imaging of implanted excision cavity wall markers. The definition of clinical target volume (CTV) as TB plus concentric 15 mm margins is based on the anatomical distribution of multifocal and multicentric disease around the primary tumour in mastectomy specimens, and the clinical locations of local tumour relapse (LR) after breast conservation surgery. If the majority of LR originate from foci of residual invasive and/or intraduct disease in the vicinity of the TB after complete microscopic resection, CTV margin logically takes account of the position of primary tumour within the surgical resection specimen. The uncertain significance of independent primary tumours as sources of preventable LR, and of wound healing responses in stimulating LR, increases the difficulties in defining optimal CTV. These uncertainties may resolve after long-term follow-up of current PBI trials. By contrast, a commonly used 10mm clinical to planning target volume (PTV) margin has a stronger evidence base, although departmental set-up errors need to be confirmed locally. A CTV-PTV margin >10mm may be required in women with larger breasts and/or large seromas, whilst the role of image-guided radiotherapy with or without TB markers in reducing CTV-PTV margins needs to be explored..
Kirby, A.M., Evans, P.M., Nerurkar, A.Y., Desai, S.S., Krupa, J., Devalia, H., della Rovere, G.Q., Harris, E.J., Kyriakidou, J. & Yarnold, J.R., et al.
(2010). How does knowledge of three-dimensional excision margins following breast conservation surgery impact upon clinical target volume definition for partial-breast radiotherapy?. Radiother oncol,
BACKGROUND AND PURPOSE: To compare partial-breast clinical target volumes generated using a standard 15 mm margin (CTV(standard)) with those generated using three-dimensional surgical excision margins (CTV(tailored 30)) in women who have undergone wide local excision (WLE) for breast cancer. MATERIAL AND METHODS: Thirty-five women underwent WLE with placement of clips in the anterior, deep and coronal excision cavity walls. Distances from tumour to each of six margins were measured microscopically. Tumour bed was defined on kV-CT images using clips. CTV(standard) was generated by adding a uniform three-dimensional 15 mm margin, and CTV(tailored 30) was generated by adding 30 mm minus the excision margin in three-dimensions. Concordance between CTV(standard) and CTV(tailored 30) was quantified using conformity (CoI), geographical-miss (GMI) and normal-tissue (NTI) indices. An external-beam partial-breast irradiation (PBI) plan was generated to cover 95% of CTV(standard) with the 95% isodose. Percentage-volume coverage of CTV(tailored 30) by the 95% isodose was measured. RESULTS: Median (range) coronal, superficial and deep excision margins were 15.0 (0.5-76.0)mm, 4.0 (0.0-60.0)mm and 4.0 (0.5-35.0)mm, respectively. Median CoI, GMI and NTI were 0.62, 0.16 and 0.20, respectively. Median coverage of CTV(tailored 30) by the PBI-plan was 97.7% (range 84.9-100.0%). CTV(tailored 30) was inadequately covered by the 95% isodose in 4/29 cases. In three cases, the excision margin in the direction of inadequate coverage was
Kirby, A.M., Evans, P.M., Donovan, E.M., Convery, H.M., Haviland, J.S. & Yarnold, J.R.
(2010). Prone versus supine positioning for whole and partial-breast radiotherapy: a comparison of non-target tissue dosimetry. Radiother oncol,
PURPOSE: To compare non-target tissue (including left-anterior-descending coronary-artery (LAD)) dosimetry of prone versus supine whole (WBI) and partial-breast irradiation (PBI). METHODS AND MATERIALS: Sixty-five post-lumpectomy breast cancer patients underwent CT-imaging supine and prone. On each dataset, the whole-breast clinical-target-volume (WB-CTV), partial-breast CTV (tumour-bed + 15 mm), ipsilateral-lung and chest-wall were outlined. Heart and LAD were outlined in left-sided cases (n=30). Tangential-field WBI and PBI plans were generated for each position. Mean LAD, heart, and ipsilateral-lung doses (x(mean)), maximum LAD (LAD(max)) doses, and the volume of chest-wall receiving 50 Gy (V(50Gy)) were compared. RESULTS: Two-hundred and sixty plans were generated. Prone positioning reduced heart and LAD doses in 19/30 WBI cases (median reduction in LAD(mean)=6.2 Gy) and 7/30 PBI cases (median reduction in LAD(max)=29.3 Gy) (no difference in 4/30 cases). However, prone positioning increased cardiac doses in 8/30 WBI (median increase in LAD(mean)=9.5 Gy) and 19/30 PBI cases (median increase in LAD(max)=22.9 Gy) (no difference in 3/30 cases). WB-CTV>1000cm(3) was associated with improved cardiac dosimetry in the prone position for WBI (p=0.04) and PBI (p=0.04). Prone positioning reduced ipsilateral-lung(mean) in 65/65 WBI and 61/65 PBI cases, and chest-wall V(50Gy) in all WBI cases. PBI reduced normal-tissue doses compared to WBI in all cases, regardless of the treatment position. CONCLUSIONS: In the context of tangential-field WBI and PBI, prone positioning is likely to benefit left-breast-affected women of larger breast volume, but to be detrimental in left-breast-affected women of smaller breast volume. Right-breast-affected women are likely to benefit from prone positioning regardless of breast volume..
Kirby, A.M., Evans, P.M., Haviland, J. & Yarnold, J.R.
(2009). Left Anterior Descending Coronary Artery (LAD) Doses from Breast Radiotherapy: is Prone Treatment Beneficial?. Clin oncol-uk,
Kirby, A.M., deSouza, N.M., Evans, P.M. & Yarnold, J.R.
(2009). MRI Delineation of Tumour Bed for Partial Breast Irradiation: Fusion/Comparison with CT/Titanium Clip-based Method. Clin oncol-uk,
Kirby, A.M., Yarnold, J.R., Evans, P.M., Morgan, V.A., Schmidt, M.A., Scurr, E.D. & desouza, N.M.
(2009). Tumor bed delineation for partial breast and breast boost radiotherapy planned in the prone position: what does MRI add to X-ray CT localization of titanium clips placed in the excision cavity wall?. Int j radiat oncol biol phys,
PURPOSE: To compare tumor bed (TB) volumes delineated using magnetic resonance imaging plus computed tomography and clips (MRCT) with those delineated using CT and clips (CT/clips) alone in postlumpectomy breast cancer patients positioned prone and to determine the value of MRCT for planning partial breast irradiation (PBI). METHODS AND MATERIALS: Thirty women with breast cancer each had 6 to 12 titanium clips secured in the excision cavity walls at lumpectomy. Patients underwent CT imaging in the prone position, followed by MRI (T(1)-weighted [standard and fat-suppressed] and T(2)-weighted sequences) in the prone position. TB volumes were delineated separately on CT and on fused MRCT datasets. Clinical target volumes (CTV) (where CTV = TB + 15 mm) and planning target volumes (PTV) (where PTV = CTV + 10 mm) were generated. Conformity indices between CT- and MRCT-defined target volumes were calculated (ratio of the volume of agreement to total delineated volume). Discordance was expressed as a geographical miss index (GMI) (where the GMI = the fraction of total delineated volume not defined by CT) and a normal tissue index (the fraction of total delineated volume designated as normal tissue on MRCT). PBI dose distributions were generated to cover CT-defined CTV (CTV(CT)) with >or=95% of the reference dose. The percentage of MRCT-defined CTV (CTV(MRCT)) receiving >or=95% of the reference dose was measured. RESULTS: Mean conformity indices were 0.54 (TB), 0.84 (CTV), and 0.89 (PTV). For TB volumes, the GMI was 0.37, and the NTI was 0.09. Median percentage volume coverage of CTV(CT) was 97.1% (range, 95.3%-100.0%) and of CTV(MRCT) was 96.5% (range, 89.0%-100.0%). CONCLUSIONS: Addition of MR to CT/clip data generated TB volumes that were discordant with those based on CT/clips alone. However, clinically satisfactory coverage of CTV(MRCT) by CTV(CT)-based tangential PBI fields provides support for CT/clip-based TB delineation remaining the method of choice for PBI/breast boost radiotherapy planned using tangential fields..
Kirby, A.M. & George Mikhaeel, N.
(2007). The role of FDG PET in the management of lymphoma: practical guidelines. Nuclear medicine communications,
Kirby, A.M. & Mikhaeel, N.G.
(2007). The role of FDG PET in the management of lymphoma: what is the evidence base?. Nuclear medicine communications,
Kirby, A.M., A'Hern, R.P., D'Ambrosio, C., Tanay, M., Syrigos, K.N., Rogers, S.J., Box, C., Eccles, S.A., Nutting, C.M. & Harrington, K.J., et al.
(2006). Gefitinib (ZD1839, Iressa(TM)) as palliative treatment in recurrent or metastatic head and neck cancer. Brit j cancer,
To assess the level of activity and toxicity of gefitinib ( ZD1839, Iressa((TM))) in a population of patients with locally recurrent and/ or metastatic head and neck cancer. Patients were recruited into an expanded access programme through the multidisciplinary head and neck clinics at the Royal Marsden and St George's Hospitals. Patients were required to have received at least one course of standard systemic chemotherapy or radiation therapy, or be medically unfit for chemotherapy. Patients were commenced on single- agent gefitinib at a dose of 500 mg day (-1). Clinical, symptomatic and radiological response, time to progression ( TTP), survival and toxicity were recorded. A total of 47 patients were enrolled ( 35 male and 12 female) with a median age of 62 years ( range 18 - 93 years). The observed clinical response rate was 8% with a disease control rate ( complete response, partial response, stable disease) of 36%. In all, 34% of patients experienced an improvement in their symptoms. The median TTP and survival were 2.6 and 4.3 months, respectively. Acneiform folliculitis was the most frequent toxicity observed ( 76%) but the majority of cases were grade 1 or 2. Only four patients experienced grade 3 toxicity of any type ( all cases of folliculitis). Gefitinib was well tolerated and yielded symptomatic improvement in one- third of patients. However, this agent appeared to possess limited antitumour activity in this group of patients with head and neck cancer in whom the objective response rate, median TTP and survival were all lower than has been reported in a previous study..
Rusby, , O'Connell, R.L., Di Micco, R., Khabra, K., Wolf, L., DeSouza, N., Roche, N., Barry, P.A. & Kirby, A.M.
The potential role of 3 dimensional surface imaging as a tool to evaluate aesthetic outcome after Breast Conserving Therapy (BCT). Breast cancer research and treatment,
Coles, C., Griffin, C., Kirby, A., Titley, J., Agrawal, R., Alhasso, A., Bhattacharya, I., Brunt, M., Ciurlionis, L., Chan, C., et al.
Partial breast radiotherapy after breast conservation surgery for early breast cancer: 5-year outcomes from the IMPORT LOW (CRUK/06/003) phase III randomised controlled trial. The lancet,
Bliss, J., Kirby, A., Coles, C. & Bhattacharya, I.
Can Interrogation Of Tumour Characteristics Lead Us To Safely Omit Adjuvant Radiotherapy In Patients With Early Breast Cancer?. Clinical oncology,
Gothard, L., Edmunds, D., Khabra, K., Kirby, A., Poonam, M., McNair, H., Roberts, D., Symonds-Tayler, R. & Donovan, E.
Low-cost Kinect Version 2 imaging system for breath hold monitoring and gating: Proof of concept study for breast cancer VMAT radiotherapy. Journal of applied clinical medical physics,
Edmunds, D., Gothard, L., Khabra, K., Kirby, A., Madhale, P., McNair, H., Roberts, D., Symonds-Tayler, R. & Donovan, E.
Low-cost Kinect Version 2 imaging system for breath hold monitoring and gating: Proof of concept study for breast cancer VMAT radiotherapy. Journal of applied clinical medical physics,
Updated ASTRO guidelines on accelerated partial breast irradiation (APBI): to whom can we offer APBI outside a clinical trial?. The british journal of radiology,
Bagenal, J., Roche, N., Ross, G., Kirby, A. & Dodwell, D.
Should patients with ductal carcinoma in situ be treated with adjuvant whole breast radiotherapy after breast conservation surgery?. Bmj,
Bliss, J., Bhattacharya, I., Haviland, J.S., Kirby, A., Hopwood, P. & Yarnold, J.
Patient reported outcomes over 5 years following whole or partial breast radiotherapy: longitudinal analysis of the IMPORT LOW phase III randomised controlled trial. Journal of clinical oncology,
Bliss, J., Bhattacharya, I., Haviland, J.S., Hopwood, P., Yarnold, J. & Kirby, A.
Can patient-reported outcomes be used instead of clinician-reported outcomes and photographs as primary endpoints of late normal tissue effects in breast radiotherapy trials? Results from the IMPORT LOW trial. Radiotherapy and oncology,
Bhattacharya, I., Haviland, J.S., Gulliford, S., Harris, E., Bliss, J. & Kirby, A.
Is breast seroma after tumour resection associated with patient-reported breast appearance change following radiotherapy? Results from the IMPORT HIGH (CRUK/06/003) trial. Radiotherapy and oncology,