The new standard of care

As the UK’s leading independent oncology specialist, we are dedicated to providing the latest evidence-based treatments from around the world, in a high quality, safe environment – without delay.

We have been at the forefront of introducing the routine use of Deep Inspiration Breath Hold (DIBH) for all left-sided breast cancer patients receiving radiotherapy (RT), based on strong evidence this reduces radiation dose to the heart and lung. DIBH is also routinely used for all patients treated with a VMAT technique, including delivering regional nodal irradiation (RNI) to the internal mammary chain (IMC), regardless of laterality.

We are the first independent oncology provider in the UK to formally implement DIBH for right-sided breast cancers, as standard as it has been shown that it provides clinically significant reductions in potentially toxic right lung doses and mean liver dose.

Evidence-base for DIBH

DIBH is easily performed by the majority of patients and adds very little to treatment delivery times. The technique used at GenesisCare is an innovative response to tumour motion, developed using 3D surface monitoring and automated gating technologies to displace organs at risk (OAR) from the high-dose region of the tangential radiation field. Many groups have shown the benefits of DIBH, both in left, and more recently right-sided radiotherapy, particularly when the internal mammary chain (IMC) requires treatment.

Dosimetric studies show DIBH for right-sided breast cancers, with or without regional nodal irradiation (RNI), provides clinically significant reductions in potentially toxic right lung doses and mean liver dose. Although hepatic dose is not usually a concern, it is recognised that free breathing treatment delivery potentially underestimates the amount of radiation the liver would receive.

DIBH further improves safety margins, enabling more accurate treatment and minimising toxicity and dose to OARs in line with the ‘as low as reasonably practicable’ (ALARP) principle. The recent implementation of the hypofractionated, high dose-per-fraction schedule from the Fast Forward trial into routine clinical practice makes accurate planning target volume and OAR dose delivery more crucial than ever.

Radiotherapy expertise

Radiotherapy is rapidly evolving, with new treatment modalities offering reduced acute and long-term side effects and significantly improved life outcomes for curative and palliative patients. GenesisCare is at the forefront of the introduction of innovative and advanced techniques. Our centres are equipped with the latest-generation linear accelerators and new modalities as standard.

The patient will be trained by the radiographers on how to achieve and hold a stable breath hold prior to the CT planning scan. Two scans will be performed at the planning CT visit. The first (free breathing) scan helps position the patient on set using SGRT, with no need for permanent ink tattoos. The second (breath hold) scan is then taken and used for planning and treating the patient.

We use the latest surface-guided radiotherapy (SGRT) techniques – AlignRT – together with VMAT 3D and 4D set-up, and automated beam gating, which automatically stops treatment when the patient moves out of position with the aligned planning CT. This is combined with DIBH techniques to displace OARs from the high-dose field and stabilize the PTV. The technique is well tolerated by patients and improves comfort compared with spirometry.

VMAT is the next generation of intensity-modulated radiotherapy (IMRT), delivering a highly conformal radiotherapy dose by changing intensity as it moves around the tumour site. This reduces treatment time as well as the overall toxicity of treatment. VMAT is used to treat many cancer types, including breast, where we are pioneering the use of Partial Breast Irradiation.

We provide VMAT to all suitable patients and use simple automation and Physics QA automation (Mobius) to create highly conformal plans for dosimetry.

Leading cancer specialist

GenesisCare is a global organisation with over 440 cancer centres throughout the UK, USA, Australia and Spain. In the UK we specialise in advanced and innovative cancer diagnostics and treatments, and collaborate with health professionals who share our vision of enabling fast access to world-class cancer care.

We work in partnership with our consultants to build a strong governance framework and to be the first to introduce many new cancer treatments safely and effectively. Our strategy is to invest early in new evidence-based treatments and modalities that hold potential for improved life outcomes.

We are a patient-first organisation and aim to provide exceptional care in everything we do. Many of our centres are rated good by the CQC and carry the Macmillan Quality Environment Mark (MQEM).

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To refer a patient for breast cancer radiotherapy at GenesisCare, complete our referral form or make an enquiry.
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