We provide advanced radiotherapy techniques as standard and we continuously invest in cancer treatments and technologies that are proven to provide the best life outcomes
Delivers a highly precise and personalised dose to the target area while minimising dose to adjacent organs. Significantly improves treatment outcomes for many tumour types, including breast, prostate, head and neck, skin and palliative treatments.
VMAT is the next generation of intensity-modulated (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. It is also used for palliative treatment as it preserves the opportunity for subsequent radiotherapy.
We provide VMAT to all suitable patients and use simple automation and Physics QA automation (Mobius) to create highly conformal plans for dosimetry.
Also known as stereotactic body radiation therapy (SBRT), SABR is one of the most important advanced radiotherapy techniques currently available for the treatment of tumours such as in the lung and liver. It focuses beams of high-dose radiation at tumour sites with sub-millimetre accuracy – with the aim of achieving local control in just a few short treatments. There is a large body of evidence that SABR treatment given at the right time, to the right patient, can make a difference to outcome. SABR, and stereotactic radiosurgery (SRS) for brain, are becoming the gold standard therapy for certain primary and many metastatic cancers, often replacing surgery.
GenesisCare is an established provider of specialist SABR treatment. We have invested in a network of lead centres that offers world-class technology, including sophisticated imaging, motion monitoring and the UK’s first MRIdian, for real-time adaptive planning and delivery. Our service is led by a team of expert NHS clinicians with extensive experience of this SABR modality for all tumour types and they oversee a nationwide rapid access pathway.
Stereotactic ablative radiotherapy, or SABR, targets intensely powerful beams of radiation to tumours in a highly conformal treatment. It targets with the aim of destroying cancer cells with minimal damage to surrounding healthy tissues.
SABR is an extreme hypofractionated treatment that can be delivered in just one to five fractions. It has revolutionised the treatment of tumour sites by offering an evidence-based alternative to surgery and to other invasive interventional procedures such as radiofrequency ablation (RFA), microwave ablation (MWA), irreversible electroporation (IRE, ‘NanoKnife’), and cryotherapy. Numerous studies have shown that SABR is highly effective in the management of primary and metastatic tumours, in particular inoperable tumours in the pancreas and liver; secondary tumours in the liver, lymph nodes, lungs, and bones; and recurrent cancer in the pelvis after previous radiotherapy. SABR may also be an alternative to surgery for prostate cancer, depending on the tumour stage.
How SABR works
SABR is an advanced form of precision radiation therapy that exploits the principles of the radiobiology of tumour cells. The high ablative doses used in SABR not only cause lethal damage to the DNA of cancer cells (as in standard radiotherapy), but also damage the tumour stroma (the basement membrane, fibroblasts, extracellular matrix, immune cells and vasculature). The combined effect is to significantly accelerate cell death (apoptosis).
Compared to conventional radiotherapy, the ability of SABR to target tumour volume and yet avoid healthy tissue with sub-millimetre accuracy is critical to outcomes of treatment. For this reason, delivery of a SABR service requires significant investment in technology and expertise, together with a robust clinical framework. This is the foundation of the GenesisCare SABR centre of excellence.
How the dose compares
SABR – dose-per-fraction of 6.7 to 10 Gy in 4 or 5 fractions with total dosage between 33.5 Gy and 50 Gy
Conventional fractionation – doses-per-fraction in the range of 1.8–2 Gy and total dosage can amount to >80 Gy with intensity-modulated radiotherapy
Hypofractionation – doses-per-fraction of 2.5 Gy and above in 20 fractions, so total is 52.5–55 Gy
GenesisCare has established a centre of excellence for SABR and stereotactic radiosurgery (SRS) led by a team of leading SABR specialists operating across five centres.
The service draws on the best practice of the world’s leading SABR treatment centres and is designed to deliver clinical excellence at each stage of the pathway. Our objective is that all eligible patients have an opportunity to benefit from SABR, with treatment starting within five days of their planning scan (or sooner for palliative patients).
Diagnostic imaging – our treatment pathway includes full diagnostics, PET/CT, MRI and CT to ensure appropriateness of patients and minimal delays in commencing treatment planning.
Referral expertise – we have refined SABR referral criteria based on the experience of our SABR specialists, published clinical studies and international best practice. All referrals are peer- reviewed by our senior SABR specialists.
Unified protocols for dose and fractionation – we use standardised dose and fractionation schedules based on tumour size and evidence-based best practice. Our dosimetrists and medical physicists calculate high-quality contouring plans, taking account of the normal tolerance of healthy tissue, organs at risk
and inter-fractional adjustments. We use a sophisticated AI planning system to calculate target volumes and all plans are peer-reviewed in multidisciplinary teams (MDTs).
High-quality imaging and set-up – we use image guided radiotherapy (IGRT) based on 3D cone beam verification immediately prior to treatment for accurate set-up. These are compared and matched with simulated X-rays taken directly from 3D CT data used for treatment planning. Our radiographers have extensive experience of CBCT interpretation and use of specialist positioning equipment to ensure sub- millimetre accuracy in set-up and minimal delay.
Superior motion management – our state- of-the-art linear accelerators integrate surface guided radiotherapy (SGRT) techniques to monitor for movements which could result in dosimetric inaccuracies. This surface data is captured in real time to minimise intrafraction variation. We also use respiratory motion management, such as breath hold, gating and beam hold. Surface data is captured at each attendance to manage interfraction variation.
Peer Review – we are committed to providing a MDT approach to the implementation of safe and evidence-based radiotherapy.
Latest-generation SABR technology – treatments are delivered with the latest- generation linear accelerators. Designed for
the technical demands of SABR, these systems incorporate IGRT and SGRT technologies. We have also introduced MR-guided radiotherapy which uses real-time MR images for truly adaptive SABR treatment.
Combined with our advanced treatment planning imaging capabilities, including 3D CT, PET/CT and MRI, we offer the most technologically advanced SABR network in the UK
GenesisCare has introduced the first MRIdian MR-guided radiotherapy system to the UK and is offering this modality as a specialist service within its SABR network.
By combining a linear accelerator with a high definition MR scanner, MRIdian allows clinicians to see as they treat, adjusting the beam to allow for movements and anatomical changes and making truly adaptive SABR possible for the first time.
We are excited to be partnering with the University of Oxford and a team of expert SABR clinicians to build a body of evidence and put us at the forefront of exploring the possibilities for this innovative approach.
Find out more about MRIdian MR-guided radiotherapy in the MRIdian tab.
Magnetic resonance image-guided radiotherapy, or MRIgRT, is the most exciting development in advanced radiotherapy for years. By combining a linear accelerator with a high definition MR scanner, MRIdian allows clinicians to see as they treat – adjusting the beam to allow for movements and anatomical changes. It provides a step-change in accurate stereotactic ablative radiotherapy (SABR), bringing a new level of control and confidence with tumour targeting and sparing of healthy tissue. MRIdian makes truly adaptive SABR possible for the first time.
With 5,000 patients treated to date worldwide, MRIdian has been widely used for gastrointestinal, lung and prostate cancer, and is increasingly recognised as a possible platform for partial breast treatments and safer re-irradiation.The possibility of incorporating on-table functional MRI into treatment pathways is just around the corner.
GenesisCare is the first to introduce MRIdian technology to the UK at our centre in Oxford. It is the foundation for an emerging MRIgRT network that will put us at the forefront of exploring the possibilities of this innovative approach. We are excited to be partnering with the University of Oxford and a team of expert SABR clinicians who will work with us to build a UK body of evidence that will impact the lives of many patients.
Real-time on-table adaptive radiotherapy brings a new level of confidence to SABR delivery
MRI-guided radiotherapy improves on conventional image-guided radiotherapy (IGRT) by providing improved soft tissue definition without additional radiation exposure through high-quality MR images.
By capturing MR images of the target many times a second, the MRIdian provides real-time moving images that capture the anatomical positional changes that occur naturally within the body. Uniquely, the MRIdian allows tracking of the target position in real time, coupled with a gating facility that prevents beam delivery when the target is outside the treatment boundaries. This level of accuracy means that uncertainty is reduced, eliminating the need for large margins around the target.
The MRIdian has opened up new avenues of treatment, particularly tumours that move and are within close proximity of organs at risk (OAR) such as tumours of the liver and pancreas, where high doses are achievable while keeping the doses to OARs within tolerance.
How it works
The MRIdian allows clinicians to provide true on-line adaptive radiotherapy. The treatment planning system is clear and intuitive making daily re-contouring of tumour
and normal tissues straightforward. The updated plans are rapidly re- optimised providing a personalised radiation treatment on every patient, every fraction.
The evidence base suggests that the MRIdian makes it possible to achieve ablative doses without reaching prohibitive levels of toxicity, particularly in the abdomen. This offers the prospect of improving clinical outcomes for previously hard-to-treat cancers such as locally advanced or recurrent pancreatic cancer and inoperable liver tumours.
Building a UK body of evidence
Through our academic collaboration with the University of Oxford, we will build on the body of evidence for MRIdian with an ongoing programme of clinical evaluation in the UK.
Our strategy for the introduction of MRIgRT is to align with international best practice based on evidence-based protocols. There is an increasing international evidence base for MR linac and notably the MRIdian system. Here are some of the pivotal studies that have informed our approach.
A clinical study from Amsterdam demonstrated a low incidence of early gastrointestinal and urinary toxicity in hypofractionation for prostate cancer. SABR is increasingly used for the treatment of localised prostate cancer. However, with any hypofractionation, concerns remain about early and late toxicity. MRIdian makes it possible to deliver SABR with reduced uncertainty margins and daily, real-time adaptive planning to reduce toxicity. Both clinician- reported and patient-reported outcomes were better than historical controls in this well-designed phase 2 study.
A retrospective study of 44 patients with inoperable pancreatic cancer evaluated the overall survival benefit of higher dose, adaptive MR-guided SABR versus standard, low-dose SABR. High-dose MRIgRT patients (n = 24) had a statistically significant improvement in 2-year overall survival (OS) (49% vs 30%, P = 0.03) and trended towards significance for 2-year freedom from local failure (FFLF) (77% vs 57%, P = 0.15) compared to standard- dose patients (n = 20, 45%). This improved OS was achieved without any increased toxicity in the high-dose group. MRIgRT is now being tested in a prospective trial, which through our academic partners at the University of Oxford, GenesisCare will be supporting.
The evidence base for SABR is growing and there is currently a range of clinical scenarios into which it can be integrated. At GenesisCare, we offer SABR in the following situations:
We have defined SABR referral criteria based on the experience of our SABR clinical expert team, published clinical studies and international best practice. All SABR referrals will be assessed for a possible benefit of treatment on MRIdian. For example:
For other tumour sites, please refer to our referral criteria via the MOSAIQ tool available on our referral portal.
We are committed to an environment of clinical excellence, objectivity and accountability. Our processes are adapted from international best practice and our team has undertaken training with centres including Amsterdam UMC, Miami Cancer Institute, Henry Ford Cancer Centre (University of Wisconsin) and Heidelberg University Centre.
The introduction of MRIdian has been overseen by Specialist Reference Groups in both urological cancers and SABR. The groups are comprised of clinicians who have undergone extensive MRIdian training and have a vast cumulative experience of delivering highly technical radiotherapy. The groups work closely together in a robust forum to guide all aspects of clinical governance, patient selection, peer review, education and credentialing. The groups also oversee research activity, developing joint protocols with our academic partners. GenesisCare will treat more patients with MRIgRT than any other institute globally, and will therefore be at the vanguard of translating research into everyday precision radiation medicine.
Find out more about clinical leads and governance at GenesisCare
We use image-guided radiotherapy (IGRT) based on 3D cone beam verification immediately prior to treatment for accurate set-up. These are compared and matched with simulated X-rays taken directly from 3D CT data used for treatment planning. Our radiographers have extensive experience of CBCT interpretation and use of specialist positioning equipment to ensure submillimetre accuracy in set-up and minimal delay.
We are one of the first companies to introduce MRI-guided radiotherapy (MRIgRT) for cancer treatments with the MRIdian. This is an exciting step forward in the real-time planning and adaptive treatment of tumours and is available for patients across the UK. MRIdian is available for prostate, lung, liver and pancreatic cancer and is an important part of these treatment pathways.
We use the latest surface-guided radiotherapy (SGRT) techniques in combination with VMAT or SABR to enable 3D and 4D set-up and superior motion management during radiotherapy.
The accuracy of radiotherapy is enhanced when combined with SGRT – a sophisticated stereovision technology that monitors thousands of points on the patient’s skin during set-up and treatment, unlike other commonly used systems that rely on CT imaging – further increasing radiation exposure.
This powerful system reduces positioning errors to improve the overall accuracy, as well as the speed and comfort of treatment.
These advances provide important benefits to our patients including the option of open-face treatment shells and tattoo-free treatments.
Stereotactic radiosurgery, or SRS, is often described as brain-area-sparing surgery. It delivers precisely-focused radiation beams at higher doses in a single or few short treatments and permits the maximum conformal dose delivery within the targets while minimising dose to the surrounding unaffected brain.
Recent studies are showing that treatment with SRS alone results in less decline in cognitive deterioration and better quality of life. Vitally this is achieved with no significant difference in overall survival.¹ SRS is now replacing conventional whole brain radiation therapy as the procedure of choice for some primary tumours and solitary or multiple brain metastases.
SRS is central to our neuro-oncology service at GenesisCare as we seek to offer our patients the option of achieving the optimum life outcome for them and their families. GenesisCare is the first independent provider to offer an exclusive SRS service for private patients across the UK.
Brain metastases (secondary brain cancer) affect up to 30% of all cancer patients. Lung cancer, breast cancer, kidney cancer and melanoma are the most common primary tumours that metastasise to the brain.
Stereotactic radiosurgery (SRS) has become increasingly recognised world-wide as the as the gold standard radiotherapy option by professional societies, based on a growing evidence base for the use of SRS alone for a patient presenting with one to four brain metastases.2
SRS is routinely used in re-irradiation after brain radiotherapy or previous SRS.
SRS is also indicated for:
The Neuro-oncology Advisory Team review all referrals and assess suitability for SRS.
Their key role is to align the neuro–clinical service with evidence-based treatments such as SRS to ensure safe, consistent care.
Find out more about the GenesisCare Neuro-oncology Advisory Team
We are leading the introduction of Deep inspiration breath hold (DIBH) with VMAT radiotherapy for left-sided breast cancers and complex right-sided cancers when regional nodal irradiation (IMC VMAT) is required. This innovative response to tumour motion provides superior protection of the heart and lung, and improves patient comfort compared with spirometry.
DIBH improves safety margins, enabling more accurate treatment and increased dose without increasing toxicity to the heart or lungs.
Spacing gels, such as SpaceOAR® Hydrogel, are a game changer in protecting the rectum from toxicity in prostate radiotherapy. The gel is inserted between the rectum and the prostate to temporarily move the anterior rectal wall further away from the prostate. The aim is to reduce the amount of radiation delivered to the rectum and limit toxicity. The gel lasts for the entire course of prostate radiotherapy treatment and is completely absorbed by the patient’s body over time.
A randomised, controlled trial demonstrated that using spacing gel in men undergoing radiotherapy for prostate cancer was safe and effective in creating perirectal space, reducing rectal irradiation and resulting in fewer patient-reported declines in bowel, urinary and sexual quality of life (QOL).1,2,3
At GenesisCare we offer spacing gels at no extra cost to all patients with a prostate in situ prior to VMAT radiotherapy. We offer insertion under local anaesthetic at some of our centres or performed as a day-case procedure at one of our partner hospitals. We also work in partnership with Nuffield Health to offer patients the nearest local hospital for their procedure.