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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
We’re proud to be the first independent healthcare provider in the UK to introduce the MRIdian – an advanced MR linac. This world-class radiotherapy system is available at our centres in Oxford and Cromwell Hospital in London and can be accessed by patients throughout the UK. We’re offering this modality as a specialist service within our 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.
Following three major non-inferiority phase 3 randomised controlled trials [1,2,3] have shown its safety and efficacy, moderate hypofractionation (20 fraction) has been adopted as a standard-of-care option for localised prostate cancer.⁴,⁵ There is now a growing body of evidence in support of extreme hypofractionation – 5 fraction (5#) SABR for patients with low- to intermediate-risk (medium-risk) and selected high-risk localised prostate cancer.
We offer this innovative treatment at our centres in Chelmsford, Cambridge, Bristol, Birmingham, Nottingham, Maidstone and Elstree on our state-of-the-art linacs and at our centres in Oxford and London using the ViewRay MRIdian MR linac. Find out more about MRIdian MR-guided radiotherapy.
We have made the 5# SABR for prostate cancer service available to offer patients an option which will provide:
Our aim, as always, is to deliver an exceptional service that improves outcomes for our patients.
You can download our current prostate protocol here
PACE-B: acute toxicity findings from an international, randomised, open-label phase 3, non-inferiority trial
PACE-B is a randomised trial of standard-of-care conventionally fractionated or moderately hypofractionated radiotherapy versus five-fraction stereotactic body radiotherapy for low-risk to intermediate (medium)-risk localised prostate cancer.⁶
Participants were randomly allocated (1:1) to conventionally fractionated or moderately hypofractionated radiotherapy (78 Gy in 39# over 7-8 weeks or 62 Gy in 20# over 4 weeks, respectively) or stereotactic body radiotherapy (36·25 Gy in 5# over 1–2 weeks).
Side effect data collected over the first three months after treatment, show that patients who had SABR had similar and low levels of side effects when compared to the patients who had conventionally fractionated or moderately hypofractionated radiotherapy.
The worst acute RTOG gastrointestinal toxic effect proportions were grade 2 or more severe toxic events (such as, diarrhoea, discomfort in the back passage, or changes in bowel habit) in:
N.B. this was a non-statistically significant difference.
The worst acute RTOG genitourinary toxicity proportions were grade 2 or worse toxicity (such as, needing to pass water more frequently, problems passing water or bladder incontinence) in:
N.B. this was a non-statistically significant difference
These results suggest that substantially shortening treatment courses with SABR does not increase gastrointestinal or genitourinary acute toxicity. Late toxicity and efficacy data for the PACE-B trial are awaited.
While past studies have included the use of gold fiducial markers as part of their imaging protocol, at GenesisCare we use imaging within acceptable guidance and rectal spacers, which reduce the effect of toxicity to healthy tissue such as the bowel. The spacer is inserted between the rectum and the prostate under local anaesthetic before radiotherapy treatment begins to temporarily move the anterior rectal wall further away from the prostate. This helps reduce the amount of radiation delivered to the rectum and limit toxicity, therefore reducing bowel, urinary and sexual function related side effects.
For patients receiving 5# SABR on the MRIdian MR linac at our centres in Oxford or London, a rectal spacer insertion is not required due to the highly accurate treatment targeting made possible with real-time MR imaging.
If you wish to refer a patient for 5# SABR for primary prostate cancer on either a conventional linac or the MRIdian MR linac, the eligibility criteria are:
If you’re an oncologist currently working with GenesisCare but are not routinely treating SABR (in private practice or in your local Trust) or have not participated in the PACE trial, we have a simple credentialing process to support you in referring and treating your prostate patients with 5# SABR. For clinicians who would prefer, eligible cases can also be referred to any credentialed clinicians to consent, plan and treat the patient before referring back to the original clinician for ongoing follow up.
The referral process and credentialing opportunity is detailed below.
If you have a patient who is accepted by the eMDT as eligible for the 5# prostate SABR protocol but you do not practice SABR routinely in your NHS or private practice and have not participated in the PACE trial, you can still access this treatment for your patient by following the credentialing process, stated below:
Similarly, for MRIdian MR linac treatments a clinician can opt to enter the credentialing programme involving a presentation, contouring exercises and the first three cases to be mentored and peer reviewed.
All MRIdian MR linac cases are subject to ongoing peer review – a best practice to ensure safety and governance for all cases.
If you would like more information about how to access these treatments for your patients, please contact email@example.com
The provision of 5# SABR for prostate cancer patients across the GenesisCare network is led and governed by the Urology SABR Advisory Team (USAT) to ensure clinical excellence and patient safety. The team consists of:
These clinical oncologists are all members of the Urology Clinical Reference Group. They review all referrals of primary urological SABR treatments to assess patient eligibility for 5# SABR either on a standard linac or the MRIdian MR linac.
The USAT will review the suitability of all primary urological SABR treatments including prostate, on either a conventional linac or on the MRIdian, and prostate reirradiation and renal primary lesions on the MRIdian. Urological cases of oligometastatic disease will also be reviewed by our SABR Advisory team.
This team will review any submitted cases on Tuesdays and Fridays through an asynchronous eMDT. This ensures a fast turnaround and a prompt outcome for patients and their referring clinicians.
The urology MR linac/SABR advisory team referral form needs to be completed and submitted to the meeting coordinator along with the minimum data set which must include the following:
This systematic review will ensure careful and appropriate case selection and maintain excellence in terms of clinical governance of the urology SABR service. Each review will generate an outcome report which in turn supports you and your patients to secure insurer preauthorisation for these state-of-the-art radiotherapy treatments.
The USAT is here to assist you and are always happy to advise you regarding this non-surgical treatment for prostate cancer.
For those yet to gain practicing privileges with GenesisCare, we are always looking to collaborate with talented consultants. We can help you build your private practice with medical secretary support, practice management systems, website and marketing support, free consultation rooms and over 300 education and engagement events per year. Our state-of-the-art IT solutions mean that tasks such as CT contouring, planning and plan approval can all be completed remotely.
Contact your local Referrer Engagement Manager (REM) to get started with the easy process.
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 10,000 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.
We’re proud to be the first independent healthcare provider in the UK to introduce the MRIdian at our centres in Oxford and Cromwell Hospital in London and can be accessed by patients throughout the UK. This 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.
MRIdian MRlinac explained
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.
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.
Treatment on the MRIdian MR Linac allows for a reduction in radiation dose to the surrounding normal tissues, such as the small bowel, spinal cord, large bowel and second kidney, reducing the risk of possible toxicity which may otherwise be caused. It also offers a reduced risk of diminished renal function when compared to other interventions.
In a study of 95 patients with larger (T1b, >4 cm) renal cell carcinoma, where 77.6% were defined as inoperable by the referring urologist. 38 patients (40%) had a grade 1 to 2 toxicity and no grade 3 to 5 toxicities were reported. Cancer-specific survival, overall survival, and progression-free survival were 96.1%, 83.7%, and 81.0% at two years and 91.4%, 69.2%, 64.9% at four years, respectively.
Read more about MRIdian for kidney cancer
The MRIdian MR linac is one of the most advanced forms of radiation therapy, demanding a high level of clinician input, a skilled team, a robust workflow and a completely new way of working.
MRIdian 50/5 chronicles our experience of how we overcame these challenges and we were able to set up a service in six months and treat our first 50 patients during the next five. In that time, the benefits to patients have been even greater than any of us imagined.
We want to share what we’ve learned so that other centres can replicate this service with the same efficiency and positive outcome. MRI-guided radiotherapy will play a major role in cancer care in the next five to ten years and will be adopted by many more healthcare organisations.
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.
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 (SRS) is often described as brain area-sparing surgery and has revolutionised the treatment of brain metastases.
It uses high-quality imaging to deliver precisely-focused radiation beams at higher doses in a single or few short treatments. SRS is a highly advanced approach that permits the maximum conformal dose delivery within the targets while minimising dose to the surrounding unaffected brain. By treating with sufficient dose intensity to ensure ablation of tumour cells, treatment can be concluded in a small number of fractions. The aim is to destroy the tumour and achieve permanent local control, while preserving important brain function.
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 radiotherapy 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. We have invested heavily in SRS technology and expertise, as part of an end-to-end pathway that includes early detection, treatment, close monitoring and follow-up. In the management of brain metastases, an approach that focuses on patient quality of life and functional outcome is becoming the norm.
GenesisCare is a specialist provider of neuro-oncology and a centre of excellence for stereotactic radiosurgery for private patients across the UK. We have invested in an end-to-end solution that involves brain-sparing technologies and innovative protocols, delivered through a team of leading clinicians at our centres in London and Oxford.
Brain metastases (secondary brain cancer) affect up to 30% of all cancer patients and are the most common sequelae of cancer. 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 worldwide 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.3
SRS is routinely used in re-irradiation after brain radiotherapy or previous SRS. SRS is shown to have the same overall survival in two to four metastases as five to ten.4
Use of stereotactic radiosurgery (SRS) is no longer limited to patients with three or fewer lesions, because data suggest that total disease burden, rather than number of lesions, is predictive of survival benefits associated with the technique.
We have experience of managing a wide range of brain and CNS tumours. Patients can be referred to our Neuro-oncology Advisory Team in Oxford or London for review and assessment. Referring clinicians are involved in decisions and are assured a fast response within five days.
Re-treatment with SRS is possible:
Contraindications for SRS:
SRS is also indicated for:
Our ambition has been to design a neuro-oncology service that treats the whole patient, not just the tumour. The incidence of brain metastasis is increasing, due to better imaging surveillance and improved systemic treatment of extracranial disease – up to 30 per cent of primary cancer patients are likely to develop a brain metastasis. Conventional radiotherapy treatments often lead to cognitive deterioration, with no benefit in terms of survival, but increasingly innovative techniques such as SRS and advanced imaging are offering improved quality of life outcomes. It’s a new way of thinking about neuro-oncology.
Tumours of the brain and central nervous system are a particular specialty for us and we are a specialist independent provider of neuro-oncology in the UK and a centre of excellence for stereotactic radiosurgery (SRS).
SRS at Oxford – Elekta Versa with Brainlab Exactrac
At our Oxford centre SRS is delivered using Brainlab Exactrac, a fast and highly accurate visualisation and patient position monitoring system that is seamlessly integrated with a state-of-the-art Elekta Versa linear accelerator. It is installed alongside the specialist treatment planning system. It employs two low-dose X-ray images, which are captured from two different angles. They are compared and matched with simulated X-rays taken directly from 3D CT data used for treatment planning. A robotic treatment table adjusts for patient position with sub-millimetre movements – maintaining the accuracy of the procedure and ensuring the radiation treatment dose is delivered as prescribed.
Due to the large number of patients treated, our experienced dosimetrists and clinical teams are experts in precise dose planning and efficient patient set-up. This ensures smooth and professional patient care, with no waiting around.
SRS at London – Gamma Knife Icon
At our new GenesisCare radiotherapy centre at Cromwell Hospital in London, we have installed the latest Leksell Gamma Knife Icon. This next generation system has the flexibility to enable more personalised, high-dose treatment plans across a wide range of patient type. It builds on the established precision of Gamma Knife, offers new technology to enable single or fractionated frame-based or frameless treatments with the same precision and accuracy.
The system is integrated with all components, including a 3D cone-beam CT, built on the same rigid structure and calibrated to one another to improve precision. During treatment, real-time motion management monitors the patient with a resolution of 0.15mm. If the patient moves outside a pre-set limit, beam delivery automatically turns off. These features lead to the increase in precision and accuracy. Studies have demonstrated that Gamma Knife Icon can deliver a 2-4x lower dose to the normal brain, when compared with earlier systems.2
Our multi-disciplinary structure is pivotal to our neuro-oncology service. Bringing together the expertise of neuro-radiologists and neuroimaging scientists, alongside neuro-oncologists and neurosurgeons, we can tailor care to every patient and optimise outcomes for high risk cases.
To facilitate this in an independent setting, we have established a bespoke neuro-oncology eMDT platform which allows peer-to-peer collaboration, accessible at any time. The eMDT enhances clinical processes, using real-time data tracking and video to enable the neuro-oncology team and wider clinical teams to discuss patient care plans while protecting the flow of sensitive data. It will also audit decision-making and outcomes data within a best practice framework. We are the first independent provider to implement a fully integrated eMDT for neuro-oncology.
Referring clinicians are invited to participate in our eMDTs.
We are committed to creating an environment of clinical excellence for SRS and neuro-oncology services. Our protocols are adapted from international best practice and overseen by a core team of specialists, selected on the basis of their extensive experience and high-quality credentials. Their key role is to align the neuro-clinical service with evidence-based treatments such as SRS to ensure safe, consistent care across all of our centres. This robust forum guides all aspects of clinical governance, patient selection, peer review, education, research and assessment of new clinicians to the neuro-oncology team. In particular, the Neuro-oncology Advisory Team form the backbone of our eMDT system – a multidisciplinary teamworking platform that connects our experts with a wider group of referring clinicians to discuss and review patient care.
The Neuro-oncology Advisory Team reviews all referrals and assesses suitability for SRS.
Patient safety is at the heart of what we do
We are CQC inspected and have a comprehensive governance framework that ensures safe treatment protocols, evaluates consultant practising privileges and reviews cases outside standard treatment protocols.
If you would like further information about our Oxford neuro-oncology service, please contact Megan Thomas (Referrer Engagement Manager):
07867 134 583
If you would like further information about our London neuro-oncology service, please contact Younan Estefanos (Referrer Engagement Manager):
07880 338 689
GenesisCare is a global organisation and the UK’s leading independent provider of advanced and innovative radiotherapy and cancer therapies. We collaborate with health professionals who share our vision to ensure fast access to world-class cancer care and our strategy is to invest early in new, evidence-based modalities that hold potential for improved life outcomes.
Tumours of the brain and central nervous system, both benign and cancerous, are a particular area of expertise for us as a specialist independent provider of neuro-oncology in the UK and a centre of excellence for stereotactic radiosurgery (SRS). We have invested heavily in SRS technology and expertise as part of an end-to-end pathway that includes early detection, treatment, close monitoring and follow-up.
In 2020 we announced the launch of our SRS services at our GenesisCare Centre for Radiotherapy at Cromwell Hospital in London, which includes our state-of-the-art Gamma Knife Icon, and innovative protocols for benign brain conditions, delivered through a team of leading clinicians.
We also welcome enquiries from any neurosurgeons, oncologists or related specialists who wish to partner with us by applying for practising privileges with GenesisCare.
Gamma Knife radiosurgery is a non-surgical radiation therapy and a well-established SRS technique that delivers large doses of highly targeted radiation to treat tumours and benign conditions including:
SRS, often described as brain area-sparing surgery, is an advanced approach that uses high-quality imaging to deliver precisely-focused radiation beams at high doses in a single or few short treatments. This permits the maximum conformal dose delivery within the targets while minimising dose to the surrounding unaffected tissue preserving important brain function.
SRS is well tolerated by patients, making the list of exclusions minimal. Patients can be referred to our Neuro-oncology Advisory Team for review and assessment. Referring clinicians are involved in decisions and are assured a fast response with MDT recommendations. SRS may not be suitable if the treatment area includes important nerves which could be accidentally damaged or the volume of disease is more than 20cc.
Our specialist radiotherapy centre at Cromwell Hospital offers the most advanced Leksell Gamma Knife Icon system for SRS, enabling a new level of accuracy in a single or fractionated dose. This next generation system has the flexibility to enable more personalised, high dose treatment plans across a range of patient types. It builds on the established precision of Gamma Knife and has the technology to enable single or fractionated frame-based or frameless treatments.
The Gamma Knife Icon is integrated with all components including a 3D cone-beam CT, built on the same rigid structure and calibrated with the Icon to improve precision. During treatment, real time motion management monitors the patient with a resolution of 15mm. If the patient moves outside a pre-set limit, beam delivery automatically turns off. Gamma Knife Icon can deliver a two to four times lower dose to the brain compared to earlier systems1.
We work with a team of neuro-oncologists, neurosurgeons, and neuro-radiologists, who have extensive experience of the Gamma Knife system and can optimise treatment for every patient.
1. Ma L et al., 2014; Int J CARS; 9:1079-1086
At GenesisCare we use advanced diagnostics and treatment planning techniques, such as fMRI and diffusion tractography, to personalise treatments and improve quality of life outcomes for benign brain tumours. fMRI and DTI are currently available in our Oxford centre. Patients can be referred from other centres as required. When required, we will help our patients with transport.
A non–invasive MRI technique, fMRI, is used to locate eloquent brain tissue related to speech, vision, movement, etc. It is used to guide neurosurgical planning and tailor surgery for intrinsic brain tumours to avoid neurological deficit and improve patient outcomes.
With the increasing neuro-oncological benefits of surgery for brain tumours, fMRI offers further potential applications to measure brain recovery processes to optimally stage and monitor treatments. In addition, patients are offered a complementary MRI technique called diffusion tensor imaging (DTI). This imaging scan provides assessment of tissue microstructure and we use tractography to provide a 3D visualisation of neural tracts and the brain’s connectivity. This provides additional information about the location of important pathways for speech, movement, vision and other behaviours important for patient quality of life, whereas conventional MRI techniques provide only anatomical information.
This service is not generally available at other providers.
Approach 1: DTI to determine proximity of tracts. Approach 2: fMRI to determine proximity of language activity
Gamma Knife radiosurgery is well established and offers high levels of patient acceptance. It is not painful and can be delivered in a single, outpatient session and completed in a few hours, allowing patients to quickly return to their normal life.
The meticulous planning and treatment processes involved in SRS at GenesisCare, together with the reduction in radiation to the healthy brain help to minimise side effects. Not everyone experiences side effects but the patient’s risk may be affected by their general health, other treatments they may have had or the location of the lesion or tumour. Some patients may experience short-term side effects which usually disappear within a few weeks of treatment.
The treating clinician will discuss potential side effects in detail with the patient as part of informed consent. Around <10% of people notice long term side effects which are related to the treatment area within the brain. These may include:
We are committed to creating an environment of clinical excellence for SRS. Our protocols are adapted from international best practice and overseen by a core team of specialists, selected on the basis of their extensive experience and high-quality credentials. Their key role is to align the neuro-clinical service with evidence-based treatments such as SRS to ensure safe, consistent care across all of our centres.
This robust forum guides all aspects of clinical governance, patient selection, peer review, education, research and assessment of new clinicians to the neuro-oncology team. In particular, the Neuro-oncology Advisory Team form the backbone of our eMDT system – a multidisciplinary teamworking platform that connects our experts with a wider group of referring clinicians to discuss and review patient care.
Patient safety is at the heart of what we do. We have a comprehensive governance framework that ensures safe treatment protocols, evaluates consultant practising privileges and reviews cases outside standard treatment protocols.
Our multidisciplinary structure is pivotal to our Gamma Knife radiosurgery service. Bringing together the expertise of neuro-radiologists and neuroimaging scientists, neurosurgeons and neuro-oncologists, we can tailor care to every patient and optimise outcomes for high-risk cases.
To facilitate this in an independent setting, we have established a bespoke eMDT platform which allows peer-to-peer collaboration, accessible at any time. The eMDT enhances clinical processes, using real-time data tracking and video to enable the neurology team and wider clinical teams to discuss patient care plans while protecting the flow of sensitive data. It will also audit decision-making and outcomes data within a best practice framework. We are the first independent provider to implement a fully integrated eMDT for neuro-oncology.
We have been at the forefront of introducing the routine use of DIBH for all left-sided breast cancer patients. We are the first independent oncology provider in the UK to formally implement DIBH for right-sided breast cancers, as standard.
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.
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 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.
Non-melanoma skin cancer (NMSC) is the most common cancer in the UK. Although it can arise in isolation, a significant group of patients have extensive skin field cancerisation (ESFC) where pre-cancerous lesions (actinic keratosis) pre-exist with cancerous lesions – basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). This carries a high risk of recurrence of pre-cancerous and cancerous lesions, requiring repeated treatment over many years. The ongoing risk of skin cancer and the physical and cosmetic impacts of disease and interventions can affect the patients’ quality of life.
Although new BCC or SCCs tend to be treated focally, a field-directed approach is optimal for patients who have substantial field UV damage with multiple AKs. Radiotherapy treatment is indicated for moderate to severe degrees of skin cancerisation where topical treatments are ineffective or intolerable in managing ESFC. It may also be used when multiple surgical excisions have made the patient surgically ‘weary’.
Recently, modern radiotherapy techniques such as Volumetric Modulated Arc Therapy (VMAT) have been used in countries, including Australia, for management of ESFC with positive outcomes. This highly conformal technique gives a more homogenous dose delivery and effectively treats large areas of skin while sparing deep tissue from toxicity, even in highly curved areas, such as whole arms or legs. It can also be used where the skin surface overlies organs that could be harmed by radiotherapy, for example, the scalp while sparing the brain tissue from irradiation.
Based on the wide experience and success of this modality by our parent company in Australia, GenesisCare has introduced VMAT to the UK for the treatment of ESFC. We are the first provider in the UK to offer this treatment as part of our evidence-based approach to introducing advanced and innovative treatments.
In Australia, more than 4000 patients have been treated with radiotherapy for ESFC and a registry has been established to monitor the safety and efficacy outcomes.
A retrospective study of 41 patients with a total of 63 treatment fields for ESFC and 12 months after radiotherapy found that 86% of patients showed complete clearance of fields after their treatment and no cases of invasive cancers were observed.1 However, eight new skin lesions were identified in seven fields, seven cases of Actinic Keratosis and one of Bowen’s disease. Additionally, 98% of patients graded cosmesis as “excellent” or ”good”.
The VMAT skin service has been developed in collaboration with our parent company in Australia, where more than 4,000 patients have been treated. Protocols are reviewed by our UK Clinical Governance Committee and are delivered through the Skin Clinical Reference Group, selected for their expertise and experience of skin radiotherapy treatments.
We are always looking to collaborate with talented consultants.
As a dermatologist, plastic surgeon or related skin cancer specialist, we invite you to partner with us. We welcome requests from individuals and academic institutions to access our state-of-the-art equipment and clinical support for treatment and research. You can also build your knowledge and network with peers at our many CPD events.
Please make an enquiry for further information about partnering with us.
We design our care to help give patients the best possible life outcomes. Which is why we offer rectal spacers as part of our standard pre‑radiotherapy treatment, at no extra cost to patients or their insurers.
Rectal spacers are a game changer in reducing the effect of toxicity to normal tissues such as the bowel. The spacer 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, therefore reducing bowel, urinary and sexual function related side effects.
The rectal spacer lasts for the entire course of prostate radiotherapy treatment and is completely absorbed by the patient’s body over time.
The rectal spacer creates space between the prostate gland and rectum, enabling a more accurately targeted radiation dose to the prostate while avoiding unnecessary radiation to healthy organs and tissue.
Studies have shown that using rectal spacers in men undergoing radiotherapy for prostate cancer is safe and effective and has been NICE-approved since 2017. By creating perirectal space, the rectal spacer reduces rectal irradiation and results in fewer patient-reported declines in bowel, urinary and sexual function, and improves quality of life (QOL).[2-7]
A rectal spacer insertion is a minimally invasive procedure that takes around 30 minutes.
Our urologists use a needle to insert the rectal spacer between the prostate and the rectum using an ultrasound guided transperineal approach. The rectal spacer stays in position during the radiotherapy treatment cycle then naturally biodegrades to be absorbed by the body over time.
The procedure is routinely performed under local anaesthetic at a number of our outpatient centres as a safe and convenient alternative to having the insertion under general anaesthetic within a hospital environment.
We accept referrals for patients receiving prostate radiotherapy treatment within the GenesisCare network, or from patients just wishing to self-fund the rectal spacer insertion.
Insertions are still available as a day case procedure, performed by urologists within the GenesisCare network at a number of our national partner hospitals, located throughout the UK.