SABR year in review

The last year has seen several significant milestones for the GenesisCare SABR service. I’d like to bring you up-to-speed on all the developments and look ahead to the coming year.

SABR – an area of exponential growth

GenesisCare has just received its 200th SABR referral, with a doubling of SABR numbers indicating that this treatment has entered mainstream clinical consciousness as a standard of care for the treatment of oligometastases – especially in the era of COVID19. Some of the impetus has come from NHS England’s successful commissioning through evaluation process – but also from the long term follow up data on the SABR-COMET trial, a randomised phase 2 study which showed that SABR was associated with an impressive improvement in 5 year overall survival from 28 months to 50 months. Whilst larger studies are needed to confirm the benefit, the totality of phase 2 trial outcome data now makes a compelling case for the non-invasive ablation of oligomets and primary tumours in the prostate, pancreas, liver and lung.

Access to Simple SABR

Over 60 consultant colleagues practising at GenesisCare have now been credentialled in the delivery of SABR for peripheral lung, non-spine bone, and pelvic lymph node metastases. They are able to treat their patients with peer review support from the SABR Advisory Team at every GenesisCare centre. All clinicians and their patients continue to have access to Complex SABR (liver, spine, pancreas, central lung, reirradiation) via Project Primrose, with many of these cases being treated on the MRIdian MR-linac at GenesisCare Oxford. Colleagues with demonstrable Complex SABR experience can also treat their patients according to GenesisCare protocols. Further credentialing workshops will be available online – please contact Judy Harris to register your interest.

The most advanced platform for Complex SABR

MRIdian offers the vastly increased soft tissue definition of MRI, along with automatic beam gating and a fully adaptive consultant-led workflow for every fraction. In the first nine months of operation over 100 patients have been treated, with five-fraction prostate SABR along with a variety of complex abdominal targets benefiting from this approach. GenesisCare became the first UK healthcare provider to treat liver, pancreatic, lung and spine tumours with MR-guidance. The network is expanding through a programme of clinician credentialing, with the initial focus being on prostate and lung cancer. Our indications are expanding to include renal cancers,  prostate reirradiation, and single fraction lung – all of which leverage the MRIdian advantage. Clinical trial access is imminent in partnership with the Oxford Institute of Radiation Oncology. In Spring 2021 we will launch our second MRIdian MRL service at the Cromwell Hospital in London.

Clinical governance

Our SABR Advisory Team of experienced, innovative SABR practitioners has grown and now includes oncologists from the Midlands, the East of England, the South East, Oxford and London. Radiographers in every centre have undergone a comprehensive programme of refresher training in IGRT delivery, supported by our lead SABR radiographer, and the SABR MDT Coordinator has supported the twice weekly SAT review process. We’ve listened to your feedback by refining the pathway, by establishing a live on-line MDT for complex cases, and by making it even easier to refer and treat SABR patients whilst ensuring that quality and safety are maintained.

New technology, new services

The recent go-live of the Varian Edge radiosurgery platform and the imminent launch of the Gamma Knife Icon service in London will mean that GenesisCare will have an unrivalled in-house range of stereotactic radiotherapy platforms, meaning that all patients have access to the technological solution that best suits their clinical problem. In the near future we’ll be announcing a further evolution of the neuro-oncology service – so please watch this space.

As always, I’d be keen to hear your feedback and ideas for how we can continue to grow the SABR service, so please don’t hesitate to get in touch.

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James Good
Clinical Director – Stereotactic Radiotherapy

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