Innovating radiotherapy: 3 years of MRI-guided radiotherapy in the UK

GenesisCare is the first independent healthcare provider to offer the MRIdian MR linac in the UK, establishing our first machine at our centre in Oxford in December 2019. Now, three years on, we look back at what we’ve achieved and what’s next – with our third MRIdian installation coming to Guildford next year.

In 2019, we installed a ViewRay® MRIdian MR linac at our centre in Oxford and became part of the global radiotherapy community that is driving the adoption of MRI-guided radiotherapy (MRIgRT). This was the first MRIdian in the UK.

In the three years since then, we’ve launched another MRIdian at our centre at the Cromwell Hospital in London – the second in the UK – so that more patients from across the UK and Europe can access and benefit from this game-changing technology.

We look to evidence-based research and work with centres around the world to bring best practice to the UK and established new protocols. This means that to date we have been able to treat over 700 patients with a variety of tumour types, stages and grades, who previously would not have had access to this treatment option.

We’ve achieved several UK-firsts using MRIgRT for a range of cancer types, including:

• Localised pancreatic cancer
• Multiple liver metastases, including the simultaneous ablation of five liver metastases
• MRI-guided fully adapted stereotactic ablative radiotherapy (SABR) for renal cancer
• Gastric MALT lymphoma
• MRI-guided prostate cancer re-irradiation and 5# MRI-guided stereotactic radiotherapy for prostate cancer over consecutive days

The full range of cancers we have and continue to treat with MRIgRT includes pancreatic, liver, lung, prostate, including prostate reirradiation, renal, bowel, pelvic and abdominal oligometastases.

MRIgRT is one of the most advanced forms of radiotherapy, demanding a high level of clinician input and a skilled team of radiotherapists, physicists and dosimetrists, to deliver a robust workflow and a completely new way of working. We’ve also trained over 50 doctors on the MRIdian, enabling them to treat more patients on this innovative technology, often providing them with otherwise unavailable options.

We’re particularly proud of The GenesisCare Foundation Compassionate Access Programme (CAP) we ran in partnership with the University of Oxford to provide MRI-guided SABR on the MRIdian, without cost, to NHS patients with localised pancreatic cancer during the Covid-19 pandemic. This was made possible through charitable funding from the GenesisCare Foundation, Pancreatic Cancer Research Fund, and ViewRay.

This programme generated clinical and patient-reported outcome data as a pilot phase prior to dose escalation within an ethically-approved study. This went on to influence the commissioning of SABR for pancreatic cancer in the NHS and informed the design of subsequent randomised clinical trials – including the EMERALD trial to evaluate the safety of delivering five, three and single fraction MRI-guided SABR to the pancreas.

Looking to the future, we will continue to firmly embed MRIgRT in UK oncology practice.

With our third MRIdian launching in Guildford in 2023, and a fourth planned for 2024, our focus, as always, is to provide world-class cancer treatment, and to bring this quality of care to more patients – especially those with few alternative treatment options.

We will continue to build on existing evidence and innovate and adopt techniques that improve outcomes and patient safety. We are currently working with our leading SABR consultants to introduce:

• MRI-guided SABR boost for patients with locally advanced or recurrent gynaecological cancers
• Preoperative short-course radiotherapy (SCRT) in rectal cancer treatment
• MRI-guided SABR for sarcoma
• Lattice radiotherapy on the MRIdian for large tumours

MRIdian SMART (MR-guided stereotactic adaptive radiation therapy) technology has been adopted by some of the world’s leading teaching and public hospitals and is described as a new paradigm in radiation oncology. We are proud to be part of this global community, driving adoption here in the UK, facilitating access and enabling more patients to benefit from this advanced technology.

We look forward to expanding our MRIgRT offering to more patients and more tumour types, as well as building our network of consultants and partners to establish the UK as a world-leader in advanced radiotherapy techniques.

Find more information about the MRIdian at GenesisCare and how to refer here.