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A new way of thinking Neuro- oncology
A new way of thinking
Neuro- oncology
Specialist outpatient oncology centres 2
GenesisCare is a global organisation and the UK’s leading independent provider of advanced and innovative radiotherapy and cancer therapies. We are the first independent provider of neuro-oncology in the UK and a centre of excellence for stereotactic radiosurgery (SRS). In the last year we have invested over £20m in an end-to-end solution that involves brain-sparing technologies and innovative protocols, delivered through a team of leading clinicians at our centre in Oxford.
We’re treating the whole patient, not just the tumour
World-class neuro-oncology service 3
New and better ways 4
eMDT 5
Stereotactic radiosurgery 6
A focus on clinical excellence in delivering neuro-oncology 7
Our centres 8
Refer to us 9
SRS vs WBRT: evidence summary 10
fMRI: evidence summary 11
Specialist outpatient oncology centres 3
Diagnostics
We provide a full neurological diagnostic pathway.
3T MRI
Powerful MRI modality for early detection and close monitoring of brain metastases.
Functional MRI (fMRI)
A non-invasive MRI technique, able to predict certain cognitive and neurological outcomes after surgery.Our centre in Oxford also offers PET/CT and genetic and genomic testing.
World-class neuro-ocology serviceAdvanced radiotherapy
Stereotactic radiosurgery (SRS)
We are a centre of excellence for stereotactic radiosurgery used to treat small brain tumours and functional abnormalities of the brain. This evidence-based approach can result in significantly less cognitive deterioration in patients with one or multiple metastases.
In collaboration with the Cromwell Hospital in London, GenesisCare is installing London’s newest and most advanced Elekta GammaKnife ICON system which will create an additional treatment option if required.
Chemotherapy
A full range of systemic anticancer therapies in private, individual chemotherapy suites.
Mixed reality
In a world-first partnership with Brainlab and Magic Leap, we use mixed reality to visualise brains scans in 3D format – offering reassurance to patients by unravelling some of the complexities of brain tumour treatment.
Patient care
Fast referrals
New patient referrals to our neuro-oncology service will be seen within 48 hours.
Patients ready for radical treatment within five days of scanning and within two days for palliative patients.
Same-day scanning, planning and treatment on request.
Multidisciplinary team-working
We provide a complete end-to-end care pathway for neuro-oncology directed through a bespoke eMDT platform.
Patient care
Transport and accommodation provided for radiotherapy patients, one-to-one cancer nurse specialists, highly skilled treatment radiographers, triage and acute admissions. We believe care should be focused on an individual, not just their cancer.
Research and governance
Pathways are designed around evidence-based protocols, using clinical trial research and data insights.
Clinical governance
Our neuro-oncology service is overseen by a world-class team of clinicians. A comprehensive governance framework ensures safe treatment protocols, evaluates consultant practising privileges and reviews cases outside standard treatment protocols.
Our centre in Oxford is rated ‘Outstanding’ by the Care Quality Commission (CQC)
Our unique partnership with the Penny Brohn UK charity supports patients to achieve clinically significant improvements in wellbeing.
The Brainlab ExacTrac patient-friendly SRS mask and 6D robotic couch ensures pinpoint accuracy.
Specialist outpatient oncology centres 4
New and better ways Functional MRI
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.
fMRI offers potential further applications to measure brain recovery processes, to optimally stage and monitor treatments.
We are the first private service to offer this to our patients in the UK.
In addition, patients are offered a complementary MRI technique called diffusion tractography imaging which provides additional information about the location of important brain pathways.
Stereotactic radiosurgery
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.
Advanced treatments as standard 1. Brown et al., 2016; JAMA; 316 (4):401–409.
Specialist outpatient oncology centres 5
We are the first independent provider to implement a fully integrated eMDT for neuro-oncology.
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.
Multidisciplinary teamworking is at the heart of excellent patient care in cancer management. 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.
eMDTPeer-to-peer team-working in a secure environment
Stereotactic radiosurgery - a gold standard treatment
Brain metastases 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.¹ SRS is routinely used in re-irradiation after brain radiotherapy or previous SRS. SRS is also indicated for: Meningiomas, acoustic neuromas and primary pituitary tumours. Other non-cancer conditions Non-cancer, eg. arteriovenous malformations, complex trigeminal neuralgia.
Specialist outpatient oncology centres 6
GenesisCare has experience of managing a wide range of brain and CNS tumours. 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 within five days.
1. Chao T. et al., Stereotactic Radiosurgery in the Management of Limited (1–4) Brain Metasteses: Systematic Review and International Stereotactic Radiosurgery Society Practice Guideline. Neurosurgery, Volume 83, Issue 3, September 2018, Pages 345–353.
Puneet Plaha Consultant Neuro-oncology surgeonOxford
Neuro-oncology surgeon with special interest in awake surgery and minimally invasiveendoscopic brain tumour surgery
Luis Aznar-Garcia ConsultantClinical Oncologist Nottingham, Oxford Neuro-oncologist specialised in Stereotactic radiosurgery (brain and spine). SABR oligometastases,HpB and breast cancer
Pieter Pretorius ConsultantNeuroradiologistOxford
Diagnostic imaging of conditions of the CNS, spine, head and neck region, including ENT and orbital conditions
Fintan Sheerin Consultant NeuroradiologistOxford
Diagnostic imaging of conditions of the CNS, spine, head and neck region
Richard Stacey Consultant NeurosurgeonOxford
Neuro-oncology and epilepsy
Natalie Voets Neuroimaging Scientist Oxford
MRI, fMRI, tractography
A focus on clinical excellence in delivering neuro-oncologyOur 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.
The Neuro-oncology Advisory Team review all referrals and assess suitability for SRS.
The Neuro-oncology Advisory Team:
Specialist outpatient oncology centres 7
Meera Nandhabalan Consultant Clinical OncologistOxford
Neuro-oncologist specialised in stereotactic radiotherapy, gliomas and benign tumours
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Our centres
We provide free transport for radiotherapy patients and Theranostic treatments to and from all areas in the UK, including the Channel Islands. We can also arrange accommodation if needed.
GenesisCare is recognised by all private medical insurers including Bupa, AXA PPP, Aviva and Vitality.
Patients can be referred to our Oxford neuro-oncology centre from anywhere in the UK or overseas
Our London neuro-oncology centre is currently undergoing refurbishment and will be re-opened in Spring 2020.
1 Nottingham2 Birmingham3 Cambridge4 Milton Keynes 5 Oxford6 Elstree7 Chelmsford
8 Bristol9 Windsor10 London11 Guildford12 Maidstone13 Southampton14 Portsmouth
Specialist outpatient oncology centres 8
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5 OxfordT 01865 224 865 F 01865 770 016 • • • • • • • • • • •
10 LondonT 0207 4605 626 F 0207 4605 622 • • • • • • • • • •
•• On site at GenesisCare • At local partner hospitals • Coming soon
GenesisCare neuro-oncology services
A focus on you
Tumours of the brain and
spinal cord
Patient Neuro Oncology Brochure_A5 Protrait_V9.indd 1Patient Neuro Oncology Brochure_A5 Protrait_V9.indd 1 22/11/2019 13:4622/11/2019 13:46
Refer to usDownload our patient brochure here
To refer to one of our neuro-oncology specialists: 01865 224 [email protected]
If you would like further information about our neuro-oncology service, including a site visit or meeting with our team, please contact Jen Ayling (Referrer Engagement Manager): 07881 093 059 [email protected]
Partner with us
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 and free consultation rooms.
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 with over 300 education and engagement events per year.
For more information, please contact:[email protected]
GenesisCare is a trading name of Genesis Cancer Care UK Limited. Registered Office: Wilson House, Waterberry Drive, Waterlooville, PO7 7XX. Company registration number: 05796994. Registered in England & Wales.
Specialist outpatient oncology centres 9
A summary of the evidence
Whole brain radiation therapy (WBRT) was the standard treatment for patients with multiple brain metastases but the associated cognitive decline and limited tumour control has spurred technical developments aimed at improved outcomes. Stereotactic radiosurgery (SRS) is a highly advanced approach that permits maximum dose delivery within the target(s) while minimising dose to the surrounding unaffected brain. The aim is to destroy the tumour and achieve permanent local control. Although WBRT with SRS has been shown to result in less frequent intracranial tumour progression than using SRS alone, numerous studies have failed to show any significant difference in overall survival rate for patients treated with SRS alone. The overriding question then is whether tumour progression in the brain is more detrimental to a patient’s wellbeing than the potential deterioration of cognitive function and quality of life (QoL) associated with WBRT.
References 1. Brown et al., 2016; JAMA; 316 (4):401-409.
SRS vs WBRT: evidence summaryCan we abandon whole brain radiotherapy?
A multi-institutional randomised clinical trial was carried out in 213 patients (SRS alone, n=111; SRS plus WBRT, n=102) with a mean age of 60.6 years and with 1 to 3 brain metastases to either receive SRS or SRS plus WBRT.¹ The primary end point was cognitive deterioration and the secondary end points included time to intracranial failure, QoL, functional independence, long-term cognitive status, and overall survival (OS). There was less cognitive deterioration at 3 months after SRS alone in 63.5% of patients (40/63) than when combined with WBRT (91.7% 44/48; P <0.001). SRS alone showed higher QoL at 3 months, including overall QoL (mean change from baseline, −1.3 vs −10.9 points, P=0.002).1 No improvement in survival occurred; median OS was 10.4 months for SRS alone and 7.4 months for SRS plus WBRT.1 This suggests that SRS alone may be a preferred strategy for patients with 1 to 3 metastases.
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fMRI: evidence summary
References 1. Glover et al., 2011; Neurosurg Clin N Am; 22(2):133-139. 2. Brown et al., 2016; JAMA; 316 (4):401-409.
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fMRI facilitates improved cognitive and neurological outcomes
Functional MRI (fMRI) is a non-invasive technique able to indirectly measure brain activity using fluctuations in brain energy demands related to neural signalling.1 It is often used to locate eloquent brain tissue to guide neurosurgical planning. fMRI generally shows high agreement with clinical gold standard tests (such as the amytal test and intraoperative direct brain stimulation) but offers the advantage of being safe and non-invasive. With the increasing neuro-oncological benefits of surgery,2 fMRI offers potential further applications to measure brain recovery processes to optimally stage and monitor treatments.
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