The delivery of stereotactic radiosurgery for intracranial metastatic disease: insights from a survey of UK hospitals through the Tessa Jowell academy
King, J. Barker, C. Wright, A. Allen, B. Huskens, N. Cahill, J.
King, J.
Barker, C.
Wright, A.
Allen, B.
Huskens, N.
Cahill, J.
Abstract
AIMS: The use of stereotactic radiosurgery (SRS) to treat patients with intracranial metastatic disease is increasing. Despite efforts to standardise practice across the centres delivering SRS in the UK, evidence suggests that patient selection, treatment volumes, and clinical practice vary significantly. This study aimed to understand the current SRS service provision and identify challenges to support more consistent, high-quality care. MATERIALS ANDMETHODS: In 2023, the Tessa Jowell Academy SRS working group distributed a national survey to centres delivering SRS for brain metastases. The survey covered service configuration, treatment protocols, imaging practices, and challenges. Responses were collected from October 2023 to March 2024, with 20 centres participating (17 in England, two in Scotland, and one in Wales). RESULTS: Substantial variation was reported in service size and delivery. Weekly SRS multidisciplinary team caseloads ranged 3 to 25 patients, and referral rates (adjusted to catchment area) varied five-fold. Most centres used Linac systems (n = 15), followed by Gamma Knife (n = 4) and Cyberknife (n = 3); only two centres had multiple machine types. Six of the 20 centres (30%) referred patients externally, mainly for Gamma Knife treatment. Treatment criteria varied widely: centres treated from ≤5 to >50 lesions, with maximum treated volumes for a single fraction varying substantially. The time from imaging to treatment ranged from within the same day to within two weeks. Variation was also noted in approaches to radionecrosis imaging, treatment margins, and steroid use. The key challenges reported included workforce capacity (reported by 50% of centres), imaging access (40%), and inappropriate referrals (15%). Encouragingly, five centres (25%) reported no major barriers to service delivery. CONCLUSION: The findings highlight a significant variation in SRS practice across the UK. The Tessa Jowell Academy will use these insights to promote standardisation, support clinical teams, and reduce unwarranted variation-ensuring equitable access to high-quality SRS for patients with brain metastases.
Description
Date
2025
Publisher
Collections
Keywords
Type
Article
Citation
King J, Barker C, Wright A, Allen B, Huskens N, Cahill J. The Delivery of Stereotactic Radiosurgery for Intracranial Metastatic Disease: Insights from a Survey of UK Hospitals Through the Tessa Jowell Academy. Clinical oncology (Royal College of Radiologists (Great Britain)). 2025 Oct 6;48:103947. PubMed PMID: 41138680. Epub 2025/10/26. eng.