The Royal Marsden

A better outlook

Our Neuro-oncology Unit offers a range of clinical trials, pioneering radiation treatment and advanced imaging techniques, and is treating more patients than ever before.
Staff preparing CyberKnife machine wearing masks

Staff preparing CyberKnife machine

Advances in immunotherapy and other targeted treatments in the past decade have hugely improved the long-term survival prospects for patients with cancers that can spread to the brain, including breast, melanoma and lung cancers.

The Royal Marsden’s Neuro-oncology Unit is treating more and more patients who experience secondary disease in the brain – or brain metastases – with stereotactic radiosurgery (SRS). We are the referral centre for 15 NHS trusts in southwest London and the southeast of England, so six in 10 of our patients come from other trusts.

Our two CyberKnife machines, funded by The Royal Marsden Cancer Charity, have been pivotal in delivering SRS treatment. With one CyberKnife in Chelsea and another in Sutton, we are now one of the largest SRS services in the country, treating 400 patients a year.

Living longer

Dr Nicola Rosenfelder, Consultant Clinical Oncologist (pictured below), explains that patients are living longer with cancer, so more are developing brain metastases – and greater access to MRI scanning means more are diagnosed earlier.

“Important advances in treatment precision enable us to use higher radiation doses in fewer sessions to deliver more effective treatment with few or no side effects, allowing patients to get back to living normal lives quickly,” she says.

“Just a few years ago, the life expectancy for patients with brain metastases would have been a few months and the treatment had significant side effects. With these improvements, survival can now be measured in years, with excellent quality of life.

“SRS is so precise that we can safely treat many small metastases in one session and can also repeat treatments if needed.”

The unit’s work in treating primary tumours has also expanded. There is a focus on increasing the number of clinical trials and establishing a brain tumour biobank to enhance research into new treatments.

We were also the first trust in the UK to use Brainlab technology for patients undergoing MRI scans to help us identify precisely how radiotherapy is affecting the brain.

Dr Nicola Rosenfelder and Dr Liam Welsh

Centre of excellence

This breadth of treatment options and collaborative work helped us to secure the Tessa Jowell Centre of Excellence status last year, in partnership with St George’s University Hospital and Royal Surrey County Hospital. We were one of only nine centres in the UK to receive this recognition.

Dr Liam Welsh, Head of the Neuro-oncology Unit (pictured above), says: “For patients with tumours such as glioblastoma, the risk of recurrence in the first year is common. We now routinely use molecular profiling to see if there is a suitable targeted treatment available on one of our clinical trials.”

Consultant Medical Oncologist Dr Juanita Lopez has been instrumental in recruiting patients to early-phase trials, including the trial of the drug lisavanbulin in the Oak Foundation Drug Development Unit, which could lead to the first-ever targeted brain cancer treatment.

“We were the lead recruiter for glioblastoma patients with FGFR mutations in the RAGNAR study of the drug erdafitinib, and we are opening the INDIGO trial of vorasidenib, which could transform treatment for patients with IDH mutations,” adds Dr Welsh.

“We also have another trial due to open for newly diagnosed glioma patients that could replace first-line chemotherapy treatment for these patients in the future.”

Darrell McDonald

Patient, 41

Darrell McDonald

“In June 2020, I was diagnosed with a sarcoma in my neck, which had spread to my lungs. After having chemotherapy, I started experiencing some clumsiness and was given a brain MRI, which confirmed I also had a couple of metastases in my brain.

“I was referred to Dr Nicola Rosenfelder, who explained that I would need radiosurgery using the CyberKnife. It was possibly the most straightforward of all my cancer treatments and I had a great response.

“When the symptoms came back much worse at Christmas, I had whole-brain radiotherapy and again had a good response. I am now starting chemotherapy for my primary tumour.

“I know my cancer is incurable, but I have the mindset that if I keep going as I am, there may well be a breakthrough for me.”

Supported by The Royal Marsden Cancer Charity

rm cancer charity logo

The Royal Marsden Cancer Charity raises money solely to support The Royal Marsden, a world-leading cancer centre.  It ensures Royal Marsden nurses, doctors and research teams can provide the very best care and develop life-saving treatments, which are used across the UK and around the world. From funding state-of-the-art equipment and ground-breaking research, to creating the very best patient environments, The Royal Marsden Cancer Charity will never stop looking for ways to improve the lives of people affected by cancer.