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How do I refer

Metastatic lesions

This is done via the 'refer a patient' system to the neurosciences MDT meeting - which is held every Tuesday morning.

The general criteria for consideration of treatment are:

  • patient must have a known diagnosis - specific cancer i.e. pathological confirmation
  • patient will need to be of good performance status i.e. Karnofsky 70 or greater (please see table below)
  • patient must have support of local site - specific cancer MDT for treatment (evidence of this should be included in the referral)
  • patient must have a total tumour volume of 20cc or less on imaging (MR criteria)
  • patient must not have had SRS within three months to any site (previous fractionated whole brain radiotherapy does not preclude SRS treatment)
  • patient must not have had SRS to this specific site within 6 months
  • patient must have no evidence of, or has controllable, extrancranial disease
  • patient must have a projected survival from extracranial disease of greater than 6 months
Karnofsky performance scale
 100   Normal; no complaints, no evidence of disease
90   Able to carry on normal activity; minor signs or symptoms of  disease
80  Normal activity with effort, some signs or symptoms of disease
70  Cares for self; unable to carry on normal activity or to do active  work
60   Requires occasional assistance but is able to care for most  personal needs
50   Requires considerable assistance and frequent medical care
40   Disabled; requires special care and assistance
30   Severely disabled; hospitalisation is indicated, although death not  imminent
20   Very sick; hospitalisation necessary; active support treatment is  necessary
10   Moribund; fatal process
  0  Dead

Additional information ideally available within referral

  • co-morbidity
  • details of any previous radiotherapy and any systemic therapy
  • medication and allergies
  • history of condition including symptoms
  • relevant social information
  • preferred contact method for patient (letter,call,email)
  • names of other consultants involved in the patient's care

Referral and treatment overview

All referrals will be discussed at MDT and if suitable will be offered an appointment in the SRST clinic.

  • The patient must be made aware that this is a rapid turn-around system and if we consider them potentially suitable for SRS or SRT, we will need to see them in the dedicated SRST clinic at the Wessex Neurological Centre on the Friday afternoon of the same week as the MDT.
  • The patient will require a treatment shell (radiosurgery mask) and CT scan to be performed either on that Friday or the following Monday.
  • All patients will require a MR scan to be performed on the Monday

If transport from more distant areas is a problem, it may be possible to stay over the weekend at Jury's Inn (hotel accommodation) - however, this must be highlighted at time of referral.

  • We will confirm the patient appointment directly after the MDT meeting, both via the contact telephone number provided and also in writing to the referrer and GP.
  • It will be scheduled for the patient to receive treatment as soon as possible after planning, but at the latest we aim to have delivered this within two weeks of the clinic visit.
  • We will act as the patient's key worker from the time of clinic agreement until completion of therapy - after which we will transfer this role back to you.
  • The patient may be given a course of steroids (or even anticonvulsants) and we will ensure that instructions for duration and/or withdrawal of these drugs are given to the patient as well as to yourself. A formal end of treatment summary will be sent with the patient and will include requirements and recommendations for further imaging.

We will be available for advise following treatment via the SRS/SRT mobile 07766 726733

It's essential for local and national audit purposes that we get clear outcome data in terms of survival and require you to inform us of date of death as soon as possible. We also need to be informed of any local recurrences or treatment-related toxicity.

Non-metastatic lesions

The pathway is very similar, although the referral is to the most appropriate MDT team. For example:

  • supratentorial meningiomas to the neuroscience MDT as above
  • skull base lesions to the skull base MDT
  • pituitary tumours to the pituitary MDT team

As the pathway here may be somewhat longer, these patients may not be seen in the Friday SRS clinic, and may be better served in a joint clinic instead - especially if there are potential surgical options to discuss. The patient will be allocated an appointment in the most appropriate clinic.

The key worker for these patients will generally be the clinical nurse specialists working in the assigned area of neuro-oncology.

Meet the team

If you are unsure who to contact, please email us on srst@uhs.nhs.uk

Doctors

  • Dr Enrico Clarke
  • Dr Heng Jeng Ching
  • Dr Eleni Simpson
  • Dr Georges Sinclair
  • Dr Ruth Carr

Advanced practitioner radiographers

  • Emma Johnson
  • Jay Kee-Pinner (interim to cover Emma Johnson)
  • Jasdeep Kalyan