A new study led by clinicians in Sheffield and Manchester and supported by the Tessa Jowell Academy reveals differences in how stereotactic radiosurgery (SRS), a type of precision radiotherapy, is delivered to patients with a brain tumour.
Published today in the journal Clinical Oncology, the study highlights differences across the UK in which patients receive treatment, how treatment is delivered and how quickly. The insights, collected from 90% of UK sites delivering SRS, will help drive efforts to standardise care so patients can access the best treatment wherever they live.
In brief
- What is SRS? A highly precise form of radiotherapy that targets tumours in the brain while sparing healthy brain tissue.
- What did we do? Collected responses 20/22 NHS centres that deliver SRS for brain metastases.
- What did we find? Marked differences in service size, patient selection, treatment approach and speed to treatment. The most common challenges were workforce capacity and MRI access.
- Why it matters: Where a patient lives may affect if and how they receive SRS. Using these insights, the Tessa Jowell Academy will support teams to reduce unwarranted variation and promote equitable, high‑quality care.
What is stereotactic radiosurgery (SRS)?
SRS is a way of delivering highly focused beams of radiation to brain tumours, usually in one or a few sessions. It is now commonly used to treat brain metastases—tumours that have spread to the brain from cancers elsewhere in the body. Compared with older techniques like whole‑brain radiotherapy, SRS can better protect memory and thinking by avoiding healthy brain tissue. Not all patients with brain metastases are suitable for SRS. For example, patients with a large volume of brain metastases, uncontrolled disease outside of the brain or poor fitness have not been shown to benefit.
A stereotactic radiosurgery unit in a UK radiotherapy centre. These highly specialised machines enable clinicians to deliver focused, high-dose treatment to brain tumours, but new national findings show that how and when patients access SRS can still depend on where they live – strengthening the need for more standardised pathways and consistent eligibility criteria across the country.
What we did
In 2023–24, clinicians in the Tessa Jowell Academy SRS Working Group designed and ran a national survey asking centres about:
- How many patients they see and treat
- Which patients are eligible (e.g., how many tumours can be treated in one go)
- How treatment is planned and delivered (machines used, dosing, margins) –
- How long patients wait from scan to treatment
- Any challenges in the way of delivering care
Twenty centres responded: 17 in England, 2 in Scotland and 1 in Wales.
What we found
1) Service size and activity vary five‑fold – even accounting for population size
- Weekly SRS multidisciplinary team (MDT) meetings discussed 3 to 25 patients per centre, and the proportion referred on for treatment ranged from 1 in 5 to 4 in 5.
- Even after adjusting for population size, referrals varied five‑fold between centres.
Why it matters: Some areas appear to treat more patients than others, suggesting different local thresholds and processes. This may also reflect differences in patient fitness between areas.
2) Which patients are selected for SRS isn’t consistent
- Maximum number of tumours treated in one patient ranged from ≤5 to more than 50; four centres reported no maximum.
- A minority of centres set a minimum size for a tumour to be treated; where specified, this ranged from 0.002 to 0.8 cm³.
- The largest single tumour treated in one session varied widely (3 to 26 cm³), with most centres using several smaller sessions (fractionation) above their own limits—but schedules differed between centres.
Why it matters: A patient eligible for SRS in one part of the UK might be declined in another unless referred elsewhere.
3) How SRS is delivered also differs
- Most centres use Linac systems; fewer use Gamma Knife or CyberKnife. Only two had more than one type.
- 30% of centres refer some patients externally, often to access a different machine.
- Treatment planning margins, steroid use, and the time from scan to treatment (same day up to two weeks) all varied.
Why it matters: Different approaches may affect waiting times, side‑effects and outcomes.
4) Workforce capacity and equipment access are nationwide challenges
- Workforce capacity (especially radiographers) and MRI access were the top constraints.
- Some centres flagged inappropriate referrals and mismatch between commissioned activity and demand.
Why it matters: Tackling these pressures could reduce delays and enable more consistent care.
A patient is positioned for stereotactic radiosurgery, using a custom head mask and laser-guided alignment to target a brain tumour with millimetre precision. New UK-wide data show that access to and delivery of SRS still varies by location, underlining the case for more consistent standards of care across services.
What this means for patients and the NHS
- The picture suggests a potential postcode lottery for access to SRS.
- Differences can stem from clinical judgement, technology limits and local resources. But where variation isn’t clinically justified, it risks inequity.
- Nationally, there is an opportunity to agree clearer standards, share best practice, and support capacity where needed.
Helen Bulbeck, Director of Services and Policy for the charity brainstrust (one of the TJBCM’s members), commented: “This important study shows both how far we’ve come with stereotactic radiosurgery and how much further we need to go. brainstrust was involved in the first round of commissioning for SRS for primary brain tumours. SRS represents a major advance – offering precision treatment that protects healthy tissue and preserves quality of life. Yet the five-fold variation in referrals between UK centres reveals an uncomfortable truth: where you live still shapes whether you can access this treatment.
The good news is that we now have the insights needed to drive change. By standardising patient selection, streamlining pathways, and tackling workforce pressures, we can ensure postcode no longer determines care. We’ve made remarkable progress – now we must complete the journey to truly equitable access.”
What happens next
The Tessa Jowell Academy, working with key charities and professional bodies, will:
- Collaborate with relevant clinicians and professional bodies to agree areas for standardisation (e.g., selection thresholds, fractionation approaches, imaging intervals)
- Support centres to streamline referral pathways and reduce time from scan to treatment
- Work with partners on workforce and imaging capacity initiatives
- Share tools, templates and case studies to help teams compare and improve services
Our aim: no matter where you live in the UK, if SRS is right for you, you can access it quickly and consistently.
Who led the work
This study was designed and conducted by a team from The Christie NHS Foundation Trust, Sheffield Teaching Hospitals, and the Tessa Jowell Brain Cancer Mission.
Author list: Jennifer King1 , Claire Barker1 , Andrew Wright2 , Bryony Allen2 , Nicky Huskens,2 Julian Cahill3
- Christie NHS Foundation Trust, Manchester, UK; 2. Tessa Jowell Brain Cancer Mission, London, UK; 3. Sheffield Teaching Hospitals, Sheffield, UK.
Contact
For media or enquiries about the Tessa Jowell Academy’s SRS programme, please contact andrew.wright@tessajowellbcm.org.
