Public Release: 

Radiotherapy is 'undervalued' and 'needs greater investment' say experts

At least a quarter of cancer patients across Europe who need radiotherapy don't receive it

European Society for Radiotherapy and Oncology (ESTRO)

7 November 2018, Brussels: Radiotherapy is 'undervalued' and 'needs greater investment' according to a new report published today (7 November 2018*) commissioned by the Marie Curie Legacy Campaign - an initiative of the European Society for Radiotherapy and Oncology (ESTRO) and the ESTRO Cancer Foundation (ECF).2

'Radiotherapy saves lives - either used alone or in combination with other types of cancer treatment,' says report author, Yolande Lievens, Chair of the Department of Radiation Oncology, Ghent University Hospital, and Past-President of ESTRO. 'Currently, radiotherapy is recommended as part of treatment for more than 50% of cancer patients, but across Europe, at least a quarter of people who need radiotherapy do not receive it. This is wholly unacceptable and a missed opportunity for cancer patients.'

Entitled Radiotherapy: seizing the opportunity in cancer care, the white paper recommends a five point plan to boost uptake of radiotherapy and calls on all stakeholders - governments and policymakers, healthcare professionals, patients and professional societies, along with national and international research funds - to become 'radiotherapy ambassadors' to help raise awareness of the benefits of radiotherapy and secure its valuable position in comprehensive, optimal cancer care.

The report's authors cite shortages of high-quality equipment, variations in training, insufficient integration of radiotherapy into treatment plans, lack of investment in research, lack of general understanding of radiotherapy as a cancer treatment and misconceptions regarding the safety of radiotherapy among the important factors contributing to radiotherapy's poor image and underuse.

The report's five key recommendations are:

  • Make radiotherapy a central component of cancer care in policies, planning and budgets
  • Achieve recognition of all radiotherapy professions and harmonise education and training standards across Europe
  • Invest in research and use of data to continuously improve radiotherapy outcomes for patients and maximise the potential of innovation
  • Fully integrate radiotherapy into treatment planning and decision-making
  • Help improve general awareness and understanding of radiotherapy to ensure it can achieve its full potential for patient care

In 2018, 4.23 million people received a cancer diagnosis in Europe3 - and the incidence of cancer is increasing. The demand for radiotherapy is expected to see a 16% increase by 2025.4,5

'Radiotherapy appears to be left on the sidelines of national health policy agendas,' says Lydia Makaroff, Director of the European Cancer Patient Coalition. 'Greater investment, improved access and better understanding of radiotherapy - both at a national and international level - is vital. This will ensure that patients get the best possible and most effective care for their particular type of cancer, leading to better outcomes and more lives saved.'


A full copy of the report can be accessed here:

* The report has been launched to coincide with the anniversary of the birth of Marie Curie, who pioneered research into ionising radiation, which laid the foundation for the use of radiation in cancer treatment.

Note to editors

Key facts about radiotherapy

Radiotherapy is a safe, non-invasive and highly effective cancer treatment, using ionising radiation, predominantly via high-energy X-rays. It is recommended as part of treatment for more than half of cancer patients.

  • At least a quarter of cancer patients who need radiotherapy do not receive it.1
  • By 2035, if every cancer patient who needs radiotherapy has access to it, almost one million more lives worldwide will be saved annually.6
  • Radiotherapy saves lives: 40% of all cancers cured are eliminated by radiotherapy either alone or in combination with other types of treatment.7
  • Radiotherapy is a key part of treatment for many of the most common types of cancer.4,8
  • Radiotherapy can also alleviate cancer symptoms such as pain and improve cancer patients' quality of life.6,9-11
  • State-of-the-art radiotherapy can specifically match the shape of the tumour it is targeting - thus avoiding damage to nearby healthy organs and tissue.12,13
  • Continuous improvements in delivery of radiotherapy have allowed treatment times to be reduced; for example, the time for an average radiotherapy course for breast or prostate cancer has almost been halved in the past two decades.14-18
  • Radiotherapy is not invasive - many patients receiving radiotherapy can still carry on with day-to-day life.8

About the report authors

The report has been authored by a panel of radiation oncology experts from across Europe under the auspices of the European Society for Radiotherapy and Oncology (ESTRO) and the ESTRO Cancer Foundation (ECF):

  • Joanna Kazmierska, Doctor of Radiation Oncology, Greater Poland Cancer Centre, Poznan, Poland
  • Núria Jornet Sala, Medical Physics Senior Consultant, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  • Michelle Leech, Associate Professor of Radiation Therapy, Trinity College Dublin, Ireland
  • Barbara Alicja Jereczek-Fossa, Chair, Department of Radiotherapy, European Institute of Oncology, Milan; Professor of Radiation Oncology, University of Milan, Italy
  • Yolande Lievens, Chair, Radiation Oncology Department, Ghent University Hospital; Associate Professor of Radiation Oncology, Ghent University; Past-President, ESTRO, Belgium
  • John Yarnold, Professor of Radiation Oncology, Institute of Cancer Research, London, UK


ESTRO was founded in 1980, as a non-profit and scientific organisation that fosters the role of radiation oncology in order to improve patients' care in the multimodality treatment of cancer. With over 7,300 members in and outside Europe, ESTRO supports all radiation oncology professionals in their daily practice: radiation oncologists, medical physicists, radiobiologists and radiation therapists and the wider oncology community. 'Radiation oncology. Optimal health for all, together' is the ESTRO vision. ESTRO promotes innovation, research and dissemination of science through its congresses, special meetings, educational courses and publications.

About the ESTRO Cancer Foundation and the Marie Curie Legacy Campaign

The ESTRO Cancer Foundation (ECF) was launched by ESTRO in 2012. Its ambition is to ensure that every cancer patient has access to appropriate and personalised cancer care. The ECF's projects are designed to raise awareness and understanding of radiotherapy. It is instrumental in facilitating research and making the resulting scientific data accessible and understandable to everyone.

The Marie Curie Legacy Campaign, pioneered by the ECF and ESTRO, is a global initiative to raise awareness of the benefits of radiotherapy and optimise the provision of radiotherapy in Europe and beyond.

For more information, visit:

For further information, please contact:

Lynsey Conway
Tel: +447778 304233

Henry Arnold
Tel: +4420 3857 3646 / +447708 220932

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  2. Kazmierska J, Sala NJ, Leech M, et al. 2018. Radiotherapy: seizing the opportunity in cancer care. Brussels: ESTRO and ECF
  3. International Agency for Research on Cancer (IARC). Global Cancer Observatory. 2018 Cancer tomorrow. Cancer Incidence and Mortality Worldwide: IARC CancerBase Available from: [Accessed 18/09/2018]
  4. Borras JM, Lievens Y, Barton M, et al. 2016. How many new cancer patients in Europe will require radiotherapy by 2025? An ESTRO-HERO analysis. Radiotherapy and Oncology 119(1): 5-11
  5. Borras JM, Grau C, Corral J, et al. 2018. Estimating the number of fractions by tumour site for European countries in 2012 and 2025: An ESTRO-HERO analysis. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 126(2): 198-204
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  7. Department of Health Cancer Policy Team. 2012 Radiotherapy Services in England 2012. London: Department of Health
  8. Thompson MK, Poortmans P, Chalmers AJ, et al. 2018. Practice-changing radiation therapy trials for the treatment of cancer: where are we 150 years after the birth of Marie Curie? British journal of cancer 119(4): 389-407
  9. Jacob S, Wong K, Delaney GP, et al. 2010. Estimation of an optimal utilisation rate for palliative radiotherapy in newly diagnosed cancer patients. Clinical oncology (Royal College of Radiologists (Great Britain)) 22(1): 56-64
  10. McDonald R, Ding K, Brundage M, et al. 2017. Effect of radiotherapy on painful bone metastases: A secondary analysis of the ncic clinical trials group symptom control trial sc.23. JAMA Oncology 3(7): 953-59
  11. Westhoff PG, de Graeff A, Monninkhof EM, et al. 2015. Quality of Life in Relation to Pain Response to Radiation Therapy for Painful Bone Metastases. International journal of radiation oncology, biology, physics 93(3): 694-701
  12. Mazzola R, Fiorentino A, Ricchetti F, et al. 2018. An update on radiation therapy in head and neck cancers. Expert Review of Anticancer Therapy 18(4): 359-64
  13. Garibaldi C, Jereczek-Fossa BA, Marvaso G, et al. 2017. Recent advances in radiation oncology. ecancermedicalscience 11: 785
  14. Owen JR, Ashton A, Bliss JM, et al. 2006. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. The Lancet Oncology 7(6): 467-71
  15. Arcangeli S, Greco C. 2016. Hypofractionated radiotherapy for organ-confined prostate cancer: is less more? Nature reviews Urology 13(7): 400-8
  16. Dearnaley D, Syndikus I, Mossop H, et al. 2016. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. The Lancet Oncology 17(8): 1047-60
  17. Schäfer R, Strnad V, Polgár C, et al. 2018. Quality-of-life results for accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation in early breast cancer after breast-conserving surgery (GEC-ESTRO): 5-year results of a randomised, phase 3 trial. The Lancet Oncology 19(6): 834-44
  18. Haviland JS, Owen JR, Dewar JA, et al. 2013. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. The Lancet Oncology 14(11): 1086-94

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