S2986
Invited Speaker
ESTRO 2026
Oncol. 2018;128(1):133-138. doi:10.1016/j.radonc.2017.12.031. [2] Fabiano S, Balermpas P, Guckenberger M, Unkelbach J. Combined proton-photon treatments - A new approach to proton therapy without a gantry.
Photon and proton therapy differ fundamentally in their physical dose deposition, dosimetric properties and robustness, but also in their availability and resource requirements. While proton therapy offers clear dosimetric advantages in selected clinical scenarios, its widespread adoption is constrained by high costs and limited infrastructure. As a result, only a minority of cancer patients currently have access to proton therapy, while the majority are treated with conventional photon-based approaches. In many healthcare systems, treatment selection follows a binary paradigm in which patients receive either photon or proton therapy. Within this framework, proton therapy is typically reserved for cases where a substantial reduction in normal tissue complication probability (NTCP) is expected. While clinically justified, this paradigm limits a more flexible and effective allocation of proton resources. In this presentation, an alternative strategy based on the integration of photon and proton modalities within a single treatment course will be discussed. The objective is to improve resource utilization and expand access to proton therapy, while maintaining clinically meaningful dosimetric benefits. Two complementary strategies for combined proton- photon therapy will be discussed. The first considers a radiotherapy course in which only a limited number of fractions are delivered using protons, while the remaining fractions are delivered using photons [1]. In this framework, the benefit of proton therapy can be optimally exploited by increasing the proton dose contribution relative to photon fractions. Photons are primarily used to achieve a fractionation effect in proximity to critical organs-at-risk. Such an approach requires careful consideration of dose summation and biological equivalence. The second approach considers the integration of a fixed proton beamline with a conventional photon linac in a shared treatment room [2]. By removing the need for a proton gantry, this strategy may reduce cost and complexity, potentially enabling wider deployment of proton therapy. The reduced flexibility in beam angle selection, which may limit the quality of the proton dose distribution, can be compensated by the photon contribution through combined photon-proton treatment planning. Results from our group, together with emerging evidence from other centers, will be presented to contextualize the opportunities and current limitations of combined proton-photon therapy. Key requirements for clinical implementation will also be outlined, including treatment planning methodologies, robustness considerations, workflow integration and patient selection criteria. References: [1] Unkelbach J, Bangert M, De Amorim Bernstein K, Andratschke N, Guckenberger M. Optimization of combined proton-photon treatments. Radiother
Radiother Oncol. 2020;145:81-87. doi:10.1016/j.radonc.2019.12.013.
5270 Shared Decision-Making in Radiotherapy: Status Quo and Opportunities to Improve Anniek R. van Hienen Radiotherapy, Maastricht University, Maastricht, Netherlands Shared decision-making (SDM) – a process in which patients and healthcare providers determine the course of treatment – has been advocated for as method of care, but implementation in clinical practice remains challenging. In radiotherapy, 88% of patients expressed a preference for sharing decisions, yet only 11,6% recalled having been offered multiple options during their radiotherapy intake (van Hienen et al., 2025). When examining SDM as interpersonal behaviour, behaviour change theory and methods can inform intervention development, facilitating SDM in radiotherapy. In this talk, we will present qualitative findings on why SDM in radiotherapy is particularly
challenging for patients and radiotherapy professionals. We will also demonstrate how
behaviour change planning models, combined with active patient participation, can be used to design theory- and evidence-based interventions to promote SDM in everyday radiotherapy practice. References: van Hienen, A. R., Offermann, C. J. W., Boersma, L. J., Jacobs, M. J. G., & Fijten, R. R. R. (2025). Bridging the care gap: Patients’ needs and experiences regarding shared decision-making in radiotherapy. Clin. Trans. Radiat. Oncol. , 50 . https://doi.org/10.1016/j.ctro.2024.100897 5271 Patient voice and patient public involvement (PPI) into the future Claire Poole Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Ireland. Cancer Institute, Trinity St.James's Cancer Institue, Dublin, Ireland The integration of the patient voice and PPI is increasingly recognised as essential to the future of radiation oncology and will play a central role in
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