S3042
Invited Speaker
ESTRO 2026
settings, and pencil beam scanning is a delivery technique flexible enough to deliver SFRT to patients. On the practical side, more compact and cost-effective solutions, including upright patient positioning systems, are increasingly the way to address the infrastructure costs that have historically limited broader adoption. Treatment planning methodology is also evolving. Robust planning across a limited set of scenarios is now the norm in proton therapy, while probabilistic planning approaches are gaining traction as an innovative alternative. Beyond technology, medical physicists contribute to the design and execution of prospective trials. Results from lung and head-and-neck cancer trials illustrate the importance of the technical component and of the necessity of running trials with mature planning, imaging, and delivery techniques. Physicists are also heavily involved in outcome analysis, e.g., by incorporating linear energy transfer (LET) and relative biological effectiveness (RBE) metrics into models and by integrating emerging data on immunological responses to particle irradiation. Their contribution to effect modeling will remain crucial in the foreseeable future. 5446 Building on foundations: Taking radiation therapist research to the next level Aileen Duffton Radiotherapy, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom. Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom Radiation therapists (RTTs) play an important role in shaping radiotherapy research, yet opportunities to develop and sustain RTT-led research remains variable across clinical settings. This teaching lecture will outline how RTT research can move from participation to leadership, with a focus on embedding research into practice and supporting sustainable development. It will also consider the wider clinical context in which radiotherapy research is undertaken, including the need to address inequalities and ensure that research priorities reflect the needs of our populations. The lecture will first explore the current position of RTT involvement in research, highlighting barriers such as limited protected time, research training, and uncertainty around research pathways. It will then examine practical strategies for progression, including building collaborative partnerships with the multi- disciplinary team, identifying clinically relevant questions, and translating service improvement into formal research activity. Attention will be paid to the importance of research culture and leadership in
The session will discuss how these outcomes can be defined, measured, and integrated into both clinical trials and routine practice. Practical approaches to incorporating these considerations into clinical decision-making will be presented, with a focus on individualising RT management plans, frailty screening, comprehensive geriatric assessment and overall care pathways according to patient priorities. Emerging evidence from geriatric oncology and radiation oncology will be highlighted, including strategies that improve overall treatment tolerance, while maintaining efficacy and quality of life. As the demographic landscape of oncology continues to shift, aligning treatment decisions with outcomes that matter most to older adults is increasingly critical. This session will provide clinicians with a practical framework to support individualised, evidence based, high quality care for the growing number of older adults undergoing RT. 5445 Emerging trends in particle therapy Marco Schwarz Radiation Oncology, University of Washington, Seattle, USA Particle therapy has grown steadily over the past two decades, moving from a predominantly academic setting to an established component of modern radiation oncology. With about 130 operational centers worldwide, proton and heavy-ion therapy are now part of routine clinical practice at many institutions. The talk will present a structured overview of the current state of particle therapy and selected directions of ongoing development. On the technological front, arc therapy techniques are extending the achievable dose conformity beyond what fixed-field approaches typically allow. Progress toward online adaptive workflows is reducing the time required for imaging, replanning, and delivery, making rapid treatment adaptation increasingly compatible with routine clinical use. Ultra-high dose rate (UHDR) delivery and the associated FLASH effect remain areas of active investigation, with preclinical results indicating both the potential to widen the therapeutic window and the challenges of translating the FLASH effect into clinical practice. The first FLASH trial in human patients used protons, and more proton trials are either ongoing or in advanced planning. Spatially fractionated radiotherapy (SFRT) approaches, ranging from grid- and lattice-based methods with centimeter-scale beamlets to proton minibeams, are attracting growing interest in preclinical and clinical
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