S1443
Interdisciplinary - Other
ESTRO 2026
accuracy (2/14), dose calculation algorithm (4/14), and grid resolution (2/14). Data were also scarce for audit (6/14) and machine QA procedures (2/14). Various delivery techniques were identified, including VMAT, IMRT, static beams, robotic, and helical tomotherapy.
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Caring for Patients, Caring for the Planet: Extreme Hypofractionated Curative Radiotherapy in the Green Era – A Pilot Study in Prostate Cancer Maria Giulia Vincini 1 , Federico Mastroleo 1 , Stefano Siccardi 2 , Valerio Bellandi 2 , Giulia Marvaso 1 , Barbara Alicja Jereczek-Fossa 1,3 1 Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy. 2 Computer science, University of Milan, Milan, Italy. 3 Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy Purpose/Objective: Concern about rising carbon dioxide (CO2) levels is increasing. Healthcare has a large carbon footprint, therefore, providing more sustainable oncology practices is a call to action. Since more than half of cancer patients receive radiation therapy (RT), understanding its potential environmental impact is essential. The aim of the present study is to estimate the carbon footprint produced by RT for prostate cancer patients, comparing moderate and extreme hypofractionated treatments. Material/Methods: Activity data for 100 prostate cancer patients treated with Varian Trilogy linear accelerator system were collected (Figure 1). Half of them underwent moderate hypofractionated RT (26 fractions) and half extreme hypofractionated RT (5 fractions). For each patient, the RT-related carbon footprint was calculated and differences between the two schedules were analyzed. The associated building energy consumption was estimated using a model built starting from the known energy use of the proton therapy building of our institution.
Conclusion: SBRT/SABR demands high precision and safety standards compared with conventionally fractionated RT. The observed scarcity of technical information in phase 3 studies and their protocols, together with the diversity of delivery techniques, highlights the need for improved reporting as well as harmonisation. These findings support the development of an ESTRO consensus guideline defining the minimum disease- agnostic technical requirements for safe and effective SBRT/SABR implementation. References: 1.Kuncman Ł, la Pinta C, Milder MTW, et al. Definition and requirements for stereotactic radiotherapy: a systematic review. Radiother Oncol. 2025;211:111107. doi:10.1016/j.radonc.2025.111107.2.Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. Published 2021 Mar 29. doi:10.1136/bmj.n71. Keywords: SBRT, Systematic Review, Technical Requirements
Results: Main results are shown in Figure 2. Considering the whole cohort, the estimated carbon footprint for 100 treatments was 116,715.23 kgCO2e, with a median value per patient of 632.98 (318.71 – 1599.03)corresponding roughly to the emissions from a round-trip flight of about 4,130 km. Patient travel accounted for 90% of the total carbon footprint for a
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