Presented during the ESTRO 2026 session “Safeguarding Access to Radiation Oncology” by Dr Dominik Wawrzuta, new research suggests that sharing proton therapy resources across national borders and strategically planning new centres could substantially improve access for cancer patients across Europe.
Proton therapy is a highly specialized form of radiotherapy that uses protons rather than conventional X-rays to target tumors. Because of its physical properties, proton therapy can reduce radiation exposure to surrounding healthy tissues, making it especially valuable for selected patients, including some children with cancer and patients with tumors close to sensitive organs such as the brain, eye, or spine.
However, proton therapy requires expensive infrastructure and is currently available only in a limited number of centres. This creates major geographic inequalities, meaning that a patient’s access may depend strongly on where they live.
Background
According to the study, there are currently 29 proton therapy centres across Europe. Existing centres provide reasonable access for about 59% of cancer patients across Europe. However, access remains uneven across regions, and even countries with a proton therapy facility may still have major internal gaps if patients live far from the centre.
Dr Wawrzuta and colleagues aimed to evaluate how access could be improved by looking beyond national borders and by identifying the most effective locations for future centres. Their work focused not only on increasing the number of centres, but also on placing them where they would most improve equity and capacity.
Methods
The researchers analyzed proton therapy access across countries in the European Economic Area, as well as the United Kingdom and Switzerland.
They used mapping methods to estimate what proportion of the population could reach a proton therapy centre within a four-hour drive. The analysis first considered access within each patient’s own country. It then examined what would happen if patients were allowed to access proton therapy centres across national borders, regardless of country.
The team also modeled future access by 2030, taking into account 21 proton therapy centres that are already planned. They then assessed whether adding a small number of strategically placed centres could further reduce access gaps.
Results
The study found that current proton therapy infrastructure provides reasonable access for 59% of the European population. If patients were allowed to cross national borders for treatment, this coverage could immediately rise to 65%, representing an additional 32 million people with improved access.
By 2030, the opening of 21 already planned centres could increase coverage to 80% of the European population. However, the analysis still identified several geographic gaps where access would remain limited.
The researchers found that adding only five additional proton therapy centres, placed strategically, could raise access to 87% by 2030. The proposed locations were Northwestern Romania, Northern Greece, Southern Italy, Northern Ireland, and Northeastern Poland.
Interpretation
The findings show that improving access to proton therapy is not simply a question of building more facilities. It is also about building them in the right places.
A cross-border approach could provide a faster improvement in access, especially in regions where patients live closer to a facility in a neighboring country than to one in their own country. At the same time, new centres should be planned based on population needs, geographic gaps, and expected increases in cancer incidence.
Dr Wawrzuta emphasized that geographic access can create financial, social, and emotional burdens for patients who must travel long distances for treatment. These burdens may be particularly important in oncology, where treatment often requires repeated visits and where patients may already be facing significant physical and psychological stress.
Clinical and Policy Relevance
The study has important implications for cancer care planning in Europe. Proton therapy is not needed for every patient receiving radiotherapy, but for selected groups it can offer meaningful benefits by reducing dose to healthy tissues.
Because the infrastructure is expensive, coordinated planning may be more efficient than each country acting independently. Cross-border agreements, referral pathways, reimbursement mechanisms, and shared treatment capacity could help maximize the use of existing centres while new centres are being developed.
The proposed five-centre expansion strategy suggests that relatively targeted investment could produce a major improvement in access, especially if guided by data rather than political or institutional preference alone.
This ESTRO 2026 study highlights a practical route to improving proton therapy access across Europe. By combining cross-border treatment access with strategic planning of new centres, proton therapy coverage could increase from 59% today to 87% by 2030.
The key message is clear: expanding proton therapy access requires not only more infrastructure, but smarter regional planning. For patients, this could mean fewer geographic barriers, more equitable access to advanced radiotherapy, and a better chance of receiving the right treatment when it is clinically indicated.
Read full press release here.