Estimating the number of fractions by tumour site for European countries in 2012 and 2025: An ESTRO-HERO analysis

Radiother Oncol. 2018 Feb;126(2):198-204. doi: 10.1016/j.radonc.2017.11.009. Epub 2017 Nov 29.


Background and purpose: The optimal number of radiotherapy fractions is a relevant input for planning resource needs. An estimation of the total number of fractions by country and tumour site is assessed for 2012 and 2025.

Methods: European cancer incidence data by tumour site and country for 2012 and 2025 were extracted from the GLOBOCAN database. Incidence and stage data were introduced in the Australian Collaboration for Cancer Outcomes Research and Evaluation (CCORE) model, producing an evidence-based proportion of incident cases with an indication for radiotherapy and fractions by indication. An indication was defined as a clinical situation in which radiotherapy was the treatment of choice.

Results: The total number of fractions if radiotherapy was given according to guidelines to all patients with an indication in Europe was estimated to be 30 million for 2012; with a forecasted increase of 16.1% by 2025, yet with differences by country and tumour. The average number of fractions per course was 17.6 with a small range of differences following stage at diagnosis. Among the treatments with radical intent the average was 24 fractions, while it decreased to 2.5 among palliative treatments.

Discussion: An increase in the total number of fractions is expected in many European countries in the coming years following the trends in cancer incidence. In planning radiotherapy resources, these increases should be balanced to the evolution towards hypofractionation, along with increased complexity and quality assurance.

Keywords: European countries; Fractions; Projection; Radiotherapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Australia
  • Databases, Factual
  • Dose Fractionation, Radiation
  • Europe / epidemiology
  • Female
  • Forecasting
  • Humans
  • Incidence
  • Male
  • Neoplasms / epidemiology
  • Neoplasms / radiotherapy*
  • Outcome Assessment, Health Care
  • Palliative Care
  • Radiation Dose Hypofractionation