ECF: ESTRO Cancer Foundation

On the initiative of ESTRO a Foundation was set-up in 2012, with the intent to create a collaborative platform to ensure that all cancer patients receive the RT treatment that they need.

Two main broad areas of barriers emerge, observing the existing literature on the subject:

  • Resources: shortages in equipment, staff, education

  • Perception: both for patients, lay public, and healthcare professionals

With the intent to support ESTRO in its effort to advance radiotherapy, the ECF tackles the barriers to an optimal provision of radiotherapy, focusing particularly on perception issues that prevent patients, decision makers and medical professionals to refer to radiotherapy.

With a project-based approach, the ECF maximises the impact of ESTRO strategy and activities. By ensuring synergies and leveraging on ESTRO activities and research, the ECF aims at disseminating data and rising awareness; ensuring education; enhancing the positioning of RT and advocating for radiotherapy and optimal cancer care.

Marie Curie Legacy Campaign



The Value Based Health Care (VBHC) project – is an ESTRO/ECF - HERO Project. The landscape of innovative interventions in radiotherapy is diverse and complex in terms of technologies, techniques and treatment schemes. The project will aim to provide a better view and agreement on different types and categorization of innovative interventions in radiation oncology.
This is the first necessary step to support policy-making and reimbursement schemes, allowing for optimisation of patient access to radiotherapy.

Supported by a grant from Elekta and Varian, the project will run for three years.

ESTRO/ECF’s new project will identify and address the causes and barriers to accessing radiotherapy along the lung cancer patient journey through:

•    Determining the optimal evidence-based utilization of radiotherapy for lung cancer in Europe
•    A review of existing literature on actual patterns of care for lung cancer radiotherapy
•    A survey of radiation oncologists in Europe to understand how they use radiotherapy in the treatment of lung cancer in their clinical practice
•    A series of interviews with clinicians and other stakeholders exploring their perceptions of current challenges in accessing radiotherapy

ESTRO is working to ensure that the importance of high-quality radiotherapy is recognised, and that consistent national policies are put in place to ensure optimal access and uptake to radiotherapy by helping countries prioritise radiotherapy as an evidence-based treatment strategy. 

The project will run for 3 years and will conclude with a White paper to set example for best practices in the European Policy fora and the future of Radiotherapy treatment in Lung Cancer in Europe.


UpLung Project Update

Based on previous ESTRO-HERO expertise and collaboration with CCORE this project has seen progress during 2021 with the development of updated lung cancer decision trees in Work Package 1, necessary in defining the optimal utilization of radiotherapy for lung cancer from a population perspective. That is, how many patients diagnosed with lung cancer would require radiotherapy during the course of their disease, based on evidence-based recommendations for all types and stages in lung cancer. Also, a systematic review of the literature on patterns of care for lung cancer treatment has been successfully completed. Apart from the insight they provide in the actual utilisation of radiotherapy for lung cancer across Europe, the outcomes of this review will be useful to compare optimal utilization of radiotherapy in this tumour with the actual use.

Starting from the concept of the CCORE decision-analytic trees, the work package works first consisted in developing a set of new decision trees, adapted to the latest evidence-based care on lung cancer radiotherapy by stage, accounting for comorbidities, and guided by a review of the available guidelines and specific literature. Then, after validation of the decision-trees by radiation oncology experts in lung cancer, they are now being populated with new epidemiological data on lung cancer (incidence from Globocan; stage data from dedicated cancer registries). For the latter, the project is initially teaming up with the Belgian Cancer Registry, to assess the optimal utilization of population-based need for radiotherapy for all lung cancer indications in Belgium. After the analysis of this granular data input, an extrapolation will be performed towards radiotherapy utilization at the European level, based on Globocan data.

Overall, the team feels the project has progressed well and the accumulated knowledge reassures that the comparison between actual and optimal use of radiotherapy in lung cancer, from the European perspective, is feasible. Next to this quantitative analysis, a qualitative evaluation will be performed to deepen the understanding of the barriers and facilitators to closing the gap in utilisation and access.


Value Based HealthCare (VBHC) – is an ESTRO/ECF - HERO Project aiming to develop a framework to define value of RO to reflect the specificities of the treatment, allowing for optimization of patient access to high-value developments in RT.

Supported by a grant from Elekta and Varian, the VBHC Project aims to providing a framework to define value in RO to reflect the specificities of the treatment, allowing for optimization of patient access to high-value developments in RT. 

The VBHC project will provide a framework to define value in RO by: 

  • Defining and categorize innovations in radiation oncology
  • Defining endpoints needed for policy making in RO
  • Linking endpoints and interventions with the evidence needed
  • Providing a value framework, publications and communication collaterals (policy papers, key messages) for the RT community to adopt and the oncology community to acknowledge it, creating potential of impacting on HTA of RT innovations.

The VBHC Project work is embedded in the HERO (Health Economics of Radiation Oncology) project of the European Society for Radiotherapy and Oncology (ESTRO), launched in 2012 with the ambition to generate a model and knowledge base for health economics and health services research in radiation oncology [Lievens & Grau].

Click HERE to know more about the HERO Project

The project will run for 3 years and will conclude by providing a framework for VBHC in radiation oncology with policy implications.

Links to publications:

Value-based radiotherapy: A new chapter of the ESTRO-HERO project

Innovation, value and reimbursement in radiation and complex surgical oncology: Time to rethink