GIRO – Global Impact: Radiotherapy in Oncology

In the past decade, the global perspective to advance radiotherapy and foster collaboration with international partner societies beyond Europe has become increasingly important.

GIRO, under the aegis of ESTRO, is a voluntary collaborative platform with international experts interested in the development of RT globally. Building up on the GTFRCC, HERO and IAEA knowledge base, the ultimate goal is to close the gap in radiotherapy access, globally.

GIRO is responding to the calls to action laid out in the report of the Global Task Force on Radiotherapy for Cancer Control: convened by the Union for International Cancer Control (UICC), the radiotherapy community in the GTFRCC provided a detailed analysis of the current situation worldwide.

GIRO is the next phase of this project: starting from this knowledge base, highlighting the importance of radiotherapy in cancer care, GIRO is a platform of exchange in order to impact on the current situation of radiotherapy worldwide at various levels including access, resources, education, reimbursement, healthcare planning.

We aim to save lives and improve quality of life of cancer patients through data-driven and evidence-based innovation in radiation oncology. Our mission is to reduce inequalities and ensure universal access to radiotherapy.

Global Task Force on Radiotherapy for Cancer Control

In 2013, the Board of the Union for International Cancer Control convened the Global Task Force on Radiotherapy for Cancer Control (GTFRCC) to address the challenge of closing the global inequity gap in access to radiotherapy.  The GTFRCC brought together over 100 experts, including radiotherapy professionals, industry partners, cancer control organisations, and economists to clarify the challenge and quantify the investment needed to provide equity in global access to radiation therapy. Further to that, by determining the global burden of cancer amenable to radiation therapy and the cost to build the infrastructure and train professionals to deliver the treatment, the GTFRCC demonstrated the economic gains as a result of an investment in radiation therapy

Invited by the Lancet Oncology to be a commission of the Lancet, the GTFRCC published their results in a standalone edition of the journal in September 2015. The release of the findings helped dispel misconceptions about radiotherapy being too costly to deliver. It brought global attention to the severity of the radiotherapy inequity problem, demonstrated a positive return on investment for radiotherapy, and articulated the need to act immediately to remedy the crisis [Atun et al. 2015].

The report along with the WHO’s Global NCD Action Plan to reduce premature mortality from NCDs by 25% and to increase the availability of technologies used to manage NCDs by 80%, has positioned radiotherapy as a priority for investment. It is now time to act and to respond to the Commission’s five calls-to-action.


  • Incorporate radiotherapy into population-based cancer control plans in 80% of countries by 2020
  • Increase by 25% the 2015 radiotherapy treatment capacity by the year 2025
  • Train 7,500 radiation oncologists; 20,000 radiation technologists; and 6,000 medical physicists in LMICs by 2025
  • Invest $46 billion by 2025 to establish radiotherapy infrastructure and training in LMICs
  • Include radiotherapy services as part of the healthcare plans for universal health coverage in 80% of LMICs by 2020

We want to widen the scope of existing projects that aim at closing the gap in access to radiotherapy, fostering scientific research, case studies, tools and practical applications.

  • In 2015, the Global Task Force on Radiotherapy for Cancer Control (GTFRCC) called for 80% of National Cancer Control Plans (NCCP) to include radiotherapy by 2020. As part of the ongoing ESTRO Global Impact of Radiotherapy in Oncology (GIRO) project, the article assessed whether inclusion of radiotherapy in NCCPs correlates with radiotherapy machine availability, national income, and geographic region.

    Read the article here
  • Radiotherapy is standard of care for cervical cancer, but major global gaps in access exist, particularly in low-income and middle-income countries. The Global Task Force on Radiotherapy for Cancer Control investment framework has been used to model the health and economic benefits of scaling up external-beam radiotherapy and brachytherapy for cervical cancer in upper-middle-income, lower-middle-income, and low-income countries between 2015 and 2035. Read the recently published paper “Scale-up of radiotherapy for cervical cancer in the era of human papillomavirus vaccination in low-income and middle-income countries: a model-based analysis of need and economic impact” , Prof. D. Rodin at al.

     Read the article here 
  • GIRO survey on international patterns of care in radiation oncology: evaluation of the use of hypofractionated radiotherapy in the treatment of breast cancer, prostate cancer, cervical cancer and bone metastases. Considering the scope of the survey and the data-driven approach, the GIRO steering committee is proud to have this survey sent under the umbrella of GIRO, ensuring coverage of all regions of the world.

    Read the article here 

Steering committee:



The publications listed below are in the area of radiotherapy access and include data at a global level:

  • Radiotherapy Prioritization in 143 National Cancer Control Plans: Correlation with Radiotherapy Machine Availability, Geography and Income Level. Prof. B. E. Wilson, et al. Read here


  • Scale-up of radiotherapy for cervical cancer in the era of human papillomavirus vaccination in low-income and middle-income countries: a model-based analysis of need and economic impact” , Prof. D. Rodin at al. Read here


  • Hypofractionated radiotherapy in the real-world setting: An international ESTRO-GIRO survey. Prof. D. Rodin, et al. Read here


  • The Lancet Commission. Expanding global access to radiotherapy. Prof. R. Atun, et al. Read here


  • Editorial: Global impact of radiotherapy in oncology: Saving one million lives by 2035. Prof. Y. Lievens et al. Read here


  • Analysis of Global Radiotherapy Needs and Costs by Geographic Region and Income Level. Zubizarreta, E., Van Dyk, J., Lievens, Y. Read here


  • Cost Evaluation to Optimise Radiation Therapy Implementation in Different Income Settings: A Time-Driven Activity-Based Analysis. Van Dyk, J., Zubizarreta, E., Lievens, Y. Read here


Organisations and Projects

The organisations and groups below frequently develop projects or release updates in the area of radiotherapy access and data. In addiation we are listing also some projects including data at global level: