ESTRO - Workshop 3 – Upright Radiotherapy: Evidence, Priorities, and the Road to Clinical adoption

Workshop 3 – Upright Radiotherapy: Evidence, Priorities, and the Road to Clinical adoption

Faculty members:

Sophie Boisbouvier (France)
Heidi Probst (United Kingdom)
Julia Thiele (Germany)
Yat Tsang (Canada)

Keywords: Evidence-based Practice; Upright Radiotherapy; Radiation Therapist

Motivation:

Interest in upright positioning in radiotherapy and particle therapy has grown considerably in recent years. The concept involves delivering treatment with a fixed beam while the patient is positioned in a sitting, semi‑sitting, or standing position on a rotating upright patient positioning system (UPPS). Although upright radiotherapy (upRT) is not a new idea, evidence supporting its clinical implementation remains limited.

As commercial UPPS solutions become increasingly available and cancer centres begin exploring or implementing upRT pathways, there is a growing need to understand what evidence, knowledge, and practical experience are required to support safe, effective and sustainable clinical adoption. Radiation therapists (RTTs) play a critical role in the upRT implantation, yet many of the issues most relevant to RTT practice have not been systematically prioritised from an international RTT perspective.

This workshop aims to identify the evidence priorities that RTTs consider most important for establishing upRT as a practical, feasible and safe clinical practice. Using a modified nominal group technique, workshop participants will contribute equally to identifying and prioritising the issues that matter most to clinical implementation. Two virtual workshops will be conducted, separated by an individual priority‑ranking survey, followed by a community validation session at the ESTRO 2027 congress.

During the first virtual workshop, participants will identify evidence gaps, implementation challenges, and knowledge needs based on their clinical experience and pre-workshop materials. The survey will then allow participants to independently rank these priorities, reducing the influence of group dynamics. A second virtual workshop will focus on discussion and consensus-building around areas of uncertainty and refinement of the final priority framework. The resulting framework will be presented to the wider international RTT community during a validation session at the ESTRO 2027 Congress, providing an opportunity to assess whether the identified priorities resonate more broadly across the profession. Through this approach, a robust, consensus‑based framework of evidence priorities for the successful clinical adoption of upRT can be established.