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.



UpLung – Utilisation of radiotherapy for Lung cancer in Europe – is an ESTRO-HERO project, supported by a grant from AstraZeneca. The aim of the UpLung project is to investigate the causes and barriers to the uptake of radiotherapy in Europe. It will seek to estimate the gap in access to radiotherapy for lung cancer, and to understand the structural and organisational aspects that are influencing the uptake of radiotherapy in Europe in this frequent cancer type.

Lung cancer is the leading cause of cancer related deaths globally and in Europe. In 2018 alone, lung cancer was responsible for almost 400,000 fatalities in Europe. Radiotherapy is a critical component of the care pathway for many lung cancer patients, aiming to achieve cure in early-stage disease and with the potential to relieve symptoms in fully metastatic patients.

Although radiotherapy is recommended for more than 50% of cancer patients, ESTRO has previously established that only 70% of the patients who could benefit from radiotherapy are getting access to this critical cancer treatment in Europe. Furthermore, the negative impact of the COVID-19 pandemic on oncology services across Europe is likely to have a prolonged effect on access to radiotherapy.

The results of the UpLung project will be to formulate a set of policy recommendations intended to close the gap in the use of radiotherapy, with the ultimate aim to improve outcome of the patients affected by lung cancer, and with an indication for radiotherapy.

A variety of contributing factors have already been identified that hinder uptake of radiotherapy, including limited health system resources, lack of inclusion in national cancer care pathways, and inequalities to access. Today, more than 40% of high-income countries do not address radiotherapy in their national cancer or non-communicable disease plans.

ESTRO/ECF’s UpLung project will identify and address the causes and barriers to accessing radiotherapy along the lung patient journey. This will be approach chiefly through:

  • Determining the optimal evidence-based utilisation 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 practise.
  • A series of interviews with clinicians and other stakeholders exploring their perceptions of current challenges in accessing radiotherapy.

The work of the UpLung project is divided into four Working Packages (WP’s). The work of each WP is divided accordingly:

WP1: Optimal radiotherapy utilisation in lung cancer; overall and by tumour stage.

WP2: Evaluation of the actual utilisation of radiotherapy in lung cancer – Patterns-of-care of radiotherapy in lung cancer.

WP3: Qualitative analysis on perceived explanatory causes and barriers to the use of radiotherapy in lung cancer.

WP4: Defining policy messages from the generated evidence.

Publications in reference
The impact of cancer incidence and stage on optimal utilization of radiotherapy: Methodology of a population based analysis by the ESTRO-HERO project

The optimal utilization proportion of external beam radiotherapy in European countries: An ESTRO-HERO analysis

Effect of COVID-19 pandemic on practice in European radiation oncology centers

Expanding global access to radiotherapy

National cancer control plans : a global analysis

Value-Based Radiation Oncology (VBRO) – 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 VBRO 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 VBRO 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 VBRO 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 VBRO 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