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Giving radiotherapy in five larger doses over one week instead of 15 to 25 smaller doses is non-inferior for cancer control and late toxicity in breast and prostate cancer, and triples the number of patients each machine can treat. The barriers are guideline inertia and payment per fraction, not hardware.
Randomised trials (FAST-Forward in breast, several in prostate) show that ultra-hypofractionated schedules are non-inferior for cancer control and late toxicity. In systems where the queue for a machine is the limiting factor, adopting these schedules as the national default protocol is the fastest capacity gain available, without any new hardware. The barrier is guideline inertia and fee-for-fraction payment.
Shares Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH, Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation, Surgery and radiotherapy cure most, get least, Most of the world has almost no cancer care.
Shares Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH, Surgery and radiotherapy cure most, get least, Most of the world has almost no cancer care, IMRT / IGRT (modern external beam).
Shares Knowledge reaches practice too slowly, Surgery and radiotherapy cure most, get least, SBRT / SABR (stereotactic radiotherapy), IMRT / IGRT (modern external beam).
Shares Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH, Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation, Surgery and radiotherapy cure most, get least, Most of the world has almost no cancer care.
Shares Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH, Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation, Most of the world has almost no cancer care, IMRT / IGRT (modern external beam).
Shares Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation, Knowledge reaches practice too slowly, Most of the world has almost no cancer care.
Shares Surgery and radiotherapy cure most, get least, SBRT / SABR (stereotactic radiotherapy), IMRT / IGRT (modern external beam), HR-positive / HER2-negative breast cancer.
Shares Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH, Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation, Most of the world has almost no cancer care.