title: The optimal utilization proportion of external beam radiotherapy in European countries: An ESTRO-HERO analysis.
abstract: OBJECTIVE
  The absolute number of new cancer patients that will require at least one course of radiotherapy in each country of Europe was estimated.
  
  
  METHODS
  The incidence and relative frequency of cancer types from the year 2012 European Cancer Observatory estimates were used in combination with the population-based stage at diagnosis from five cancer registries. These data were applied to the decision trees of the evidence-based indications to calculate the Optimal Utilization Proportion (OUP) by tumour site.
  
  
  RESULTS
  In the minimum scenario, the OUP ranged from 47.0% in the Russian Federation to 53.2% in Belgium with no clear geographical pattern of the variability among countries. The impact of stage at diagnosis on the OUP by country was rather limited. Within the 24 countries where data on actual use of radiotherapy were available, a gap between optimal and actual use has been observed in most of the countries.
  
  
  CONCLUSIONS
  The actual utilization of radiotherapy is significantly lower than the optimal use predicted from the evidence based estimates in the literature. This discrepancy poses a major challenge for policy makers when planning the resources at the national level to improve the provision in European countries.
authors.affiliation: University of Barcelona, Spain. Electronic address: jmborras@iconcologia.net.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Borras
authors.affiliation: Ghent University Hospital, Belgium.
authors.forename: Yolande
authors.initials: Y
authors.lastname: Lievens
authors.affiliation: University of Calgary, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Dunscombe
authors.affiliation: Trinity College, Dublin, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Coffey
authors.affiliation: Electroradiology Dep. University of Medical Sciences, Greater Poland Cancer Centre, Poznan, Poland.
authors.forename: Julian
authors.initials: J
authors.lastname: Malicki
authors.affiliation: Doctoral programme in Public Health, Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Spain; Catalonian Cancer Plan, Department of Health, Spain.
authors.forename: Julieta
authors.initials: J
authors.lastname: Corral
authors.affiliation: European Society for Radiotherapy and Oncology, Belgium.
authors.forename: Chiara
authors.initials: C
authors.lastname: Gasparotto
authors.affiliation: European Society for Radiotherapy and Oncology, Belgium.
authors.forename: Noemie
authors.initials: N
authors.lastname: Defourny
authors.affiliation: CCORE, Ingham Institute for Applied Medical Research, UNSW, Liverpool, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Barton
authors.affiliation: The Netherlands Cancer Registry/Netherlands Comprehensive Cancer Organisation, The Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Verhoeven
authors.affiliation: Belgian Cancer Registry, Brussels, Belgium.
authors.forename: Liesbeth
authors.initials: L
authors.lastname: van Eycken
authors.affiliation: Cancer Registry, Institute of Oncology Ljubljana, Slovenia.
authors.forename: Maja
authors.initials: M
authors.lastname: Primic-Zakelj
authors.affiliation: Cancer Registry, Greater Poland Cancer Centre, Poznan, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Trojanowski
authors.affiliation: Dept. of Radiation Oncology, Institute of Oncology Ljubljana, Slovenia.
authors.forename: Primoz
authors.initials: P
authors.lastname: Strojan
authors.affiliation: Aarhus University Hospital, Denmark.
authors.forename: Cai
authors.initials: C
authors.lastname: Grau
mesh_terms: D005060:Europe; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy*
keywords: European countries; Optimal utilization; Planning; Radiotherapy