Savings Associated with Radiotherapy clinical trials are a major source of cost savings and improved efficiency in cancer care. Radiotherapy contributes to 40% of cancer cures, but represents only 5% of cancer budgets internationally. Research in radiotherapy, including the use of stereotactic ablative radiotherapy known as SABR, offers immediate and scalable economic, societal, and environmental benefits. SABR in the oligometastatic setting can delay the need for costly systemic drugs, reducing expenditure and improving patient quality of life. A key innovation from clinical trials is hypofractionation, where treatment is delivered in fewer, higher intensity sessions. This approach maintains cancer control while reducing hospital visits, freeing up treatment capacity, and cutting travel related carbon emissions. Hypofractionation has now been adopted widely thanks to landmark studies.
• FAST Forward Breast Cancer Trial: Demonstrated that five radiotherapy sessions provide the same benefit as fifteen to twenty five, transforming global practice. For Irish patients, this means fewer visits, lower costs, and less disruption to life. A retrospective review of 68 patients treated under the FAST-Forward protocol at SLRON showed a total cost reduction of €47,489 and a saving of 13,820 minutes of staff time. Annually in Ireland approximately 800 patients are now treated using the FAST-Forward regime, saving an estimated €569,000 per year. The FAST Forward Boost Trial starting in 2026 will test if the radiotherapy treatment including the tumour boost can also be delivered in five sessions instead of fifteen. This trial has the potential to eliminate 9,360 fractions per year nationally saving around 2,340 hours of linear accelerator time, the equivalent to running a treatment machine 12 hours a day for 6 months, and delivering a further cost saving of approximately €482,449 per year.
• Prostate Cancer Trials including CHHiP, PACE, and INSPIRE: These studies proved that prostate radiotherapy can be safely shortened from seven or eight weeks to four weeks, and even further to just five sessions, with similar cancer outcomes. The INSPIRE trial, opening in 2026 across Ireland, will investigate next generation five treatment schedules, with significant potential savings due to the high incidence of prostate cancer.
• SABR COMET and SIMPLIFY Trials: COMET showed SABR can double progression free survival from 6 to 12 months, delaying the need for expensive drug therapies. The SIMPLIFY trial activated across all research active radiotherapy departments nationally will treat a projected 70 patients in a single session instead of three to five, saving around four treatments per patient at a cost of approximately €1000 per fraction of SABR. This will enable savings of approximately €280,000 each year this trial runs in Ireland.