Inequitable Access to Proton Beam Therapy in Europe: Efficiency, Equity, and Strategic Infrastructure Planning to 2030

Dominik Wawrzuta et al.

This study assessed the geographic accessibility and capacity of proton beam therapy (PBT) across 31 European countries and modelled how infrastructure expansion could influence equity by 2030. The authors analysed 69,918 administrative subregions using the enhanced two-step floating catchment area (E2SFCA) method, integrating travel time, treatment capacity, and competing regional demand. In 2025, 26 operational PBT centres provided 54 treatment rooms, while estimated European demand reached approximately 78,500 patients. Despite existing infrastructure, more than 56,000 patients lived in areas with no access or critical shortages. Among countries with domestic PBT capacity, 67.2% of theoretically eligible patients lived in regions with critical accessibility. The projected increase in cancer incidence of approximately 9% by 2030 is expected to further challenge established systems. Although 17 additional centres are planned, Southern and Eastern Europe are projected to improve accessibility, whereas several Northern and Western European countries may experience declining capacity relative to demand. The study also modelled the impact of adding one strategically located single-room PBT facility in each country. In the ten countries showing the greatest potential benefit, this intervention reduced the national weighted Gini coefficient by a mean of 35.4%.

In conclusions, substantial capacity deficits and pronounced geographic inequalities persist across European PBT systems and may worsen by 2030 without targeted intervention. Centralised, high-throughput centres remain efficient in small, densely populated countries, but are insufficient for geographically extensive nations such as France, Italy, and Spain. Decentralised networks incorporating strategically located single-room facilities could substantially improve equity. The study provides a quantitative framework to guide European PBT infrastructure planning, although workforce, reimbursement, referral pathways, and actual clinical utilisation must also be considered.

Published by Radiotherapy and Oncology 2026. 

https://doi.org/10.1016/j.radonc.2026.111718