Evidence map›Paper›PMID 41550258›Full record

ArticlePhysics and imaging in radiation oncology2026

An ESTRO-EPTN Delphi consensus on robustness evaluation in proton therapy.

Francesco Fracchiolla, Arturs Meijers, Ester Orlandi, Erik Korevaar, Gillian Whitfield, Kenneth Jensen, Mischa Hoogeman, Robin Wijsman, Emmanuel Jouglar, Eva Van Weerd and 32 more

Abstract read
In one paragraph

Article in Physics and imaging in radiation oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

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  5. Maintaining quality of scientific peer-review and publishing inPhysics and imaging in radiation oncology · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

42 authors.

Francesco FracchiollaUO Fisica Sanitaria, APSS, Trento, Italy.
Arturs MeijersCenter for Proton Therapy, Paul Scherrer Institut, Forschungsstrasse 111, Villigen 5232, Switzerland.
Ester OrlandiDepartment of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.
Erik KorevaarDepartment of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Gillian WhitfieldDepartment of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK.
Kenneth JensenDanish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
Mischa HoogemanErasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, the Netherlands.
Robin WijsmanDepartment of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Emmanuel JouglarInstitut Curie, PSL Research University, Department of Radiation Oncology, Orsay Protontherapy Center, F-91400 Orsay, France.
Eva Van WeerdHolland Proton Therapy Center, Delft, the Netherlands.
Juan M PérezCentro de Protonterapia Quironsalud, Madrid, Spain.
Ilaria RinaldiDepartment of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Magdalena Garbacz-StryszewskaCyclotron Centre Bronowice, Institute of Nuclear Physics Polish Academy of Sciences, ul. Radzikowskiego 152, 31-342 Krakow, Poland.
Marco CianchettiUO Protonterapia, APSS, Trento, Italy.
Marta Montero FeijooCentro de Protonterapia Quironsalud, Madrid, Spain.
Silvia MolinelliMedical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Italy.
Ulrik Vindelev ElstrømDanish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
Alessia PicaCenter for Proton Therapy, Paul Scherrer Institut, Forschungsstrasse 111, Villigen 5232, Switzerland.
Andrew GoslingDepartment of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK.
Beata KoczurHeidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
Christina Vallhagen DahlgrenThe Skandion Clinic, Uppsala, Sweden.
Daniela AlterioDivision of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy.
Einar DaleDepartment of Oncology, Oslo University Hospital, Oslo, Norway.
Goudjil FaridInstitut Curie, PSL Research University, Department of Radiation Oncology, Orsay Protontherapy Center, F-91400 Orsay, France.
Inge CompterDepartment of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Jérôme DoyenDepartment of Radiation Therapy, Antoine Lacassagne Cancer Center, University of Côte d'Azur, Nice, France.
Jon Espen DaleCancer Clinic, Haukeland University Hospital Bergen, Norway.
Johanna FärlinDepartment of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden.
Konrad UrbanekDepartment of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, Kraków, Poland.
Lars Fredrik FjæraDepartment of Medical Physics, Oslo University Hospital, Oslo, Norway.
Maarten LambrechtDepartment of Radiotherapy-Oncology, Leuvens Kanker Instituut, Universitair Ziekenhuis Leuven, Leuven, Belgium.
Maren UglandCancer Clinic, Haukeland University Hospital Bergen, Norway.
Maria TschicheDepartment of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany.
Marie VidalInstitut Méditerranéen de Protonthérapie - Centre Antoine Lacassagne, Nice, France.
Matthew LoweChristie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK.
Rebecca BütofDepartment of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany.
Sarah GullifordDepartment of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK.
Stefania ComiUnit of Medical Physics, European Institute of Oncology (IEO) IRCCS, Milano, Italy.
Steven HabrakenHolland Proton Therapy Center, Delft, the Netherlands.
Thomas TessonnierHeidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
Edmond SterpinKU Leuven, Department of Oncology, Experimental Radiotherapy Lab, Leuven, Belgium.
Lamberto WidesottUO Fisica Sanitaria, APSS, Trento, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background and purpose: Robustness evaluation (RE) is vital for proton treatment planning, but lacks international consensus or guidelines, with clinics using varied, self-developed methods focused on selected uncertainties. This ESTRO project surveys expert opinions on clinical RE methods to inform future treatment planning system (TPS) development. Materials and methods: A study within the European Particle Therapy Network (EPTN) involved 24 European proton therapy centres, with one radiation oncologist and one medical physicist per centre. The goal was to reach a consensus on transitioning from Planning Target Volume (PTV)-based planning to robustly optimized planning, including uncertainties, methods, and reporting of robustness evaluations. An internal committee drafted 39 statements, reviewed by an independent committee. Following a two-round Delphi procedure, consensus was set at a 75% agreement threshold. Results: Twenty of 24 contacted centers (83.0%) responded to both questionnaire rounds. Consensus was reached on 26 of 39 statements (66.7%), with 5 being high-priority. Strong agreement emerged regarding which uncertainties to include in RE (range, setup, intra-fraction, anatomy changes), methodologies (e.g., for moving targets, combining setup and range), and how to report RE results clinically. Disagreement was found on using the PTV for both planning and dose reporting. The results also offer important implications for TPS vendors and future software development. Conclusions: The ESTRO Delphi consensus may serve as practical guidance on points where a clear consensus was achieved. For remaining points, the development of guidelines is recommended to standardize methodologies and reporting. Furthermore, TPS vendors are encouraged to align their developments with the community's articulated requirements.

Indexed as

ConsensusEuropean particle therapy networkProton therapyRobustness evaluation

Identifiers

PMID41550258
PMCPMC12809403

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.