Planning and deploying a remote satellite radiotherapy unit: a practical guide for clinicians and health administrators.

Access to radiotherapy in Spain remains uneven, with rural and sparsely populated areas facing significant geographic, social, and economic barriers. Satellite radiotherapy units, conceived as extensions of central radiation oncology departments, have emerged as a practical solution to improve equity of access while maintaining safety and technical standards. This review examines the rationale, models, and implementation strategies of such units, with particular emphasis on the recent deployment in Soria (Castilla y León, Spain). We describe international experiences and Spanish case studies, analyzing their organizational, technological, and regulatory dimensions. The Soria project highlights both the potential benefits and the inherent challenges of decentralization: while improved treatment adherence, reduced patient burden, and decongestion of hub centers were evident, persistent obstacles include limited patient volume, difficulties in recruiting and retaining specialized staff, interoperability gaps between information systems, and ambiguities in governance structures. Lessons learned from this experience underline the critical importance of robust integration with the reference center, standardized clinical protocols, reliable digital connectivity, and a clear definition of responsibilities between institutions. Despite these barriers, satellite units represent a feasible and scalable strategy to address regional disparities in oncology care. Their long-term success depends on sustained institutional support, strategic workforce planning, and alignment with national policies aimed at ensuring equitable access to advanced cancer treatment.