KEY POINTS
- Proton therapy accessibility was modelled across 31 European countries and 69,918 administrative subregions using travel time, treatment-room capacity, population demand, and competition between catchment areas. The baseline assumed a six-hour maximum driving catchment, 300 patients per room annually, and proton eligibility in 4.3% of patients requiring radiotherapy.
- Europe had 26 operational proton centres with 54 treatment rooms in 2025, distributed across only 14 countries. The model estimated proton demand at 78,500 patients, including approximately 67,000 living in countries with domestic proton infrastructure.
- Even within countries operating proton centres, 67.2% of theoretically eligible patients lived in areas with critical shortages, while only 4.6% had high accessibility. Overall, more than 56,000 patients lived in areas with either no domestic access or severe supply constraints.
- National capacity and geography produced very different systems. Austria, Czechia, and Denmark combined capacity-to-demand ratios above 0.80 with relatively equitable distribution, while Norway had a capacity surplus (1.04) but substantial geographic inequality (Gini 0.52).
- France, Spain, Poland, and Italy combined capacity-to-demand ratios below 0.20 with Gini coefficients above 0.50. Belgium and the Netherlands had comparatively even geographic distribution but insufficient aggregate capacity. Allowing unrestricted cross-border treatment produced only limited system-wide improvement because few countries had spare capacity.
- By 2030, the model projects expansion to 43 centres and 77 rooms, but cancer incidence is expected to rise by approximately 9%. Planned construction may improve access in parts of Southern and Eastern Europe, while capacity relative to demand may deteriorate in several Northern and Western European countries.
- Adding one strategically positioned single-room facility in each of the ten countries with the greatest modelled equity gains reduced the national weighted Gini coefficient by a mean of 35.4%. The largest reductions were projected in Sweden, Portugal, and Austria, supporting targeted regional placement rather than automatic expansion of existing metropolitan hubs.
- The analysis estimates potential geographic access rather than actual referrals or utilization. Results depend on assumptions about eligibility, room throughput, project completion, reimbursement, workforce, internal cancer incidence patterns, and national restrictions on cross-border care.
CLINICAL TAKEAWAY
European proton planning cannot be reduced to counting centres or treatment rooms. Large countries may require decentralized regional networks, including single-room systems, while compact countries may be served efficiently by centralized hubs; investment decisions should combine capacity, geography, workforce, referral pathways, and expected clinical demand.