Accelerated radiotherapy pathways: a systematic review on same-day planning and treatment in radiation oncology

AbstractIntroduction and background Same-day radiotherapy, integrating consultation, simulation, planning, and treatment within a single day, is an emerging approach in radiation oncology. Advances in imaging integration, automation, and adaptive planning have enabled shorter timelines between consultation and treatment initiation, but prospective clinical evidence remains limited. This systematic review evaluates indications, feasibility, treatment accuracy, and patient satisfaction with same-day radiotherapy. Materials and methods A systematic literature search was conducted in August 2025 using PubMed, Embase, and the Cochrane Library in accordance with PRISMA 2020 guidelines. Eligible studies included prospective or observational reports of radiotherapy for solid malignancies delivered on the same day as treatment planning. Results Of 124 identified records, 13 studies met inclusion criteria. Most were prospective (n = 9), with four retrospective studies. Median study size was 39 patients, with a median ECOG performance status of 1. Treatment intent was predominantly palliative (54%), followed by curative (31%) and ablative (15%). Bone metastases were the most common indication; curative treatments included lung, prostate, brain, breast, and uveal tumors. Stereotactic radiotherapy (54%) and hypofractionated external-beam radiotherapy (38%) were most frequently used. Procedure times ranged from 25 to 470 min. Patient satisfaction, reported in three studies, was consistently good. Treatment accuracy was only assessed in three (23%) studies. Conclusion Current evidence supports the feasibility of same-day radiotherapy, particularly in palliative settings, with favorable patient satisfaction and robust treatment accuracy, where reported. Larger prospective studies are required to standardize workflows and assess outcomes in curative settings, as well as health-system, financial, and legal implications.