Will upright radiotherapy become a new standard? STAND: Perspectives and acceptability from the global radiotherapy community

This study explored the acceptability and the perspectives of radiotherapy (RT) professionals about upright RT (upRT). The survey was developed, pre-tested and piloted with the support of the European Society for Radiotherapy and Oncology (ESTRO). It comprised up to 20 questions and 59 items, assessed using a 4-point Likert scale and organised into four sections: upright radiotherapy (upRT) provision within the respondent's centre, acceptability factors, patient groups and techniques that may benefit from upRT, and respondent demographics. Descriptive statistics summarised responses. Fisher's exact tests assessed the influence of demographic data on responses. From September to December 2025, 307 analysable responses were collected. Forty-four respondents (14%) had access to upRT. Among 263 without access to upRT, 191 (73%) were not familiar with upRT, 212 (81%) would be willing to use it, and 111 (42%) believe it could become a standard. Professionals working in Europe were less familiar with upRT (p = 0.0003), and respondents with fewer than 15 years of professional experience were less willing to use upRT (p = 0.03). Among 226 responses, the main perceived benefit was the improvement of psychological comfort (n = 175, 77%). Regarding the obstacles of implementation, 156/226 respondents (69%) reported the complexity of multimodality imaging. Training was a key challenge reported by 184/224 (82%) respondents once upRT would be implemented. Participants perceived that patients requiring a thoracic treatment (n = 129, 66%) or a proton/ion treatment (n = 98, 51%), would benefit the most from upRT according to 194 responses. UpRT remains limited in availability, is thought not to be routinely used soon, although RT professionals expressed willingness to use it. Further data are required to define the clinical role of upRT.