White paper on radiotherapy in France: Ten objectives to strengthen one of the major modalities of cancer treatment.

Radiotherapy is a major component of cancer treatment and contributing to the cure of approximately 220,000 patients annually in France, and to sustained long-term disease control in a substantial proportion of patients. Continuous technological advances - including image-guided radiotherapy, adaptive radiotherapy, and emerging ultra-high dose rate techniques - are transforming clinical practice and improving therapeutic outcomes. However, these innovations also raise important challenges related to equitable access, sustainable financing, workforce capacity, professional training, and the maintenance of high standards of quality and safety. The Société française de radiothérapie oncologique (SFRO; the French society of radiation oncology) conducted a national strategic reflection on the future of radiotherapy in France. Through multidisciplinary consultation involving radiation oncologists, medical physicists, radiation therapists, and healthcare stakeholders, a white paper was developed to assess current challenges and define priorities for the coming years. Four strategic priorities emerged: (i) ensuring equitable access to modern radiotherapy technologies across the national territory; (ii) strengthening patient-centred care and supportive care throughout the treatment pathway; (iii) reinforcing safety and quality frameworks in an increasingly complex technological environment; and (iv) improving workforce planning, training, translational and clinical research, and professional recognition within the radiotherapy field. Ten proposals are outlined to support innovation, strengthen research capacity, modernize financing mechanisms, enhance patient engagement, and address workforce shortages, particularly among radiation therapists and dosimetrists. The recommendations presented in this white paper aim to guide policymakers and healthcare stakeholders in sustaining the development and international competitiveness of radiation oncology in France.