Facing the climate change: Is radiotherapy as green as we would like? A systematic review

Purpose: To focus on the ecological footprint of radiotherapy (RT), on opportunities for sustainable practices, on future research directions. Methods: Different databases were interrogated using the following terms: Carbon Footprint, Sustainab*, Carbon Dioxide, Radiotherapy, and relative synonyms. Results: 931 records were retrieved; 15 reports were included in the review. Eight main thematic areas have been identified. Nine research works analyzed the environmental impact of photon-based external beam RT. Particle therapy was the subject of one work. Other thematic areas were brachytherapy, intra-operative RT, telemedicine, travel-related issues, and the impact of COVID-19. Conclusion: This review demonstrates the strong interest in identifying novel strategies for a more environmentally friendly RT and serves as a clarion call to unveil the environmental impact of carbon footprints entwined with radiation therapy. Future research should address current gaps to guide the transition towards greener practices, reducing the environmental footprint and maintaining high-quality care.