Dr. Vapiwala stated that the specialty’s biggest challenge is not proving that radiotherapy works. Rather, it is making sure that all stakeholders, patients, colleagues, policymakers and the public understand that it does. She reminded the audience how much evidence the field has built around proving its effectiveness.
Part of conveying the right message is in remembering how far the field has come, since many current preconceived notions are rooted in the past. Treatment courses have shrunk from weeks to days. Image guidance and adaptive planning have brought millimeter precision. Immunotherapy combinations, biomarkers, particle therapy and radiopharmaceuticals are also opening new possibilities. “This is not incremental progress — this is a generational shift in what radiotherapy is and what it can do,” Dr. Vapiwala said.
Many patients hear about radiation first from referring physicians, friends, family or the internet, and some fear it more than chemotherapy. Often an entire narrative has been formed before the patient has even received a consult. With this background noise, as practitioners, we might find ourselves spending time awkwardly defending RT to patients, and we need to get to the messaging earlier.
She reminded us that storytelling has the power to shape individual and societal beliefs, and, drawing on a quick survey of the literature, showed how RT has been portrayed in recent years. Over half of New York Times articles on RT have featured a negative tone, focusing on errors or implying ineffectiveness. “Our treatment modality carries significant historical baggage, and we need to acknowledge it in order to address it.” Dr. Vapiwala presented numerous examples of how ASTRO turned media crises into opportunities to provide accurate information, morphing anger into meaningful action, using data to drive dialogue and correct misrepresentation. ASTRO answered multiple stories with evidence and help from partner societies, resulting in several cases of headlines being corrected.
When media coverage or other public discussions do not get the story right, Dr. Vapiwala urged the audience to push firmly and professionally for more balanced reporting, and use data to drive dialogue and push for fairer characterizations of the field. “Doing and saying nothing is no longer tenable.”
“It’s in our patients’ best interest that our non-radonc colleagues understand what we do, and that we not forgo the moments to correct.” She advised turning frustration into motivation to teach. “We can tell our own story.”
Dr. Vapiwala noted that as RT has evolved, the language should too. She then announced Radiotherapy Reframe, a new joint ESTRO-ASTRO initiative to modernize radiation oncology terminology so that it informs rather than frightens. The initiative will assess the intended and unintended effects of terminology and generate consensus-based, patient-centered recommendations that better reflect RT and related techniques.
She closed with tangible actions everyone can take to tell the field’s story: be mindful of jargon, leverage AI and multimedia tools to better serve patients and clearly explain the specialty to others. “Data doesn’t speak to people. That requires dialogue, and that is what we do.”
Published on: September 29, 2026
