New Study Highlights Patient Preference for Upright Radiotherapy

As upright radiotherapy continues to move from concept to clinical reality, understanding how patients experience treatment is becoming just as important as demonstrating technical feasibility. 

A newly published pilot study in Technical Innovations & Patient Support in Radiation Oncology has provided further evidence that treating patients in an upright position may offer important benefits in terms of comfort and the overall treatment experience. 

The study, led by researchers at Centre Léon Bérard in collaboration with the National Physical Laboratory, University College London and Leo Cancer Care, compared upright and conventional supine positioning in 15 patients receiving radiotherapy for breast and lung cancer.  

Putting the Patient Experience First 

Over five research appointments, each participant experienced both upright and conventional supine positioning. Researchers evaluated physical comfort, psychological experience, lung function and the ability to perform Deep Inspiration Breath Hold (DIBH). 

The findings were encouraging. 

• 60% of patients preferred upright positioning for physical comfort, compared with just 7% who preferred the conventional supine position, while the remaining patients had no preference.  

• Two-thirds of patients (67%) preferred the upright position psychologically, reporting that it felt more natural and reassuring.  

• More than half (53%) also preferred performing Deep Inspiration Breath Hold (DIBH) in the upright position.  

Patients also reported significantly less pain when standing up after upright positioning than after lying supine, suggesting that the upright position may reduce some of the musculoskeletal discomfort associated with conventional treatment. Lower back discomfort was reported more frequently in the supine position, while only a small number of patients experienced knee discomfort when upright, highlighting opportunities to further refine patient support systems as the technology evolves.  

Maintaining Clinical Performance 

Importantly, the improvements in patient experience did not come at the expense of treatment feasibility. 

Every participant successfully completed a clinically relevant 20-second Deep Inspiration Breath Hold in both positions, demonstrating that upright positioning is compatible with modern breath-hold techniques used in breast and thoracic radiotherapy.  

The researchers also observed differences in breathing mechanics. While overall vital capacity remained unchanged between positions, upright positioning was associated with changes in respiratory function that may indicate reduced respiratory motion. If confirmed in future imaging and dosimetric studies, this could contribute to smaller treatment margins and improved protection of healthy tissue.  

Building the Evidence Base 

Although this was a small pilot study involving 15 patients, the findings add to a growing body of evidence supporting upright radiotherapy. 

Previous research has demonstrated anatomical and dosimetric advantages associated with upright positioning. This latest study builds on that work by focusing on an equally important question: how patients feel during treatment. 

As upright radiotherapy continues to develop, patient comfort, dignity and overall treatment experience should remain central to innovation. Studies such as this help ensure that new technologies are evaluated not only for what they can achieve technically, but also for the difference they can make to the people receiving treatment. 

Read the full scientific paper here.

Boisbouvier S, Criscuolo A, Underwood T, Grégoire V. Upright versus supine positioning for breast and lung radiotherapy: a pilot study on patient comfort, experience and lung function. Technical Innovations & Patient Support in Radiation Oncology. 2026;38:100409.