Timely delivery of radical radiotherapy: guidelines for the management of unscheduled treatment interruptions, fourth edition

Date of next review: 

Please note: Radiotherapy Dose Fractionation Third Edition and Timely Delivery of Radical Radiotherapy: guidelines for the management of unscheduled treatment interruptions, fourth edition are both currently under review and due to be published later in 2023. You should therefore refer to the Bladder Consensus Statements for the latest guidance on radical and palliative fractionation schedules for bladder cancer, and how treatment interruptions should be managed in the bladder cancer patient (i.e. bladder cancer should be treated as a Category 1 tumour).

During the COVID-19 pandemic, additional guidance on the management of unscheduled treatment interruptions has been published on the RCR's COVID-19 cancer treatment documents page

The Royal College of Radiologists has updated its guidance on managing unscheduled interruptions to radical radiotherapy treatment. This fourth edition is endorsed by the Society and College of Radiographers (SCoR) and the Institute of Physics and Engineering in Medicine (IPEM), and is supported by The Royal Australian and New Zealand College of Radiologists

Purpose of the guidance

This document aims to provide guidance to clinicians on how to manage unavoidable interruptions in treatments to ensure the best outcomes for patients. It also provides guidance on categorisations of patients based on the likely severity of the impact of an interruption in their treatment.

This fourth edition replaces replaces The Timely Delivery of Radical Radiotherapy: Standards and Guidelines for the management of unscheduled treatment interruptions, Third Edition 2008.  


The recommendations of the guidance include:  

  • Consideration of published evidence on the impact of unscheduled gaps in radiotherapy treatment for different tumour types including impact of length and timing of interruption

  • Evidence based categorisation of patients according to their tumour type and treatment intent (category 1, 2 and 3) to help departments prioritise patients according to the need to manage interruptions.

  • Identifying the causes of unscheduled treatment interruptions

  • Procedures for oncology departments to adopt to prevent or minimise the effect of prolongation of any radiotherapy treatment

  • Specific advice on unscheduled interruptions during SABR, proton and superficial radiotherapy treatments.

  • How oncology departments can implement and audit local protocols to best manage unscheduled interruptions of radical radiotherapy

  • Methodology for assessing the impact of treatment interruptions and worked examples of biological compensation

Who is this guidance for

- Clinical oncologists
- Radiotherapy service managers
- Radiographers
- Medical physicists
- Commissioners and providers of radiotherapy services

Related learning resources 

The RCR has a variety of CPD resources relating to radiotherapy delivery in the radiotherapy section of the RCR Learning e-learning hub. (login required)