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Bridging the access to radiotherapy gap with the ARCHERY Study

08 Sep 2025

Today, on World Radiotherapy Awareness Day, we recognise the life-saving role of radiotherapy in cancer care and showcase ARCHERY, a study aiming to improve the radiotherapy planning pathway in low and middle-income countries (LMICs).

Radiotherapy plays a crucial role in cancer treatment. It helps cure about 40% of cancers and is a necessary part of treatment for approximately half of all cancer patients. Despite how important it is, radiotherapy is often overlooked in national cancer control plans and underrepresented in policy discussions. In addition, even though radiotherapy is crucial for cancer treatment, only 10-40% of patients in LMICs can access it. However, there is scope for improving access within existing resources by making current care pathways more efficient. The process of taking treatment images, deciding where to direct the radiotherapy, creating a treatment plan, and providing treatment is time-consuming and requires substantial human resources, which are often not available or have limited capacity.

In many LMICs, planning and delivering radiotherapy can take weeks or even months. These delays lead to long waiting times for treatment, causing anxiety for patients, and may result in the cancer getting worse and lower chances of survival. Mistakes at any stage of the radiotherapy planning pathway can also affect how well the treatment works and how safe it is. A major reason for these challenges is the lack of equipment and a shortage of trained professionals.

To help address this issue, the ARCHERY study is evaluating a novel artificial intelligence (AI)-based software to improve the radiotherapy planning pathway. This AI tool, the Radiotherapy Planning Assistant (RPA), can automate two components of the pathway, including:

  1. Outlining areas that are at risk of tumour spread and protecting areas at risk of radiation damage.
  2. Definition of the position, size, and shape of the radiation beams.

If the RPA can be integrated into the routine radiotherapy workflow, it could bring major benefits, including reducing the time clinicians spend on treatment planning from hours to minutes, reducing variation between clinicians, improving the quality of plans for all patients, and supporting more efficient workforce allocation. Faster treatment preparation and better use of specialists could also lead to cost savings, making radiotherapy more affordable.

The ARCHERY study is one of the very few large multicentre, international prospective randomised studies using an AI-technology in the cancer treatment pathway. In ARCHERY, patients with prostate, cervical, and head and neck cancers are eligible, with radiotherapy being the primary modality of cancer cure for these cancers, and also plays a key role in the management of these cancers in the palliative setting, both for local control and symptom management. The study involves six clinical teams across India, Jordan, Malaysia, and South Africa, reflecting a shared commitment to robust science and improving patient care.

Chief Investigator Professor Ajay Aggarwal says, “With recruitment due to be completed by the end of 2025, we now look to the analysis of the AI, focussing on the quality of the RPA-generated plans by benchmarking them to international standards as the benchmark. We are also assessing the timeliness, cost savings, and budget impact of using AI-supported planning compared to the standard manual planning approach. We are excited about the transformative potential of ARCHERY to deliver high-quality and timely radiotherapy across all resource settings. If the RPA demonstrates the expected improvements, the intention is to provide the tool for use in a not-for-profit manner to public sector cancer hospitals in low resource settings, bringing us one step closer to equitable cancer care for all”.

The ARCHERY study is designed by the MRC Clinical Trials Unit at UCL and led by Professor Ajay Aggarwal, a Consultant Clinical Oncologist at Guy's & St Thomas' NHS Trust in London and an Associate Professor at the London School of Hygiene and Tropical Medicine. 

The AI-based contouring models that are included in the RPA were all developed by the University of Texas MD Anderson Cancer Centre led by Dr Laurence Court and team.

Partners include the UK Radiotherapy Trials Quality Assurance group (RTTQA) under the leadership of Professor Peter Hoskin and the team of Professor Yolande Lievens, Ghent University Hospital.

Co-investigators are:

Professor Jeannette Parkes, Cape Town University, Dr Issa Mohamad, King Hussein Cancer Centre, Professor Christoph Trauernicht, Stellenbosch University, Dr Indranil Mallick, Tata Memorial Centre, Professor Sarbani Ghosh-Laskar, Tata Memorial Hospital, and Dr Rozita Abdul Malik, University of Malaya (Malaysia).  

The study is sponsored by UCL and funded by the Rising Tide Foundation, the National Institutes of Health (NIH) in the US, and the UK's Medical Research Council.

 

Further information: