Technological evolution in radiation oncology: A comprehensive institutional audit of clinical workflows, dosimetric precision, and outcomes following transition from legacy 2D radiotherapy to high‑precision digital platforms

Abstract

Background: The evolution of radiation oncology technology from legacy two‑dimensional (2D) planning systems to high‑precision digital radiotherapy platforms has fundamentally altered oncologic treatment delivery. This institutional audit evaluates the epidemiology, treatment utilization, workflow kinetics, dosimetric capability, and clinical outcomes associated with this technological transition within a tertiary regional cancer center.

Methods and Materials: A retrospective institutional audit was conducted on 1,192 consecutive oncology patients treated between January 2023 and February 2026. The cohort was stratified into a legacy conventional radiotherapy cohort (n=1,060) and a high‑precision digital radiotherapy cohort (n=132). Clinical variables included demographic characteristics, cancer site distribution, stage at presentation, systemic comorbidities, treatment modality utilization, and radiotherapy technique distribution. Disease control rate (DCR) was calculated using verified follow‑up outcomes.

Results: The median age of the cohort was 56 years with a female predominance of 64.5%. Breast cancer, head and neck malignancies, and gynecologic cancers represented the dominant disease triad, accounting for 67.4% of the institutional workload. More than half of the patients presented with advanced disease (Stage III– IV, 53%). Radiotherapy was utilized in 70% of patients. Adoption of modern high‑precision radiotherapy techniques including VMAT, IMRT, and stereotactic radiotherapy enabled improved conformality, enhanced organ‑at‑risk sparing, and reduction in treatment interruptions. Disease control rate improved from 66% in the legacy era to 79.7% following adoption of precision radiotherapy.

Conclusion: Transition from legacy radiotherapy techniques to modern digital precision platforms significantly improves treatment precision and disease control outcomes. These findings demonstrate that technological modernization can meaningfully elevate oncologic care even in resource‑limited regional centers.