ESTRO Annual Meeting vs ASTRO Annual Meeting

[WildRivers]

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I've never been to ESTRO, so what I'm going to say is just from what I see produced from the meeting and from social media.

I mostly stopped attending ASTRO because, as noted in my pinned speech here, the meeting feels much more like an industry sponsored trade show rather than a scientific meeting. The plenary presentations have gone from hit or miss to pretty dismal and uninteresting. They had their woke era of trash where some navigation study was a plenary. Rarely do any of the presentations excite people or change practice meaningfully or enlighten us about something we had not previously conceived of. Contra this - there is "excitement" because one of ASTRO's plenaries is an LDRT trial from like 13 years ago that was initially published in "Russian Open Medical Journal". There are a few people on the by-line that are definitely friends - so no ill will towards them - but if we have to look back that far to a study that was ignored until recently and highlight that - it just reeks of desperation.

ESTRO, the last few years, produces bangers. This meeting alone had 15 legit RCTs, 5 of which will be published in Lancet Oncology. The types of studies actually seem important to us as practicing physicians. The social media messages - X, LinkedIn, Instagram - appear to be true grassroots interest and passion, rather than appointed "social champions" like ASTRO uses, "ASTRO" turf, to be cute. LinkedIn especially had such great content and fun posts and messages. The cities they choose are attractive - Stockholm this year, Milan next year. Boston is fine, but then you get a place like San Antonio. I know, I know it's a nice city and lovely and all that, but if I'm from some middle income or lower income Western country and I get to go one meeting every few years, I'm gonna be irritated if it's somewhere not that exciting. In addition, people have told me they feel that there is far less industry at ESTRO meetings, as well.

Anyway, it's hard for me to separate my disdain for the organization from the actual quality of the annual meeting. I've been trying to quantitatively look at what's produced over the last several years, but it's a bit tricky. But, likely will be a post soon.

If I was a meeting person (I'm not) - if I had limited CME (I do), I'd probably skip the American meetings and go to ESTRO every other year or maybe one of the site specific ones - I did go to an ESTRO GI meeting in Spain that was very high quality. ASTRO also has a lot of add on things to tack on costs. One of my partner's is getting a Gold Medal and to attend that event would cost $500.

What are other people's thoughts? Is this just me being totally biased? I feel like that is possible.

 

[fiji128]

I haven't been to an Astro conference in years and years. Not sure what the case is for me using my time to attend at this point. Seems like anything that matters in the US goes to ASCO these days anyhow.

 

[medgator]

. Seems like anything that matters in the US goes to ASCO these days anyhow.

💯💯💯

 

[Gfunk6]

I’ve attended both and at this point I strongly prefer ESTRO. To be candid, I’ve become fairly disillusioned with what ASTRO has evolved into over the years. That doesn’t mean there aren’t good people involved or useful sessions, but the organizations no longer feel philosophically similar.

A few reasons:

1. Meeting content is better, at least from my perspective.
   I find ESTRO much more focused on high-impact clinical trials, practice-changing data, and multidisciplinary discussion. It’s common to see RO + MO + surgical perspectives in the same session, and the moderators are generally excellent. There’s also an odd but refreshing sense of camaraderie and even humor/playfulness that seems largely absent at ASTRO. People appear to genuinely enjoy being there.
2. Less contamination from industry.
   ESTRO absolutely has an exhibit hall and industry presence, so I’m not claiming purity. But I do think there is greater awareness of maintaining separation between scientific discourse and commercial influence. One speaker this year openly said we should intentionally preserve distance between science and industry. I found that remarkable to hear at a major meeting.
3. Very little advocacy noise.
   This is probably the biggest one for me philosophically. ESTRO seems far less preoccupied with reimbursement, coding, payment models, coverage, and similar topics. The emphasis is overwhelmingly on science, technology, outcomes, toxicity, workflow, and clinical implementation. I leave feeling like I learned radiation oncology rather than healthcare administration.
4. Cost and value are dramatically better.
   ESTRO membership is cheaper. Meeting registration is cheaper. And unlike ASTRO, ESTRO includes extremely good video access. Sessions are often uploaded within ~24 hours, meaning if you miss a high-impact presentation because you attended another track, you can often watch it during the meeting itself. That alone materially increases the educational value.
5. The cities are dramatically better.
   This sounds superficial but matters more than people admit. Vienna and Stockholm are simply more enjoyable conference environments than most U.S. meeting cities. You can spend mornings in sessions and evenings actually seeing a place with history, architecture, museums, transit, food, etc. It lends itself to genuine cultural immersion rather than hotel → convention center → airport.

I’m aware reasonable people disagree. But if someone asked me where I would spend my own time and money in 2026 and beyond, I would choose ESTRO without hesitation.

 

[WildRivers]

Although advocacy/billing/coding stuff is of great interest to me - I absolutely agree that it is overwhelming the radiation oncology zeitgeist. I have spent more cognitive time on figuring out how to get a patient authorized for treatment and auditing our billing then I am studying clinical radiation oncology. You are right in that somehow we need to separate that.

 

[TheWallnerus]

Although advocacy/billing/coding stuff is of great interest to me - I absolutely agree that it is overwhelming the radiation oncology zeitgeist. I have spent more cognitive time on figuring out how to get a patient authorized for treatment and auditing our billing then I am studying clinical radiation oncology. You are right in that somehow we need to separate that.

Yes. In some ways rad onc (in US) is a field that you now go into if you want to learn how to negotiate with payors and navigate prior auth, maintain billing and coding compliance, and fight Medicare all the time.

 

[Palex80]

I’ve attended both and at this point I strongly prefer ESTRO. To be candid, I’ve become fairly disillusioned with what ASTRO has evolved into over the years. That doesn’t mean there aren’t good people involved or useful sessions, but the organizations no longer feel philosophically similar.

A few reasons:

1. Meeting content is better, at least from my perspective.
   I find ESTRO much more focused on high-impact clinical trials, practice-changing data, and multidisciplinary discussion. It’s common to see RO + MO + surgical perspectives in the same session, and the moderators are generally excellent. There’s also an odd but refreshing sense of camaraderie and even humor/playfulness that seems largely absent at ASTRO. People appear to genuinely enjoy being there.
2. Less contamination from industry.
   ESTRO absolutely has an exhibit hall and industry presence, so I’m not claiming purity. But I do think there is greater awareness of maintaining separation between scientific discourse and commercial influence. One speaker this year openly said we should intentionally preserve distance between science and industry. I found that remarkable to hear at a major meeting.
3. Very little advocacy noise.
   This is probably the biggest one for me philosophically. ESTRO seems far less preoccupied with reimbursement, coding, payment models, coverage, and similar topics. The emphasis is overwhelmingly on science, technology, outcomes, toxicity, workflow, and clinical implementation. I leave feeling like I learned radiation oncology rather than healthcare administration.
4. Cost and value are dramatically better.
   ESTRO membership is cheaper. Meeting registration is cheaper. And unlike ASTRO, ESTRO includes extremely good video access. Sessions are often uploaded within ~24 hours, meaning if you miss a high-impact presentation because you attended another track, you can often watch it during the meeting itself. That alone materially increases the educational value.
5. The cities are dramatically better.
   This sounds superficial but matters more than people admit. Vienna and Stockholm are simply more enjoyable conference environments than most U.S. meeting cities. You can spend mornings in sessions and evenings actually seeing a place with history, architecture, museums, transit, food, etc. It lends itself to genuine cultural immersion rather than hotel → convention center → airport.

I’m aware reasonable people disagree. But if someone asked me where I would spend my own time and money in 2026 and beyond, I would choose ESTRO without hesitation.

Let me provide some context, or at least my opinion.

1. Yes. This also has to do with the fact however, that many of the radiation oncologists attending ESTRO also work as clinical oncologists. They prescribe medication.
2. Yes. This also has to do with the more tight framework / compliance rules of the EU. Blunt industry advertisement is less likely in congresses.
3. Yes. Has to do with the fact that people from dozens of countries join. Advocacy for reimbursement in Italy will achieve little at an ESTRO congress.
4. True. I am not sure why ASTRO has to be so expensive, certainly not for the buffet.
5. True. On the other hand, I am kind of tired of visiting the same (lovely) cities, over and over. 🙂


One more thing. And I am sorry, but I need to point it out.
Point 1 may have to do with how US politics have shifted in the decade and the damage this has caused.
I saw quite a few colleagues from outside of Europe presenting very high quality data at ESTRO. Some of that data may have even made it to ASCO or ASTRO.
But they opted for ESTRO instead. Talking to colleagues from med onc, very few will go to ASCO this year. Many have decided to present their data at ESMO, later this year, and did not submit to ASCO.

A young colleague from India or Egypt will likely choose ESMO/ESTRO over ASCO/ASTRO, not only based on science.

 

[temujim]

Let me provide some context, or at least my opinion.

1. Yes. This also has to do with the fact however, that many of the radiation oncologists attending ESTRO also work as clinical oncologists. They prescribe medication.
2. Yes. This also has to do with the more tight framework / compliance rules of the EU. Blunt industry advertisement is less likely in congresses.
3. Yes. Has to do with the fact that people from dozens of countries join. Advocacy for reimbursement in Italy will achieve little at an ESTRO congress.
4. True. I am not sure why ASTRO has to be so expensive, certainly not for the buffet.
5. True. On the other hand, I am kind of tired of visiting the same (lovely) cities, over and over. 🙂


One more thing. And I am sorry, but I need to point it out.
Point 1 may have to do with how US politics have shifted in the decade and the damage this has caused.
I saw quite a few colleagues from outside of Europe presenting very high quality data at ESTRO. Some of that data may have even made it to ASCO or ASTRO.
But they opted for ESTRO instead. Talking to colleagues from med onc, very few will go to ASCO this year. Many have decided to present their data at ESMO, later this year, and did not submit to ASCO.

A young colleague from India or Egypt will likely choose ESMO/ESTRO over ASCO/ASTRO, not only based on science.

I prefer ESTRO/ESMO myself for many of the same reasons. One not listed is to hear perspectives might not otherwise. ASTRO has a bad habit of inviting the same voices over and over.

The ESMO industry floor maybe still limited by EU regs, but this past year it was still pretty crazy. Clear difference between ESTRO/ESMO; on par with ASCO/ASTRO.

The ESTRO/ESMO hotel choices can be pretty sub par, but that may be more of a function of availability.

I heard from colleagues that some Europeans boycotted ASTRO last year, perhaps over politics, though this is all second/third hand.

 

[taserlaser]

To that last point, while advancing one’s career is still considered and certainly the US is geographically more proximate, there is an abrupt and voluminous preference to avoid the US from those in Canada. I still think from the majority here people will still travel for US conferences, but any visible minority and especially those with significant accents are quite hesistant given the current climate. ESTRO is the much safer option.

Of note, we also saw Canadian applications for medical physics residencies were much higher volume this year we suspect due to this and visa policy changes etc.

 

[medgator]

To that last point, while advancing one’s career is still considered and certainly the US is geographically more proximate, there is an abrupt and voluminous preference to avoid the US from those in Canada. I still think from the majority here people will still travel for US conferences, but any visible minority and especially those with significant accents are quite hesistant given the current climate. ESTRO is the much safer option.

Of note, we also saw Canadian applications for medical physics residencies were much higher volume this year we suspect due to this and visa policy changes etc.

When I was in Central Mexico on a trip met a lot of Canadians who were there purposely avoiding the US

Many parts of the US are suffering tourism wise thanks to the current politics and situation

 

[A_DeMichele]

wish ESTRO sold streaming-only access

 

[Gfunk6]

wish ESTRO sold streaming-only access

Yes, but consider the following:

1. ESTRO Congress fee for members is slightly less than $600 USD and includes streaming
2. ASTRO Annual meeting fee for streaming ONLY is $1,100 USD. Strangely, the in-person fee (which includes streaming, but I suppose not live-casting) is $1,000 USD

 

[OTN]

Yes, but consider the following:

1. ESTRO Congress fee for members is slightly less than $600 USD and includes streaming
2. ASTRO Annual meeting fee for streaming ONLY is $1,100 USD. Strangely, the in-person fee (which includes streaming, but I suppose not live-casting) is $1,000 USD

Europe is poorer than the US, so everything is cheaper. That at least makes sense.

What that doesn't explain is how European radoncs have been able to run absolute circles around US academic radoncs over the last 15 years. Partial breast protocol? Italian. Hypofractionated breast? UK and Canadian (ok they're not European, but they're not US docs either). PACE prostate trials? UK. Germans have both benign and Hodgkin's data all to themselves. Etc.

 

[yesmaster]

ASTRO is a good example of shrinkflation

 

[Gfunk6]

Yes, but consider the following:

1. ESTRO Congress fee for members is slightly less than $600 USD and includes streaming
2. ASTRO Annual meeting fee for streaming ONLY is $1,100 USD. Strangely, the in-person fee (which includes streaming, but I suppose not live-casting) is $1,000 USD

The above presumes that you are an active member of the respective organization.

ESTRO Annual Membership is slightly less than $130 USD
ASTRO Annual Membership is $775 USD

 

[medgator]

The above presumes that you are an active member of the respective organization.

ESTRO Annual Membership is slightly less than $130 USD
ASTRO Annual Membership is $775 USD

Geez what a contrast. I wonder how much of that ASTRO fee goes to lobbying

 

[OTN]

Let's not forget speaker fees

 

[xrt123]

Right now more palliation is the trend in radiation oncology which is boring and pays nothing. Consults are steady because patient are living longer to get the wonderful 8 Gy in a single fraction. Radiation oncology ownership over concurrent therapies is needed as many new agents are far less toxic than prior chemotherapies. ASTRO, please, please, please start pushing your members to start running trials with concurrent medicines prescribed by RAD ONCs. Immunotherapy. Next gen ADT. Targeted agents.

No one can explain to me why I can easily prescribe Enzalutamide/Pluvicto but not a Parp inhibitor. PLEASE train our future residents to prescribe these meds and new radiopharm. People will show up to the ASTRO conference/Annual meeting if you start exciting doctors who want to help patients and can expand his or her practice. Lets compete with ESTRO and not give up.

 

[NotMattSpraker]

Europe is poorer than the US, so everything is cheaper. That at least makes sense.

ASTROs prices are quite high compared to other American society costs as well.

 

[Palex80]

Europe is poorer than the US, so everything is cheaper. That at least makes sense.

ESTRO was in Stockholm.

Stockholm is not a cheap city. Not even by US standards.

 

[Gfunk6]

No one can explain to me why I can easily prescribe Enzalutamide/Pluvicto but not a Parp inhibitor. PLEASE train our future residents to prescribe these meds and new radiopharm. People will show up to the ASTRO conference/Annual meeting if you start exciting doctors who want to help patients and can expand his or her practice. Lets compete with ESTRO and not give up.

Here is the explanation:

ASTRO is not going to reorganize the specialty around a vanishingly small subset of independent ROs who want standalone systemic prescribing.

Radiopharm is different because it is closer to the radiation domain and has a natural ownership argument. But broad systemic therapy? In the U.S., that train left the station decades ago.

 

[communitydoc13]

Here is the explanation:

ASTRO is not going to reorganize the specialty around a vanishingly small subset of independent ROs who want standalone systemic prescribing.

Radiopharm is different because it is closer to the radiation domain and has a natural ownership argument. But broad systemic therapy? In the U.S., that train left the station decades ago.

Absolutely.

But there is a dearth of medoncs. They run clinics with armies of APPs, who manage the ridiculous follow-up/on treatment volume mandated by IO and targeted therapies prescribed for long durations...

...and, we are actively moving into the era of sub-cutaneous IO among other drugs.

If we want a progressive and resilient specialty, not a lame one, it's time to encourage our high IQ, well versed in holistic and evidence-based medicine, radiation doctors to start taking ownership of more solid tumor malignancies, including the systemic portion of therapy.

Maybe we all just secretly want to preserve our nice lifestyles however.

 

[TheWallnerus]

In private practice oncology centers where’s there’s both radiation and med onc, the med onc to rad onc revenue ratio is now as high as 8 or 9 to 1. I know it sounds high so believe me or not. That said, it seems to be a great, perhaps ultimately existential, economic idea for rad onc to attempt some specialty creep into med onc. But better yet, consider quitting rad onc and go become a med onc.

 

[TheWallnerus]

Some large academic rad onc depts experiencing ~$7-10m Q1 2026 vs Q1 2025 revenue drop-offs(not a direct quote from article, this is scuttlebutt)

Payers Fail to Reset Radiation Oncology Payments to Match Coding Changes—and Some Clinics May Close, Leading Oncologist Says | AJMC

Todd Doyle, MD, of OneOncology, warns that commercial payers lag on updating bundled codes, which has slashed radiation oncology revenue and risks community cancer access in 2026.

www.ajmc.com