Radiotherapy Market Size, LINAC, Proton Therapy, Adaptive RT & Forecast 2035

Radiotherapy Market Size & Forecast 2035

The global radiotherapy market was valued at US$6.84 billion in 2025 and is projected to reach US$11.80 billion by 2035, growing at a CAGR of 5.6% during 2026-2035. Market growth is supported by rising global cancer treatment demand, replacement and modernization of linear accelerators, greater use of image-guided and adaptive radiotherapy, expansion of stereotactic treatments, investment in proton therapy and growing adoption of AI-enabled treatment planning and workflow software.

Radiotherapy remains essential to modern cancer care. The IAEA reported in June 2026 that more than half of people with cancer require radiotherapy as part of their treatment, while GLOBOCAN 2024 recorded 20.64 million new cancer cases worldwide. Cancer incidence is projected to reach 34.4 million cases by 2050, increasing the long-term need for treatment capacity.

The commercial opportunity is also changing. Hospitals are no longer purchasing only a radiation-delivery machine. New investment increasingly covers high-resolution onboard imaging, adaptive treatment software, AI contouring, treatment planning systems, oncology information systems, motion management, quality assurance, service contracts and recurring software upgrades. Elekta's FY2025/26 results illustrate this lifecycle model: 44% of its net sales came from service, while the company had an installed base of around 7,500 devices.

Radiotherapy Market Highlights

• 2025 Market Size: US$6.84 Billion
• 2035 Market Size: US$11.80 Billion
• CAGR, 2026-2035: 5.6%
• Largest Region: North America
• North America Market Share: 40.2% in the 2024 source-year analysis
• Fastest-Growing Region: Asia-Pacific
• Asia-Pacific Market Share: 21.8% in the 2024 source-year analysis
• Leading Treatment Type: External Beam Radiation Therapy
• External Beam Radiation Therapy Share: 38.04% in the 2024 source-year analysis
• Primary Equipment Platform: Medical Linear Accelerators
• High-Growth Technologies: Adaptive radiotherapy, MR-guided radiotherapy, CT-LINACs, SBRT/SRS, proton therapy, surface-guided RT and AI-enabled planning
• Primary Buyers: Hospitals, comprehensive cancer centers, radiation oncology networks and specialty treatment centers
• Key Investment Areas: LINAC replacement, bunker utilization, proton therapy integration, AI planning, workflow software, service contracts, imaging upgrades and capacity expansion.

Radiotherapy Is a Capacity Market as Much as a Medical Device Market

Radiotherapy has a different commercial structure from pharmaceutical oncology.

A cancer drug generates revenue through repeated doses for an individual patient. Radiotherapy infrastructure generates value through machine capacity, treatment throughput, equipment utilization, maintenance, software and the number of fractions that can be delivered during the life of the system.

A modern radiation oncology department can retain a treatment platform for many years while purchasing upgrades, software licenses, replacement imaging components and service contracts throughout the equipment lifecycle.

Elekta's FY2025/26 business model demonstrates the importance of this recurring revenue. The company reported SEK 16.72 billion in annual net sales, of which SEK 9.33 billion came from solutions and SEK 7.39 billion from service. Service therefore represented 44% of total sales.

Accuray shows a similar pattern. During the first nine months of fiscal 2026, its service revenue reached US$169.1 million compared with US$131.9 million in product revenue.

For market buyers, this means radiotherapy procurement should be evaluated on total cost of ownership, not acquisition price alone. System uptime, service coverage, software compatibility, treatment capacity, upgrade paths, and usable lifetime can materially affect the economics of a radiation oncology program.

Key Takeaways for Radiotherapy Market Buyers

• The global radiotherapy market will increase from US$6.84 billion in 2025 to US$11.80 billion by 2035, supported by a 5.6% CAGR during 2026-2035.
• External beam radiation therapy remains the largest treatment segment, holding 38.04% of the market in the source-year analysis and benefiting from broad use of LINAC-based IMRT, IGRT, VMAT, SBRT, and SRS.
• North America leads commercial revenue with a 40.2% source-year market share, while Asia-Pacific holds 21.8% and offers the strongest capacity-expansion opportunity.
• Adaptive radiotherapy is becoming a mainstream equipment-upgrade driver. Varian's Ethos integrates AI-assisted adaptive treatment and CBCT-based dose calculation, while Elekta received U.S. FDA 510(k) clearance for its Evo CT-LINAC in January 2026.
• Proton therapy economics are changing. IBA had 42 proton therapy projects in equipment backlog and 46 active sites at the end of Q1 2026, while Mevion has introduced a proton system designed to fit inside a conventional LINAC vault.
• Software and services are becoming a larger recurring-revenue layer. Elekta generates 44% of sales from service and reported that 23% of Oncology Information System software orders were SaaS in FY2025/26.
• Hypofractionation changes equipment economics. Fewer fractions can reduce treatment burden for each patient while releasing machine capacity for additional patients. An IAEA-coauthored analysis found that broader hypofractionation could provide radiotherapy access to an additional 2.2 million patients globally.

Where Radiotherapy Revenue Is Moving: Hardware to Connected Treatment Platforms

Linear Accelerators Remain the Core Capital Purchase

LINACs remain the backbone of external beam radiotherapy because they can support routine and advanced treatment techniques on the same platform.

Hospitals increasingly expect new systems to handle:

• IMRT and VMAT
• IGRT
• SBRT and SRS
• motion management
• surface guidance
• high-quality CBCT
• adaptive workflows
• automated planning
• oncology information system integration.

Varian's Halcyon platform illustrates the throughput-oriented buying proposition. The company states that Halcyon can deliver image-guided treatments in less than ten minutes and combines HyperSight imaging, motion-management options and streamlined workflows intended to support higher patient throughput.

Elekta is competing with a different imaging architecture through Elekta Evo, which received FDA clearance in January 2026. Evo combines a LINAC with AI-enhanced high-definition CT imaging through the Iris imaging system.

For hospitals, the purchasing question is therefore moving from "Which LINAC should we buy?" to “Which treatment ecosystem gives us the highest clinical coverage and throughput from each bunker?”

External Beam Radiation Therapy Holds the Largest Market Share

External beam radiation therapy accounted for 38.04% of the radiotherapy market in the 2024 source-year analysis, making it the largest treatment-type segment.

Its leadership reflects the ability of external beam platforms to treat a wide range of solid tumors, including breast, lung, prostate, head and neck, colorectal, gynecologic and brain cancers.

The segment also captures many of the industry's highest-value technology upgrades.

IMRT and VMAT

Intensity-modulated radiation therapy allows dose intensity to vary across individual beam fields, improving target conformity and limiting dose to surrounding organs.

VMAT extends this concept through continuous arc delivery and remains a major workflow for modern LINAC systems.

The commercial opportunity is mature but durable because IMRT and VMAT functionality forms the baseline required for newer stereotactic and adaptive workflows.

Image-Guided Radiation Therapy

IGRT has moved from an optional feature toward a core requirement for modern radiotherapy systems.

High-quality onboard CBCT allows clinicians to visualize anatomical position immediately before treatment. Newer platforms are improving image quality sufficiently to support treatment adaptation and direct dose calculation.

Varian's HyperSight on Ethos supports CBCT-based adaptive workflows, while Elekta's Evo uses AI-enhanced CT imaging to improve visualization of targets and organs at risk.

SBRT and SRS

Stereotactic treatment is commercially attractive because it delivers highly conformal radiation in a small number of fractions.

CyberKnife provides a dedicated robotic platform for stereotactic radiosurgery and SBRT with real-time target tracking. Accuray describes treatment delivery times as short as 15 minutes for selected ultrahypofractionated workflows.

SBRT also improves machine capacity when appropriately substituted for longer conventional courses. This makes stereotactic capability valuable both clinically and operationally.

Adaptive Radiotherapy Is Becoming the Main Premium LINAC Upgrade Cycle

Adaptive radiotherapy changes a patient's treatment plan in response to anatomy observed during treatment rather than relying only on the anatomy captured at simulation.

This becomes important when tumors shrink, patients lose weight or organs such as the bladder, rectum, bowel or pancreas change position between fractions.

Two equipment strategies are competing.

CBCT-Guided Adaptive Radiotherapy

Varian's Ethos platform combines AI-assisted planning and segmentation with HyperSight CBCT imaging. Current Ethos capabilities include direct dose calculation on HyperSight CBCT images for supported adaptive workflows.

Elekta's Evo expands high-definition CT imaging into conventional LINAC workflows. FDA clearance in January 2026 gives Elekta a new U.S. platform for CT-guided precision treatment and future adaptive workflow competition.

CBCT-guided adaptation is commercially attractive because it builds on the LINAC infrastructure already familiar to most radiation oncology departments.

MR-Guided Adaptive Radiotherapy

MR-LINAC systems combine radiation delivery with magnetic resonance imaging.

The main clinical advantage is improved soft-tissue visualization without adding ionizing imaging dose. This is particularly relevant in abdominal and pelvic tumors where daily organ position can change significantly.

A 2025 multicenter SMART ONE Phase II study demonstrated the feasibility of MR-guided single-fraction SBRT for selected tumors. In-room time was below 90 minutes for 87.1% of delivered plans, and one-year local control reached 96.2%.

MR-guided systems remain more infrastructure- and workflow-intensive than conventional LINACs, so purchasing decisions depend heavily on patient volume, clinical mix, and whether the center can capture enough advanced cases to support utilization.

AI Is Moving From Contouring Into the Entire Radiotherapy Workflow

AI adoption in radiotherapy began with image segmentation and automated contouring, but the commercial opportunity is widening.

Current applications include:

• organ-at-risk segmentation
• target contour support
• treatment-plan optimization
• synthetic CT generation
• image reconstruction
• adaptive replanning
• treatment workflow orchestration
• quality assurance
• patient monitoring.

GE HealthCare received FDA 510(k) clearance in 2025 for MR Contour DL, an AI model that segments 37 organs and structures across head-and-neck and pelvic imaging. The model is being integrated into the company's Intelligent Radiation Therapy workflow platform.

At ESTRO 2026, Siemens Healthineers highlighted AI autocontouring, adaptive treatment, ARIA CORE workflow integration and new radiation therapy imaging as part of an increasingly connected treatment environment.

GE HealthCare similarly used ESTRO 2026 to expand its AI-enabled radiation oncology and theranostics workflow strategy through iRT and MIM software.

The commercial consequence is significant: software can generate recurring revenue without requiring the hospital to purchase a new radiation-delivery system every time a workflow improves.

Hypofractionation Creates a Throughput Opportunity, Not Simply Fewer Treatments

Hypofractionation uses fewer treatment fractions with a larger radiation dose per session.

At first glance, this might appear negative for a market in which treatment has historically been measured in fractions. The equipment economics are different.

Shorter treatment courses free LINAC slots, allowing a center with the same number of machines to treat more patients.

The IAEA reported that implementing hypofractionated approaches in breast and prostate cancer could make treatment available to 2.2 million additional patients worldwide. The same analysis noted that 50%-70% of cancer patients need radiotherapy and that more than half of those patients live in low- and middle-income countries.

For equipment vendors, hypofractionation shifts competitive advantage toward systems that can deliver:

high-quality imaging, stereotactic accuracy, rapid treatment planning and short treatment slots.

For hospitals, it can increase bunker productivity and reduce waiting lists.

Proton Therapy Is Moving From Mega-Center Economics Toward Smaller Footprints

Proton therapy has traditionally required substantially larger capital investment than conventional photon radiotherapy because of accelerators, beam transport systems, gantries and specialized buildings.

This cost profile is changing.

IBA Builds a Large Global Proton Backlog

IBA reported €334.3 million in proton therapy revenue during 2025, increasing 57% from 2024. Proton equipment revenue more than doubled, and the company ended 2025 with 43 proton therapy projects in equipment backlog.

By the end of Q1 2026, IBA reported:

42 projects in proton equipment backlog, nine installations underway and 46 active proton therapy sites worldwide.

The company's group backlog stood at €1.6 billion, including €0.73 billion of equipment backlog and €0.83 billion of service backlog.

The service backlog is commercially important because proton therapy centers require long-term support, maintenance and upgrades after installation.

Mevion Targets Existing LINAC Vaults

Mevion is addressing one of proton therapy's largest adoption barriers: construction.

Its S250-FIT system is designed for installation inside a conventional LINAC vault. In April 2026, Stanford Medicine unveiled the first installation inside an existing 1,200-square-foot treatment vault without constructing a separate proton building.

The system has U.S. FDA clearance and CE marking.

If this model scales, proton procurement can move closer to a replacement-cycle decision rather than requiring an entirely separate cancer-center infrastructure project.

Hitachi Demonstrates the Long Lifecycle of Proton Infrastructure

The University of Tsukuba's second proton system began treating patients in September 2025. The new facility includes spot-scanning technology, an accelerator and two rotating gantry rooms, with the consortium contracted to support the facility for 20 years.

This illustrates why service, maintenance and facility partnerships are strategically important in proton therapy.

Biology-Guided Radiotherapy Opens a Different Precision-Treatment Model

RefleXion is developing a radiotherapy architecture that combines PET detection with external-beam treatment.

Its SCINTIX technology uses radiotracer signals from cancer cells to guide treatment delivery.

In January 2026, FDA cleared the next-generation RefleXion X2 with SCINTIX for primary and metastatic lung and bone tumors. The new platform increases PET sensitivity twentyfold and expands the imaging field of view from 5 cm to 20 cm.

Commercial adoption is also moving beyond large academic centers. RefleXion reported that the first SCINTIX patient at a freestanding cancer center was treated in October 2025. Medicare payment rates for SCINTIX procedures became effective in January 2026 across jurisdictions administered by Novitas Solutions and First Coast Service Options.

The technology remains a small share of the overall market, but it represents a differentiated attempt to combine tumor biology, molecular imaging and external beam radiotherapy in real time.

Brachytherapy Remains a High-Value Specialist Segment

Brachytherapy delivers radioactive material directly inside or close to the tumor.

It remains important in cervical, prostate, endometrial and selected breast, head-and-neck and other cancers.

Its economics differ from LINAC-based external beam treatment because investment can include:

• afterloaders
• radioactive sources
• applicators
• treatment-planning software
• imaging
• source replacement
• procedural guidance.

Brachytherapy continues to be particularly important in cervical cancer, where radiotherapy infrastructure and trained personnel are required to deliver curative treatment. WHO and IAEA identify radiotherapy equipment, including external beam systems and brachytherapy devices, as essential components of comprehensive cancer care.

The growth challenge is workforce availability. High-quality brachytherapy requires specialist radiation oncologists, physicists and procedural expertise, creating greater concentration in high-volume centers.

Systemic Radiation Therapy Is Increasingly Linked With Theranostics

The DMI radiotherapy scope also includes systemic radiation therapy, alongside external beam treatment and brachytherapy.

This category covers therapies in which radioactive material is administered systemically and accumulates in selected tissues or tumors.

Its commercial structure differs substantially from LINAC-based radiotherapy because revenue is generated through radiopharmaceutical products, isotope supply, molecular imaging and specialized nuclear medicine facilities.

The boundary between radiotherapy and theranostics is becoming more commercially relevant as radiation oncology, molecular imaging and radiopharmaceutical therapy become increasingly connected.

GE HealthCare used ESTRO 2026 to introduce its iRT for Theranostics workflow concept, designed to coordinate data and treatment processes across multidisciplinary theranostics programs.

For market forecasting, equipment-led radiotherapy and systemic radiopharmaceutical therapy should therefore be analyzed separately even when both sit within the broader radiation treatment ecosystem.

Radiotherapy Market Growth Drivers

Global Cancer Incidence Continues to Increase

GLOBOCAN 2024 recorded 20,636,441 new cancer cases and 9,762,507 deaths worldwide. Cancer incidence is projected to increase to 34.4 million cases by 2050, 67% above the 2024 level.

Because more than half of people with cancer require radiotherapy during their treatment journey, increasing cancer incidence directly translates into greater demand for radiation oncology capacity.

Replacement of Aging LINAC Fleets

Mature markets do not depend only on greenfield cancer centers.

Large installed bases create an ongoing replacement market as hospitals upgrade older machines to gain:

• better onboard imaging
• faster treatment
• adaptive capability
• stereotactic accuracy
• lower energy use
• improved software connectivity.

Elekta's installed base of around 7,500 devices illustrates the scale of lifecycle replacement and service opportunity.

AI Reduces Planning Bottlenecks

Treatment planning requires contouring, dose calculation, optimization, and quality review.

AI-based contouring and workflow automation can reduce manual workload, allowing departments to process more patients without a proportional increase in specialist staffing.

GE's MR Contour DL clearance and the increasing incorporation of AI planning into Varian and Elekta platforms demonstrate how software has become part of radiotherapy capacity expansion.

Emerging Markets Need More Treatment Capacity

The IAEA states that access remains highly unequal and that more than half of patients who need radiotherapy are located in low- and middle-income countries.

By June 2026, more than 100 countries had requested support through the IAEA's Rays of Hope initiative, while 20 facilities were operating as regional Anchor Centres for training, research and innovation.

Capacity expansion in Asia, Africa and Latin America creates demand for systems that combine reliability, lower infrastructure requirements and manageable service costs.

Radiotherapy Market Restraints

High Capital Cost Extends Procurement Cycles

A radiation oncology project involves substantially more than the equipment purchase.

Capital requirements can include:

• radiation-shielded bunker construction
• electrical and cooling systems
• planning CT or MRI
• treatment planning software
• oncology information systems
• patient-positioning systems
• dosimetry and QA equipment
• installation
• commissioning
• staff training.

Proton therapy adds even larger infrastructure requirements, although compact designs are beginning to reduce this barrier.

Large capital budgets can make purchasing decisions highly dependent on government tenders, reimbursement policy and hospital financing.

Workforce Availability Limits Equipment Utilization

A LINAC without trained radiation oncologists, radiation therapists and medical physicists cannot create treatment capacity.

Access initiatives therefore increasingly combine equipment investment with workforce training. The IAEA's Rays of Hope strategy explicitly includes training, research, quality assurance and capacity building alongside equipment access.

Installation Delays Can Shift Vendor Revenue Between Periods

Large radiation systems frequently require construction readiness and site acceptance before revenue can be recognized.

Accuray's fiscal 2026 results showed how geopolitical disruptions and delayed installations in the Middle East affected product shipments and service revenue.

This creates lumpier revenue than pharmaceutical markets and makes order backlog and book-to-bill ratios important indicators of vendor performance.

Radiotherapy Market Regional Analysis

North America Holds 40.2% of the Global Market

North America held 40.2% of radiotherapy market revenue in the 2024 source-year analysis, making it the largest regional market.

The region's leadership reflects a large installed LINAC base, high cancer-care expenditure, rapid replacement cycles and early adoption of technologies including SBRT, adaptive radiotherapy, MR-guided treatment and proton therapy.

North America recorded 2.77 million new cancer cases in 2024, representing 13.4% of global cancer incidence.

Commercial activity remains strong in 2026. Siemens Healthineers reported 9.2% comparable growth in its Precision Therapy segment in Q3 FY2026, while Elekta launched Evo into the U.S. following FDA clearance.

The United States is also the first market for RefleXion X2, the first installation of Mevion's vault-based S250-FIT proton system and several of the industry's highest-value adaptive RT platforms.

North American growth through 2035 is likely to come more from replacement, software, premium imaging, adaptive upgrades, and services than from simply adding conventional LINAC capacity.

Asia-Pacific Holds 21.8% and Offers the Strongest Capacity Expansion

Asia-Pacific represented 21.8% of market revenue in the 2024 source-year analysis and is the fastest-growing region.

Asia accounted for 50.7% of worldwide cancer incidence in 2024, with 10.47 million new cases.

The large difference between Asia's cancer share and its current radiotherapy revenue share shows why the region has substantial capacity-expansion potential.

China is building conventional and proton treatment infrastructure. IBA reported progress on major ProteusPLUS installations in Chengdu and Shenzhen during 2025, while the company entered 2026 with multiple proton projects under installation.

Japan remains a major proton-therapy market and began treatment on a renewed Hitachi proton system at the University of Tsukuba in September 2025.

India presents a different opportunity: demand is driven by patient volume and the need for additional LINAC capacity, creating stronger buying interest in equipment with lower installation costs, high throughput, and reliable service coverage.

Europe Is a Mature Replacement and Software Market

Europe recorded 4.33 million new cancer cases in 2024, representing 21.0% of global incidence.

The region has a mature radiotherapy installed base, so growth increasingly comes from system replacement, and upgrades rather than greenfield installation alone.

Elekta reported strong commercial momentum in Europe during FY2025/26, supported by new product launches. The company's annual report also notes that mature markets increasingly generate a greater share of recurring service and software revenue.

Europe is particularly important for:

adaptive radiotherapy, MR-LINAC adoption, proton therapy, radiotherapy software, replacement LINACs and hypofractionated treatment.

Mevion introduced its LINAC-vault-compatible proton system to the European market at ESTRO 2026 after receiving CE marking, potentially lowering the facility barrier for centers considering proton investment.

Latin America Needs Both Replacement and Greenfield Capacity

Latin America and the Caribbean recorded 1.58 million new cancer cases in 2024, representing 7.7% of global incidence.

The region combines advanced private oncology networks with public-sector systems that continue to face radiotherapy capacity constraints.

Brazil and Mexico offer the largest commercial opportunities because of population size, specialist hospital networks and increasing private oncology investment.

Equipment buyers in the region place particular value on system uptime, technical-service coverage, cost per patient and the ability to deliver IMRT, IGRT and stereotactic treatment from one platform.

Software and remote support can become more important as health systems attempt to standardize care across geographically dispersed treatment centers.

Middle East and Africa Have the Largest Access-Led Opportunity

Africa recorded 1.22 million new cancer cases in 2024, while access to radiation oncology remains substantially below clinical need in many countries.

The IAEA continues to identify inadequate access to imaging and radiotherapy in low- and middle-income countries as a major global cancer-care gap.

Commercial success in this region depends less on selling the highest-specification platform and more on delivering:

reliable equipment, manageable bunker requirements, long-term service, workforce training, remote support and sustainable financing.

Gulf Cooperation Council countries form a separate premium market within the broader Middle East and Africa region, with growing demand for advanced LINACs, stereotactic systems and proton therapy.

Radiotherapy Procurement: What Hospitals Are Actually Buying

For a hospital or cancer-center buyer, a radiotherapy tender should be evaluated as a 10-year-plus clinical infrastructure decision.

Treatment Capacity

Systems should be compared using expected daily patient throughput, fraction duration, imaging time, setup time and downtime.

A faster machine has limited value if planning or patient setup remains the bottleneck.

Clinical Coverage

A single system capable of treating routine breast and prostate cases as well as lung SBRT, intracranial SRS and complex head-and-neck IMRT can support higher utilization than a specialized system serving a narrow patient population.

Imaging Quality

Onboard imaging increasingly determines whether the machine can support smaller margins and adaptive treatment.

HyperSight and Elekta Iris demonstrate how vendors are using improved CBCT/CT imaging to differentiate new platforms.

Adaptive Capability

Buyers need to distinguish between systems offering true online replanning and systems that provide advanced image guidance without a fully integrated adaptive workflow.

Treatment time, contouring workload and physician availability can determine whether adaptive capabilities are used routinely after purchase.

Service and Uptime

Service is one of the largest lifetime costs and one of the largest vendor revenue pools.

Elekta's 44% service revenue contribution and IBA's €0.83 billion service backlog in Q1 2026 show the financial importance of installed-base support.

Software Interoperability

Hospitals increasingly operate mixed equipment fleets.

Treatment planning, oncology information systems, imaging and analytics therefore need to communicate across multiple devices.

Open integration and compatibility can materially influence replacement decisions.

Upgrade Path

Software-defined improvements can extend useful equipment life.

Elekta designed Iris imaging so that it can be upgraded on supported existing linacs, while RefleXion states that existing customers can transition to X2 capabilities with limited disruption.

Competitive Landscape and Company Positioning

Siemens Healthineers / Varian

Siemens Healthineers operates one of the broadest radiation oncology portfolios through Varian.

Its ecosystem covers treatment delivery, adaptive therapy, planning, oncology information systems, imaging, and service. Major platforms include TrueBeam, Halcyon, Ethos, HyperSight, Eclipse and ARIA.

Varian revenue grew 1.4% in Q4 FY2025, while Siemens reorganized Varian into its broader Precision Therapy segment for its new strategy phase. By Q3 FY2026, Precision Therapy was growing 9.2% on a comparable basis.

The company's primary competitive advantage is its integrated cancer-care architecture, particularly where hospitals want imaging, radiotherapy and software from a connected supplier.

Elekta

Elekta competes through LINACs, MR-guided treatment, brachytherapy, radiosurgery, oncology software and recurring services.

The company ended FY2025/26 with an installed base of around 7,500 devices and reported SEK 16.72 billion in annual sales. Service represented 44% of revenue.

Elekta Evo is a major current product catalyst. U.S. FDA clearance in January 2026 expands the company's ability to compete for CT-guided precision and adaptive-capable LINAC replacements.

IBA

IBA has one of the strongest pure-play positions in proton therapy.

The company reported €334.3 million in proton therapy revenue during 2025, up 57%, and entered 2026 with a large equipment and service backlog.

By Q1 2026, it had 46 active proton therapy sites worldwide and 42 projects in equipment backlog.

Its competitive model combines high-value capital installations with long-duration service and maintenance revenue.

Accuray

Accuray competes through CyberKnife and Radixact, with a strong positioning in robotic radiosurgery, SBRT, motion synchronization and helical treatment delivery.

Its first nine months of FY2026 generated US$301.0 million in total revenue, including US$169.1 million from service. Order backlog stood at US$356.2 million at March 31, 2026.

The company's strategic opportunity lies in stereotactic treatment, real-time motion management and extending adaptive workflows across its installed base.

RefleXion Medical

RefleXion occupies a differentiated niche through biology-guided radiotherapy.

FDA clearance of the RefleXion X2 with SCINTIX in January 2026 expands its platform for lung and bone tumors while improving PET detection sensitivity.

The emerging commercial opportunity is particularly interesting in U.S. community and freestanding cancer centers after new Medicare payment rates became effective during 2026 in several jurisdictions.

GE HealthCare

GE HealthCare's radiotherapy strategy is concentrated more heavily on the imaging, simulation, software and workflow side of the market than direct high-energy radiation delivery.

FDA clearance of MR Contour DL in 2025 added deep-learning segmentation for 37 structures, while iRT is being expanded as a workflow orchestration platform for radiation therapy and theranostics.

This positions GE around the planning and imaging bottlenecks that occur before radiation delivery.

Mevion Medical Systems

Mevion specializes in compact proton therapy.

The S250-FIT addresses one of the largest barriers in proton therapy by allowing installation in a standard LINAC-sized vault. The first installation at Stanford Medicine was unveiled in April 2026.

If compact proton platforms gain broader clinical and reimbursement acceptance, they could materially expand the number of hospitals capable of entering the proton market.

Hitachi

Hitachi remains an important proton therapy supplier, particularly in Asia.

Its second University of Tsukuba proton installation began clinical treatment in September 2025 and includes spot scanning, an accelerator and two rotating gantry treatment rooms.

Long-term operations agreements also demonstrate the importance of lifecycle service in particle therapy.

Recent Developments Reshaping the Radiotherapy Market

May 2026 - Mevion Brings Proton Therapy Into a Standard LINAC Vault

Mevion introduced the S250-FIT to European radiation oncology buyers at ESTRO 2026. The system has FDA clearance and CE marking and is designed to operate inside existing LINAC-vault infrastructure.

May 2026 - GE HealthCare Expands AI-Enabled Radiation Oncology Workflows

At ESTRO 2026, GE HealthCare presented updated iRT capabilities, MIM oncology software and workflow integration spanning radiotherapy and theranostics.

January 2026 - Elekta Evo Receives U.S. FDA Clearance

Elekta received FDA 510(k) clearance for Evo, bringing AI-enhanced CT imaging and its Iris imaging architecture to the U.S. radiation oncology market.

January 2026 - RefleXion X2 Receives FDA Clearance

The RefleXion X2 with SCINTIX gained clearance for primary and metastatic lung and bone tumors. The platform provides a twentyfold increase in PET sensitivity compared with the earlier generation.

September 2025 - Varian Expands Halcyon

Varian announced upgraded Halcyon capabilities including enhanced positioning, motion management and HyperSight imaging at ASTRO 2025.

September 2025 - New Hitachi Proton Facility Begins Treatment

The University of Tsukuba began clinical treatment with its renewed two-room proton therapy facility.

May 2025 - GE HealthCare Receives Clearance for AI MR Contouring

GE HealthCare announced FDA clearance of MR Contour DL, enabling AI segmentation of 37 organs and structures for radiotherapy planning.

Radiotherapy Market Scope

What Buyers and Investors Should Watch Through 2035

• Replacement demand will be as important as new installations in mature markets. Hospitals with established radiation departments are increasingly replacing older LINACs with platforms offering better imaging and software rather than constructing additional bunkers.

• Service revenue will remain structurally attractive. Once a system is installed, uptime and clinical safety make ongoing maintenance essential. Elekta's 44% service revenue contribution and IBA's larger service backlog relative to equipment backlog show why vendors value their installed bases.

• Adaptive RT needs to prove operational value. A system can offer impressive adaptive technology, but routine use depends on how much physician, physicist and therapist time each adaptive fraction requires.

• AI value will be measured in staff time saved. Radiation oncology departments facing workforce constraints will prioritize solutions that reduce contouring, planning and QA time without creating new review bottlenecks.

• Proton therapy must solve infrastructure economics. Compact single-room and vault-compatible systems can broaden the addressable customer base if clinical volume and reimbursement justify investment.

• Emerging-market products need different design priorities. High throughput, equipment reliability, remote support and lower infrastructure requirements can be more important than maximum feature density.

• Hypofractionation rewards productivity. Vendors able to deliver precise SBRT and ultrahypofractionation in short treatment slots can benefit even as average fractions per patient decline.