Friday again: Timing and referral patterns of acute radiotherapy in a tertiary supraregional care network

Purpose Acute radiotherapy is essential in oncological emergencies, but delays may occur before or after referral to radiation oncology. The primary aim of this study was to characterize timing intervals in a tertiary supraregional care network. Methods This retrospective single-centre analysis included patients treated with acute radiotherapy for urgent tumour-related symptoms at our department between 2009 and 2024. Timing intervals from symptom onset to presentation and from presentation to radiotherapy start were analyzed. Referral patterns and weekday distribution were secondary organisational outcomes; symptomatic response and survival were assessed descriptively. All comparative analyses were exploratory and unadjusted. Results Overall, 314 patients treated at 349 treatment sites were included. The most frequent indication was metastatic spinal cord compression-related symptoms (260/349; 74.5%). 45.8% of all treatment sites were referred from external institutions. Median time from symptom onset to presentation was 5 days (IQR 2–16.25), whereas median time from presentation to radiotherapy start was 0 days (IQR 0–1). Treatment was initiated on the same day in 218 treatment sites (62.6%) and within one day in 305 (87.6%). Symptomatic response was evaluable for 275 treatment sites, of which 168 (61.1%) showed at least partial improvement. Median survival was 84 days (95% CI: 67–98). Presentations accumulated towards the weekend, with Friday being the most common presentation day. Conclusion Acute radiotherapy was initiated rapidly after presentation, whereas a substantially longer interval occurred before presentation to radiation oncology. Improvements should focus on earlier symptom recognition and structured regional emergency pathways.