“Predicting is difficult, especially predicting the future….”

The evolution in radiotherapy nowadays allows highly conformal treatment. Even for moving targets, the radiation therapy can be given with high precision, avoiding as much as possible the irradiation of healthy tissue. This allows reduction of the number of fractions and increase of the biological effect of the treatment. The literature shows us that this increase in biological effect opens the perspective of ablative radiotherapy as an alternative to surgery, whether this is for selected primary tumours or for limited metastatic sub-sites. This ablative radiotherapy will change the treatment paradigms in oncology radically. It is cost-effective, non-invasive and, as the treatment is given in a limited number of fractions not requiring a hospital stay, it has no negative impact on the quality of life of the patient. (BELG J MED ONCOL 2012;6:151–156)