Unfortunately, movie-plot cyberattacks have become reality for multiple healthcare systems over the past few years. Here is a real-world retrospective dosimetric analysis of 26 patients treated under contingency conditions during a March 2023 ransomware attack that paralyzed a large Barcelona cancer center. Radiotherapy courses were halted for up to 12 days, with urgent patients transferred and replanned at a partner institution with no prior imaging available for reference. Importantly, most patients derived benefit from subpar treatment continuation in lieu of a 12-day break, though select head and neck and mediastinal nodal cases with poor coverage sans fused PET-imaging dipped below treatment-pause thresholds of biologically-effective coverage. The authors propose future-proofing via redundant offline (i.e.disconnected from main network) backups (e.g., encrypted external hard drives physically unplugged after back-up), extended log-storage, predefined cross-institution workflows, and tumor-specific contingency strategies. | Cases, Int J Radiat Oncol Biol Phys 2026
