Radiation Oncology Department - Americas Centro de Oncologia Integrado - Rio de Janeiro - Brazil.
Ribeirão Preto Medical School, Department of medical imagings, hematology and oncology of University of São Paulo (FMRP-USP), Brazil.
Int J Radiat Oncol Biol Phys. 2022 Nov 1;114(3):545-553. doi: 10.1016/j.ijrobp.2022.06.074. Epub 2022 Jun 29.
Ensuring optimal access to radiation therapy (RT) facilities is challenging for many countries. External beam RT and brachytherapy (BCT) are required to treat advanced cervical cancer. In this analysis, we evaluated the system-level capacity of BCT in Brazil and its relationship with access to complete cervix cancer radiation treatment with both external beam RT and BCT.
We used official government reports to compile data on BCT and linear accelerator (LINAC) numbers, geographic distribution and coverage, cervical cancer annual incidence, and prevalence in Brazil. We also evaluated changes in national BCT capacity between 2001 and 2021. The 2020 relationship between cervical cancer cases for RT per BCT unit, LINAC per BCT unit, and the LINAC supply for each Brazilian state and region were evaluated. For comparison, the LINAC per BCT unit ratio in Brazil was compared with Europe using International Atomic Energy Agency data.
Eighty-five percent (23/27) of Brazilian states have at least 1 BCT unit; nationally, there are 117 cervical cancer cases for RT per BCT unit. Compared with the benchmark of 200 cervical cancer cases per BCT device per year, there are enough BCT units to fill capacity in Brazil nationally and regionally. The ratio of total cervix cancer cases per BCT unit decreased substantially over time from 142 in 2013 to 117 in 2021 (P < .0001). Nationally, there are 252 LINAC units in the public system with a ratio of 1985 new cancer cases/LINAC. Brazilian regions have a LINAC shortage ranging from 15 to 141 units. There were 2.55 LINACs per BCT unit in Brazil, compared with 3.25 in Europe (P = .012).
Over 20 years, BCT capacity in Brazil has increased to meet the cervical cancer demand. However, the LINAC shortage has persisted over the decades, affecting access to complete treatment and possibly the oncological outcomes. These data can help organize the patient treatment flow, avoid treatment delays, and improve survival.
确保许多国家都能获得最佳的放射治疗（RT）设施是一项挑战。外照射 RT 和近距离放射治疗（BCT）是治疗晚期宫颈癌的必要手段。在这项分析中，我们评估了巴西 BCT 的系统级能力及其与同时使用外照射 RT 和 BCT 进行完整宫颈癌放射治疗的可达性之间的关系。
我们使用官方政府报告来汇编巴西 BCT 和直线加速器（LINAC）数量、地理分布和覆盖范围、宫颈癌年发病率以及巴西流行率的数据。我们还评估了 2001 年至 2021 年期间国家 BCT 能力的变化。评估了 2020 年 RT 每 BCT 单位、BCT 每 LINAC 单位以及每个巴西州和地区的 LINAC 供应量与宫颈癌病例之间的关系。为了进行比较，还使用国际原子能机构的数据比较了巴西的 LINAC 每 BCT 单位比率与欧洲的比率。
85%（23/27）的巴西州都至少有 1 个 BCT 单位；全国范围内，RT 每 BCT 单位有 117 例宫颈癌病例。与每年每个 BCT 设备 200 例宫颈癌病例的基准相比，巴西全国和地区都有足够的 BCT 单位来满足需求。RT 每 BCT 单位的总宫颈癌病例数在过去的时间里从 2013 年的 142 例显著下降到 2021 年的 117 例（P<0.0001）。全国范围内，公共系统中有 252 台 LINAC 装置，比率为每 1985 例新癌症病例/LINAC。巴西地区的 LINAC 短缺数量从 15 个到 141 个不等。巴西的 BCT 单位有 2.55 个 LINAC，而欧洲有 3.25 个（P=0.012）。
在过去的 20 年中，巴西的 BCT 能力有所增加，以满足宫颈癌的需求。然而，LINAC 短缺问题在过去几十年中一直存在，影响了完整治疗的可及性，并可能影响了肿瘤学结局。这些数据可以帮助组织患者的治疗流程，避免治疗延误，并提高生存率。
