Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA; Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
Lancet Oncol. 2023 Sep;24(9):e376-e384. doi: 10.1016/S1470-2045(23)00299-1.
The inequitable access to radiotherapy globally is a complex undertaking that will require sustained work identifying gaps and mobilising efforts to resolve. The purpose of this review is to identify gaps and needs in radiotherapy in Latin America and the Caribbean. Data from 41 countries in Latin America and the Caribbean on teletherapy megavoltage units and brachytherapy resources were extracted from the International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centers. These data were then matched to open-source data from GLOBOCAN and World Bank Data which included data on population size, gross national income per capita, cancer incidence, and mortality. These data were matched to current and projected cancer incidence and mortality (as estimated by the Global Cancer Observatory in 2020) to calculate current and projected gaps in external beam radiotherapy facilities. For brachytherapy, the analysis was focused on cervical cancer and included high dose rate and low dose rate machines. As of Oct 22, 2022, external beam radiotherapy was available in 32 (78%) of 41 countries, representing 742 radiotherapy centres and 1122 megavoltage units. Average coverage was 63%. LINACs accounted for 85% (955 of 1122) of megavoltage units and Cobalt-60 capacity decreased to 12% compared with in 2018. Median megavoltage units per 1000 cancer cases were 0·8 (IQR 0·54-1·03). Most countries clustered in the same range of gross national income per capita for teletherapy units per 1000 cases at a median of US$9380. The current deficit in megavoltage units is estimated at 668 units and is projected to be 2455 units by 2030. 28 (68%) of 41 countries had 279 installed brachytherapy services, both high dose rate and low dose rate, which could treat 108 420 patients with cervical cancer per year and meet the current needs, albeit with inequitable distribution of resources. Overall, this review indicated a 15% improvement in the current external beam radiotherapy capacity in Latin America and the Caribbean compared with 2018. However, there is still a current shortage of at least 668 extra units. By 2030, the need for megavoltage units will be double the current capacity. There is inequitable distribution of brachytherapy resources across the region primarily in the Caribbean. Adoption of hypofractionation can help overcome machine shortage; however, it will present technical challenges that need to be taken into account. Rays of Hope, is a novel IAEA initiative that is designed to mobilise global efforts to address radiotherapy gaps while ensuring the highest return on investment.
全球放疗资源获取不平等是一项复杂的任务，需要持续努力发现差距并调动资源加以解决。本研究旨在明确拉丁美洲和加勒比地区放疗领域的差距和需求。从国际原子能机构（IAEA）放疗中心名录中提取了拉丁美洲和加勒比地区 41 个国家的远距放疗兆伏级单位和近距离放疗资源数据。然后，将这些数据与全球肿瘤学（GLOBOCAN）和世界银行数据中的公开数据进行匹配，其中包括人口规模、人均国民总收入、癌症发病率和死亡率。将这些数据与当前和预计的癌症发病率和死亡率（由全球癌症观测站于 2020 年估计）进行匹配，以计算外照射放疗设备的当前和预计差距。对于近距离放疗，分析重点为宫颈癌，包括高剂量率和低剂量率机器。截至 2022 年 10 月 22 日，41 个国家中有 32 个（78%）可提供外照射放疗，代表 742 个放疗中心和 1122 个兆伏级单位。平均覆盖率为 63%。线性加速器（LINACs）占兆伏级单位的 85%（1122 个中的 955 个），钴-60 容量与 2018 年相比下降至 12%。每 1000 例癌症的兆伏级单位中位数为 0.8（IQR 0.54-1.03）。大多数国家的每 1000 例病例的远距放疗单位人均国民总收入中位数都在同一范围内，为 9380 美元。目前估计兆伏级单位短缺 668 个，预计到 2030 年将短缺 2455 个。41 个国家中有 28 个（68%）设有 279 个近距离放疗服务机构，包括高剂量率和低剂量率机器，每年可治疗 108420 例宫颈癌患者，能够满足当前需求，但资源分布不均。总的来说，与 2018 年相比，拉丁美洲和加勒比地区目前的外照射放疗能力提高了 15%。然而，目前仍至少短缺 668 个单位。到 2030 年，对兆伏级单位的需求将是目前的两倍。该地区的近距离放疗资源分布不均，主要在加勒比地区。采用超分割放疗可以帮助克服机器短缺，但这将带来技术挑战，需要加以考虑。“放疗之光照亮希望”是 IAEA 推出的一项新倡议，旨在调动全球力量解决放疗差距问题，同时确保投资回报最大化。
