Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Collaboration for Cancer Outcomes, Research and Evaluation, Liverpool Hospital, Ingham Institute, University of New South Wales, Liverpool, NSW, Australia.
Lancet Oncol. 2024 Feb;25(2):225-234. doi: 10.1016/S1470-2045(23)00619-8.
Cancer incidence and mortality is increasing rapidly worldwide, with a higher cancer burden observed in the Asia-Pacific region than in other regions. To date, evidence-based modelling of radiotherapy demand has been based on stage data from high-income countries (HIC) that do not account for the later stage at presentation seen in many low-income and middle-income countries (LMICs). We aimed to estimate the current and projected demand and supply in megavoltage radiotherapy machines in the Asia-Pacific region, using a national income-group adjusted model.
Novel LMIC radiotherapy demand and outcome models were created by adjusting previously developed models that used HIC cancer staging data. These models were applied to the cancer case mix (ie, the incidence of each different cancer) in each LMIC in the Asia-Pacific region to estimate the current and projected optimal radiotherapy utilisation rate (ie, the proportion of cancer cases that would require radiotherapy on the basis of guideline recommendations), and to estimate the number of megavoltage machines needed in each country to meet this demand. Information on the number of megavoltage machines available in each country was retrieved from the Directory of Radiotherapy Centres. Gaps were determined by comparing the projected number of megavoltage machines needed with the number of machines available in each region. Megavoltage machine numbers, local control, and overall survival benefits were compared with previous data from 2012 and projected data for 2040.
57 countries within the Asia-Pacific region were included in the analysis with 9·48 million new cases of cancer in 2020, an increase of 2·66 million from 2012. Local control was 7·42% and overall survival was 3·05%. Across the Asia-Pacific overall, the current optimal radiotherapy utilisation rate is 49·10%, which means that 4·66 million people will need radiotherapy in 2020, an increase of 1·38 million (42%) from 2012. The number of megavoltage machines increased by 1261 (31%) between 2012 and 2020, but the demand for these machines increased by 3584 (42%). The Asia-Pacific region only has 43·9% of the megavoltage machines needed to meet demand, ranging from 9·9-40·5% in LMICs compared with 67·9% in HICs. 12 000 additional megavoltage machines will be needed to meet the projected demand for 2040.
The difference between supply and demand with regard to megavoltage machine availability has continued to widen in LMICs over the past decade and is projected to worsen by 2040. The data from this study can be used to provide evidence for the need to incorporate radiotherapy in national cancer control plans and to inform governments and policy makers within the Asia-Pacific region regarding the urgent need for investment in this sector.
The Regional Cooperative Agreement for Research, Development and Training Related to Nuclear Science and Technology for Asia and the Pacific (RCA) Regional Office (RCARP03).
全球癌症发病率和死亡率迅速上升，亚太地区的癌症负担高于其他地区。迄今为止，放射治疗需求的循证建模是基于高收入国家（HIC）的分期数据，这些数据并未考虑到许多低收入和中等收入国家（LMIC）中晚期就诊的情况。我们旨在使用按国民收入分组调整的模型，估计亚太地区兆伏放疗机的当前和预计需求和供应。
通过调整先前使用 HIC 癌症分期数据开发的模型，创建了新的 LMIC 放疗需求和结果模型。将这些模型应用于亚太地区每个 LMIC 的癌症病例组合（即每种不同癌症的发病率），以估计当前和预计最佳放疗利用率（即根据指南建议，需要放疗的癌症病例比例），并估计每个国家满足此需求所需的兆伏放疗机数量。从放射治疗中心目录中检索了每个国家可用的兆伏放疗机数量的信息。通过比较每个地区所需的兆伏放疗机数量与现有机器数量来确定差距。比较了兆伏放疗机数量、局部控制和总生存获益与 2012 年的先前数据和 2040 年的预计数据。
分析包括亚太地区的 57 个国家，2020 年有 948 万例新癌症病例，比 2012 年增加了 266 万例。局部控制率为 7.42%，总生存率为 3.05%。整个亚太地区，目前的最佳放疗利用率为 49.10%，这意味着 2020 年将有 466 万人需要放疗，比 2012 年增加了 138 万人（42%）。2012 年至 2020 年间，兆伏放疗机数量增加了 1261 台（31%），但对这些机器的需求增加了 3584 台（42%）。亚太地区只有满足需求所需的兆伏放疗机的 43.9%，而中低收入国家的比例在 9.9%至 40.5%之间，高收入国家为 67.9%。为满足 2040 年的预计需求，还需要增加 12000 台兆伏放疗机。
过去十年中，中低收入国家在兆伏放疗机供应和需求方面的差距继续扩大，并预计到 2040 年将进一步恶化。本研究的数据可用于为将放疗纳入国家癌症控制计划提供依据，并告知亚太地区各国政府和决策者在该领域急需投资。
亚洲及太平洋核科学技术研究、开发和培训区域合作协定（RCA）区域办事处（RCARP03）。
