Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria.
Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria.
Lancet Oncol. 2024 Nov;25(11):e545-e580. doi: 10.1016/S1470-2045(24)00407-8. Epub 2024 Sep 30.
Following on from the 2015 Lancet Oncology Commission on expanding global access to radiotherapy, Radiotherapy and theranostics: a Lancet Oncology Commission was created to assess the access and availability of radiotherapy to date and to address the important issue of access to the promising field of theranostics at a global level. A marked disparity in the availability of radiotherapy machines between high-income countries and low-income and middle-income countries (LMICs) has been identified previously and remains a major problem. The availability of a suitably trained and credentialled workforce has also been highlighted as a major limiting factor to effective implementation of radiotherapy, particularly in LMICs. We investigated initiatives that could mitigate these issues in radiotherapy, such as extended treatment hours, hypofractionation protocols, and new technologies. The broad implementation of hypofractionation techniques compared with conventional radiotherapy in prostate cancer and breast cancer was projected to provide radiotherapy for an additional 2·2 million patients (0·8 million patients with prostate cancer and 1·4 million patients with breast cancer) with existing resources, highlighting the importance of implementing new technologies in LMICs. A global survey undertaken for this Commission revealed that use of radiopharmaceutical therapy-other than I-was highly variable in high-income countries and LMICs, with supply chains, workforces, and regulatory issues affecting access and availability. The capacity for radioisotope production was highlighted as a key issue, and training and credentialling of health professionals involved in theranostics is required to ensure equitable access and availability for patient treatment. New initiatives-such as the International Atomic Energy Agency's Rays of Hope programme-and interest by international development banks in investing in radiotherapy should be supported by health-care systems and governments, and extended to accelerate the momentum generated by recognising global disparities in access to radiotherapy. In this Commission, we propose actions and investments that could enhance access to radiotherapy and theranostics worldwide, particularly in LMICs, to realise health and economic benefits and reduce the burden of cancer by accessing these treatments.
继 2015 年柳叶刀肿瘤学委员会关于扩大全球放射治疗机会的报告之后，放射治疗和治疗学：柳叶刀肿瘤学委员会成立，以评估迄今为止放射治疗的可及性和可获得性，并解决在全球范围内获得治疗学这一充满希望领域的重要问题。以前已经确定，高收入国家和低收入和中等收入国家（LMICs）之间的放射治疗机的可用性存在明显差异，这仍然是一个主要问题。受过适当培训和认证的劳动力的可用性也被强调为有效实施放射治疗的主要限制因素，特别是在 LMICs。我们调查了可以减轻放射治疗中这些问题的举措，例如延长治疗时间、分次治疗方案和新技术。与前列腺癌和乳腺癌的常规放射治疗相比，广泛实施的分次治疗技术预计将利用现有资源为另外 220 万名患者（0.8 万名前列腺癌患者和 140 万名乳腺癌患者）提供放射治疗，突出了在 LMICs 实施新技术的重要性。该委员会进行的一项全球调查显示，高收入国家和 LMICs 中放射性药物治疗-除 I 外-的使用情况差异很大，供应链、劳动力和监管问题影响着可及性和可获得性。放射同位素生产能力是一个关键问题，需要对参与治疗学的卫生专业人员进行培训和认证，以确保患者治疗的公平可及性和可获得性。新的举措-例如国际原子能机构的“希望之光”计划-和国际开发银行对投资放射治疗的兴趣-应该得到卫生保健系统和政府的支持，并扩大这些举措，以加速认识到放射治疗机会全球差异所产生的势头。在本委员会中，我们提出了可以增强全球放射治疗和治疗学可及性的行动和投资建议，特别是在 LMICs 中，以实现健康和经济效益，并通过获得这些治疗来减轻癌症负担。
