ESTRO 36 Abstract Book

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S177 ESTRO 36
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Canada, Latin America and the Caribbean (LAC) includes
Mexico, Asia-Pacific (AP) includes Australia, New Zealand,
and the Pacific islands, and all the post-Soviet states are
included in Europe (EU). AP is bigger than all the other
regions together in terms of population and also in terms
of additional resources needed. The weighted GNI per
capita is US$ 2,086 for AF, US$ 6,343 for AP, US$ 9,863 for
LAC, US$ 25,225 for EU, and US$ 54,140 for NA. This is an
important observation, as the scale of salaries and training
costs used by the GTFRCC was fixed for each income
group, but the reality shows that there are big differences
between the same income group in different regions
(Zubizarreta E et al. Analysis of global radiotherapy needs
and costs by geographic region and income level. Clinical
Oncology 2017, 29). According to IAEA-DIRAC there are
13,133 megavoltage machines worldwide, of which cobalt
machines represent 15%, and the total number required is
16,666, but NA has near the double of machines needed.
Assuming working days of 12 hs. AF covers 34% of its needs,
AP 61%, EU 92%, and LAC 88%. Globally, 73% of the needs
are covered worldwide. The table below summarises the
main findings of the analysis. Around 40,000 additional
professionals would be needed if the additional equipment
needed would be installed: 8,732 RO, 6,122 MP, 21,100
RTT, and 3,787 dosimetrists. 70.5% of these correspond to
AP. Operating costs will increase 23% globally, but the cost
per patient will decrease 10%. By region, AF requires 239%
(percent extra needs) additional investment (new or
upgraded Mv machines, staff), AP 54%, EU 13%, LAC 23%,
and NA 6%. The figure below shows the additional
investment to obtain full access to RT in 2016, a total of
US$ 17.6 billion. 12% correspond to AF, 59.4% to AP, 14.6%
to EU, 5.2% to LAC, and 8.8% to NA. The main conclusion
is that an additional investment of 25% is needed today
worldwide to obtain full access to RT, US$ 17.6 billion, and
that a separate analysis of each region provides a clearer
picture, as the situation is totally different in all of them.
SP-0337 “From the ground up” – tackling challenges at
the country level
M.L. Yap1
1Liverpool Cancer Therapy Centre, Ingham Institute for
Applied Medical Research, Liverpool, Australia
The global incidence of cancer is rising rapidly,
particularly in low and middle-income countries (LMICs).
Radiotherapy is a core component of cancer care and has
been demonstrated to be cost effective. Despite this,
there is a significant shortfall of services in LMICs, with
65% of low-income countries having no radiotherapy
services available. Recently, an evidence-based case for
investment in radiotherapy services in LMICs has been
developed. The Collaboration for Cancer Outcomes,
Research and Evaluation (CCORE) group have
demonstrated that if the gap in radiotherapy services in
LMICs were closed by 2035, millions of patients would
derive local control and/or survival benefits as a result of
radiotherapy. In addition, the Global Task Force for
Radiotherapy in Cancer Control (GTFRCC)'s Lancet
Oncology Commission paper demonstrated that although
initial outlays are required to start up a radiotherapy
service, economic net gains can be achieved in LMICs over
a 20-year period. IT has been estimated that >5500
megavoltage machines would be required to meet the gap
in radiotherapy services in LMICs.
However the challenges pertaining to radiotherapy in
LMICs are not just limited to the supply of radiotherapy
machines, but also concern the safe and effective running
of new and established radiotherapy departments. The
breakdown of the solitary radiotherapy machine in Uganda
was publicised in the mainstream media last year, as a
stark image of the challenges facing LMIC radiotherapy
departments. There is a severe shortage of trained
radiotherapy and oncology staff in LMICs, with the GTFRCC
report estimating that over 30 000 radiation oncologists,
22 000 medical physicists and 78 000 radiation therapists
will need to be trained in LMICs by 2035 in order to meet
the projected radiotherapy demand. Regional
organisations such as RANZCR-FRO’s Asia Pacific Radiation
Oncology Special Interest Group (APROSIG) aim to support
LMIC radiotherapy departments in this endeavour,
alongside international initiatives such as the
International Cancer Experts Corp, and Medical Physicists
without Borders.
As well as regional/international support, the key factors
on a local level imperative to success will be discussed,
with examples such as Cambodia and Botswana used to
illustrate these. With regards to technology use in these
countries, the approach has been stratified to the needs
and expertise on a local level. Collaboration between
these local, regional and international initiatives, as well
as the IAEA, PACT, ESTRO, ASTRO and other organisations
is crucial to the safe and effective delivery of radiotherapy
in LMICs.
SP-0338 Access to radiotherapy: cancer-specific
approaches to a global problem
D.Rodin
1Princess Margaret Centre, Department of Radiation
Oncologym Toronto, Canada
Abstract not received
Proffered Papers: Dose measurement and dose
calculation for proton beams
OC-0339 Water calorimetry in a pulsed PBS proton
beam
S. Rossomme1, R. Trimaud2, V. Floquet2, M. Vidal2, A.
Gerard2, J. Herault2, H. Palmans3,4, J.M. Denis5, D.
Rodriguez Garcia 5, S. Deloule6, S. Vynckier1,5