ESTRO 36 Abstract Book

S175

ESTRO 36 2017

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of tongue in 19 (49%). Prescription dose was 70 Gy in 33

fractions. At mid-RT; significant increase in mean T1+C SI

was noted in the following muscles: ADM, ITM, GHM, and

MPC (p=0.005, 0.01, 0.04, and 0.002, respectively) and

significant increase in mean T2 SI was noted only in MPC

(p=0.0005). At post-RT; significant increase in mean T1+C

SI was detected in all studied muscles (p<0.05 for all).

After Bonferroni correction for multiple comparisons, all

remained significant except buccinators, pterygoids, and

masseter. Post-RT increase in T2 SI was detected only in

pharyngeal constrictors and medial pterygoids (p<0.05)

and remained significant after Bonferroni correction for

pharyngeal constrictors. No significant changes in mean T1

SI was detected in all tested muscles in both time points.

There were no dose-parameter relationship in all muscles

with increased T1+C and T2 SIs in all studied time points.

Mean dose to muscle groups with significant increase in

T1+C after Bonferroni correction was significantly higher

compared to other muscle groups (52.7 vs. 37.5 Gy,

p<0.0001). Simultaneously, mean dose to pharyngeal

constrictors that showed significant T2 increase was

significantly higher compared to other muscle groups (63.2

vs. 41.2 Gy, p<0.0001).

Conclusion

Significant dose-dependent increase in mid-RT and post-

RT T1+C and T2 signal intensities is noted in non-target

swallowing muscles particularly in pharyngeal constrictors

due to higher beam-path dose to these muscles.

Symposium: GTFRCC

SP-0335 GTFRCC: where to go from here?

Y. Lievens

University Hospital Ghent,

Department of Radiation Oncology, Gent, Belgium

The Global Task Force on Radiotherapy for Cancer Control

(GTFRCC) has not only highlighted the urgent need for

addressing the inequity gap in access to radiotherapy

globally, it has also demonstrated that judicious

investment in radiotherapy infrastructure and training is

both effective and cost-effective. Indeed, in addition to

preventing millions of cancer deaths in the decades to

come, investing in radiotherapy has also been shown to

bring value for money and a positive return on investment

to the societies involved. The GTFRCC has articulated five

calls-to-action in order to remedy the radiotherapy

shortage and to make sure that radiotherapy is included

into the multidisciplinary approach to cancer care.

To ascertain a global impact by 2035, the time is now to

build upon the GTFRCC results. ESTRO and the

stakeholders involved in the GTFRCC have decided to join

forces by establishing a new collaborative group with the

aim of identifying timely, effective, and achievable

responses to the GTFRCC’s calls-to-action, and of

positioning radiotherapy as an essential component of

effective cancer care globally. It is our pleasure to launch

this initiative at ESTRO 36!

SP-0336 Costs and needs of radiotherapy: a regional

perspective

E.H. Zubizarreta - zubi

IAEA, Applied Radiation Biology and Radiotherapy,

Wien, Austria

This analysis presents the resources needed and costs at

the present time globally and by region to give full access

to RT. The variables and methodology were the same used

by the GTFRCC. The GTFRCC reported the resources

needed and costs to reach full access to RT in 2035 by

income group, but not per region (Atun R et al. Expanding

global access to radiotherapy. Lancet Oncol 2015; 16(10)).

The division in regions adopted by the IAEA was used:

Africa (AF), North America (NA) only includes USA and

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.