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Conclusion
While RTU for the selected tumor sites were 7-16% higher
in the CBB communities than in all communities, they are
still 30-65% below the estimated optimal RTU and differed
significantly from Canadian CBB. CBB is based on the
assumption that there is perfect service delivery in some
parts of the health service that can be used to benchmark
the whole service. This approach may be applicable in well
resourced service delivery model in Canada, but until the
feasibility of the CBB is tested and proved applicable in
different geographical regions, the CBB approach does not
seem reproducible in other jurisdictions and may not be
recommended for benchmarking RT services. We
recommend the evidence-based approach of optimal RTU.
PV-0093 Availability of radiotherapy in Africa: past and
present of an unsolved problem
E.H. Zubizarreta
1
, A. Polo
1
1
IAEA, Radiation Oncology and Biology, Wien, Austria
Purpose or Objective
To present data on availability of megavoltage (Mv) units
(cobalt machines (Co) and linacs) in Africa from 1991 to
2015 and the additional resources needed to reach full
capacity, including a cost analysis.
Material and Methods
The list and income classification of countries were taken
from the World Bank, Country and Lending Groups, 2017
fiscal year [1]. Data on population, number of cancer cases
per country, and number of cancer cases for each cancer
site was obtained from GLOBOCAN 2012 [2]. The number
of radiotherapy courses needed to treat all patients with
an indication for radiotherapy was calculated using the
methodology form the Collaboration for Cancer Outcomes
Research and Evaluation (CCORE) [3,4]. Data on
availability of radiotherapy (RT)bequipment was obtained
from the IAEA Directory of Radiotherapy Centres (DIRAC)
[5]. For the cost analysis we used an internally produced
Excel sheet with data from December 2013. 51 countries
were included in the analysis. Historical data was obtained
from different published data [6,7,8,9]. Most of the other
variables used for the calculations were taken from the
GTFRCC report [10].
Results
The population in Africa is 1.07 billion, with a weighted
GNI per capita of US$ 2,086, and it is calculated that
438,000 cancer cases need radiotherapy annually. Mv units
were 103 in 1991 (71 Co and 32 linacs), 155 in 1998 (93 Co
and 62 linacs), 277 in 2010 (88 Co and 189 linacs), 278 in
2013 (84 Co and 194 linacs), and 291 in 2015 (86 Co and
205 linacs), representing an increase of 283% in almost 25
years (fig 1). The proportion of Co units decreased from
69% to 30% in that period (fig 1). A total of 813 Mv units
are required to treat 438,000 cancer patients needing RT.
Only 149,000 can be treated with the installed capacity,
which represents a coverage of 34% of the needs. Low
income countries can only treat 4,800 cases, 3% of the
needs.
The additional investment to bring full access is 2.12
billion US$, which includes additional infrastructure,
equipment, and training (fig2). The investment in 26 low
income countries (LIC) represents 52% of the total, 40% for
16 lower middle income countries (L-MIC), and 8% for 9
upper middle income countries (U-MIC) (fig 2). The annual
operating costs should jump from 182 to 571 million US$,
an increase of 214%, but the average cost per RT course
would only from US$ 1,226 to US$ 1,306.
Conclusion
Only 3 to 4 out of 10 cancer patients needing radiotherapy
in Africa have access to treatment, but only 3 out of 100
can receive treatment in LIC, where the situation is
dramatic. The additional investment required to bring full
access is 2.12 billion US$, half of it in LIC. If full capacity
was obtained, operational costs will increase 214%. The
cost per RT course will only increase 6%.
Award Lecture: Van der Schueren Award lecture
SP-0094 Substantial and “for free” improvement of
radiotherapy practice in high and low income
countries
B. Heijmen
1
1
Erasmus MC Cancer Institute, Radiation Oncology,
Rotterdam, The Netherlands
Radiotherapy is a highly technology driven medical field.
Enormous amounts of money are spent on development
and clinical use of advanced treatment units such as
modern linear accelerators, robotic delivery systems, and
units for particle therapy. Recently, evidence has been
gathered pointing at massive and serious sub-optimal use
of such equipment, related to problems with treatment
plan generation. The current interactive trial-and-error
planning approach, in which a planner iteratively tries to
steer a treatment planning system towards an
acceptable/optimal plan, results in variable and sub-
optimal plan quality. A direct and painful consequence is
that the expensive, and in principle highly potent
treatment equipment is sub-optimally used. Much of the
evidence for the planning problems has been provided in
studies using fully automated treatment plan generation,
instead of interactive trial-and-error planning. This
lecture will discuss opportunities to “for free”
substantially increase quality of radiotherapy practice in
both high and low income countries by large-scale
introduction of automated treatment plan generation.
Award Lecture: Iridium Award Lecture
SP-0095 Brachytherapy physics developments: Look
back in anger, grateful, and with hope
J. Venselaar
1
1
Dr. Bernard Verbeeten Instituut, Tilburg, The
Netherlands
Brachytherapy (BT) is by nature a strong tool in cancer
treatment. Numerous textbooks and scientific articles
include the statement that bringing the source of radiation
directly into the tumour is a very direct and reliable
approach. The result is a dose distribution that is tailored