ESTRO 36 Abstract Book

S175 ESTRO 36 2017 _______________________________________________________________________________________________

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. 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 1 1 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 Symposium: GTFRCC SP-0335 GTFRCC: where to go from here? Y. Lievens 1 1 University Hospital Ghent, Department of Radiation Oncology, Gent, Belgium

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.