Implementing hypofractionation - fewer but higher doses of radiation per daily treatment session over a shorter time frame - compared with conventional radiotherapy in prostate and breast cancer could provide radiotherapy for an additional 2.2 million patients globally, according to a Lancet Oncology Commission led by the International Atomic Energy Agency (IAEA). The report notes that hypofractionation for a range of cancers is associated with benefits of lower costs, increased treatment precision and reduced treatment time, which can liberate machine time and improve access to treatment.
The Lancet Oncology Commission on Radiotherapy and Theranostics report, launched today during the American Society for Radiation Oncology in Washington, DC, highlights the importance of implementing cost-effective approaches in low- and middle-income countries (LMICs) where access to radiotherapy and theranostics is most limited. The report draws on data obtained from a survey of 200 radiotherapy centres spanning 55 countries.
About 50 to 70 per cent of all patients with cancer need radiotherapy, and more than 50 per cent of this population reside in LMICs. International efforts that focus on sustainability, strengthen infrastructure and build cancer care capacities - such as the IAEA's Rays of Hope initiative - can help address global gaps, the report notes. Looking ahead to 2050, the projected surge in new cancer cases would require the 2022 workforce to expand by more than 60 per cent to reach the needed 84 646 radiation oncologists, 47 026 medical physicists and 141 077 radiotherapy technologists globally, according to the report.
While investing in radiotherapy leads to economic benefits ranging between $278.1 billion and $365.4 billion worldwide for the period from 2015 to 2035, further improvements can be achieved by resource-sparing approaches. A 50 per cent substitution of conventional radiotherapy with hypofractionated radiotherapy could result in $2.76 billion in cost-savings for prostate and breast cancer, for example. At 80 percent substitution, this grows to $4.41 billion.
"For healthcare practitioners and policy makers around the world, this report can serve as an evidence base to scale up the adoption and implementation of resource-sparing approaches that have been shown to be safe and effective. The report also shows that advanced technologies such as stereotactic body radiation therapy - a type of hypofractionation that delivers precise, high doses but requires more advanced equipment - may be cost-effective over the course of a patient's disease as compared to more conventional methods," said May Abdel-Wahab, co-lead author of the report and Director of the IAEA Division of Human Health.
Access to theranostics
Following up on the 2015 Lancet Oncology Commission on expanding access to radiotherapy, the IAEA, together with experts from 44 academic institutions and medical centres from 23 countries, assessed the access and availability of radiotherapy and theranostics in the latest report. Theranostics, the combination of radionuclides to diagnose and treat cancer patients, requires knowledge of radiation principles and radiation biology, as well as expertise in imaging technologies and radiopharmaceutical use for effective cancer treatment approaches.
Health economics modelling of a radiopharmaceutical treatment for prostate cancer, for example, showed a social impact totalling $725 million over a seven-year period. However, the Commission's global survey of nuclear medicine facilities across 82 countries along with IAEA data from an additional 84 countries shows that radioisotope supply chains, trained workforce availability and regulatory challenges affect the implementation of radiopharmaceutical therapies.
"These data underlines both the potential benefits and urgent need for action for theranostics availability. As one of the fastest growing areas of cancer treatment, this report demonstrates the compelling rationale for ensuring that adequate supplies, equipment, infrastructure and personnel for theranostics delivery are all in place to provide optimal patient care," said co-lead author Andrew Scott, Professor at the University of Melbourne and La Trobe University in Melbourne, Australia.
The Commission proposes actions and investments that could enhance global access to both radiotherapy and theranostics, particularly in LMICs, to realize health and economic benefits and to reduce the burden of cancer.
"Across the globe, access to high-quality cancer care remains out of reach for far too many patients. In addressing this inequality, the Lancet Oncology Commission report outlines compelling data and recommendations to help us provide access to the care that every patient deserves," said IAEA Director General Rafael Mariano Grossi. "Through initiatives like Rays of Hope, we are actively working to bridge these gaps by expanding radiotherapy services and building sustainable cancer care capacities in low- and middle-income countries, ensuring that no patient is left behind."
The IAEA's Rays of Hope initiative, launched in 2022, aims to help widen access to cancer care in LMICs by improving the availability of radiotherapy services, medical imaging and nuclear medicine. A network of regional Anchor Centres has been established to provide targeted support and expertise to neighbouring countries, focusing on education, training, research and quality assurance.
