S1353
Interdisciplinary - Global health
ESTRO 2026
Cervical cancer incidence data for 2022 and projections for 2045 were obtained from GLOBOCAN. The CCORE BT utilisation rate [1] and population benefit models [2] were adapted for LMIC stage distribution and income-specific BT case mix to estimate the optimal proportion of cervical cancer patients requiring BT and the number of machines needed. Available BT machines were identified through the IAEA DIRAC database and literature review. Machine deficits were then compared with cervical cancer mortality and projected to 2045, accounting for the impact of HPV vaccination and coverage in different income settings. Results: In 2022, 661,949 women were diagnosed with cervical cancer, of whom 425,799 (64%) required BT. Globally, 2,131 BT machines were needed, yet only 1110 were available (52% of demand), leaving a shortfall of 1,144 machines concentrated in LMICs, with no overall deficit in high-income countries combined (Figure 1). The Asia-Pacific region accounted for 67% of the global deficit and Africa 33%.
Conclusion: Global BT deficits are resulting in preventable deaths, disproportionately affecting LMICs. Despite advances in prevention, inadequate BT access will continue to drive high cervical cancer mortality through to 2045. In addition to upscaling HPV vaccination and screening, closing this gap requires urgent integration of BT into national cancer control plans, substantial investment in equipment and workforce, and adoption of evidence-based fractionation schedules which optimise limited resources. References: 1. Thompson S et al. Estimation of the optimal brachytherapy utilisation rate in the treatment of carcinoma of the uterine cervix: review of clinical practice guidelines and primary evidence. Cancer. 2006;107(12):2932-41.2. Hannah TP et al. The population benefit of radiotherapy for cervical cancer: Local control and survival estimates for optimally utilised radiotherapy and chemoradiation. Radiotherapy and Oncology. 2015;114:389-394. Keywords: Brachytherapy, Cervical Cancer, Global Health Digital Poster 996 Radiotherapy Resilience: Lessons for Crisis Preparedness and Continuity of Care in Germany Mehmet Köksal 1 , Stephanie Abolmaali 2 , Edwin Bölke 3 , Christiane Matuschek 3 , Wilfried Budach 3 , Dirk Vordermark 4 , Mümtaz Köksal 3 1 Medical Faculty, University of Medicine, Pharmacy, Sciences and Technology, Târgu Mure ș , Romania. 2 Department of Medical Physics, Bielefeld University, Medical School and University Medical Center OWL, Klinikum Mitte, Bielefeld, Germany. 3 Department of Radiation Oncology, Bielefeld University, Medical School and University Medical Center OWL, Klinikum Mitte, Bielefeld, Germany. 4 Department of Radiation Oncology, University Hospital Halle (Saale), Halle, Germany Purpose/Objective: Radiotherapy is a cornerstone of cancer care but is highly dependent on stable infrastructure,
Machine deficits strongly correlated with age- standardised mortality across regions (Figure 2). In 2022, 256,654 women across 111 countries would have benefited from BT but had no access, resulting in an estimated 26,164 preventable deaths, of which over 98% (n=25,702) occurred in LMICs. Looking ahead by 2045, if HPV vaccination coverage and screening continue at current rates, an additional 866 BT machines will be required in LMICs. Without these, 22,369 women are projected to die annually due to lack of BT access beyond deficits in external beam radiotherapy in LMICs. Adoption of resource-efficient abbreviated BT fractionation schedules could expand treatment capacity and narrow the supply–demand gap.
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