S1372
Interdisciplinary - Global health
ESTRO 2026
pancreas 323 → 1,140 cases/year under optimised schedules (table).
University of Manchester, Manchester, United Kingdom. 3 School of Medical Sciences, University of Manchester, Manchester, United Kingdom. 4 Faculty of Medicine, The Hashemite University, Zarqa, Jordan. 5 Division of Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom. 6 Radiation Oncology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia Purpose/Objective: Radiotherapy access remains highly unequal worldwide. Hypofractionated (HFRT) and ultra- hypofractionated radiotherapy (UHRT) improve efficiency and reduce cost, yet their global impact on capacity and overall survival (OS) has not been quantified. This study modelled optimal HFRT/UHRT adoption across 180 countries, stratified by income, and quantified residual financial and access gaps
despite optimisation. Material/Methods: Cancer incidence for breast, prostate, rectal,
pancreatic, bladder and non-small cell lung cancer (NSCLC) was extracted from GLOBOCAN 2022. Radiotherapy utilisation rates (RTU) were assigned using the CCORE framework and income-adjusted according to Awwad et al. Machine supply was retrieved from the IAEA-DIRAC database. Radiotherapy capacity was modelled assuming 9,700 fractions per megavoltage machine (MVM)/ year and 3,000 operating hours/ year. Eligibility for HFRT and UHRT (for breast, prostate, rectal, pancreatic cancers) was determined from major trials and/or practise guidelines. Efficiency penalties were applied to UHRT to account for image guidance, complexity and beam- on time (breast/rectum: × 0.9; prostate/pancreas: × 0.675). Per-patient costs for conventional fractionation (CF), HFRT, and UHRT were calculated using time-driven activity-based costing (TDABC) via the IAEA RT cost estimator. OS benefit was modelled using income-stratified OS gains (LIC 2.79%; L-MIC 5.03%; U-MIC 2.23%; HIC 2.29%), comparing achievable benefit under CF, HFRT, and UHRT to the theoretical maximal OS benefit in each income group. Results: HFRT and UHRT significantly reduced per-patient costs across all income levels. In breast cancer, HFRT reduced cost from $1,702.79 → $1,035.26 ( − 39.3%) in LICs and $3,889.51 → $2,564.63 ( − 34.1%) in HICs; UHRT further reduced these to $440.75 ( − 74.1%) and $1,354.61 ( − 65.2%), respectively. Cost reductions were similar in prostate (HFRT − 48.2% to − 43.3%; UHRT − 65.6% to − 58.3%) and pancreas (HFRT − 44.5% to − 37.8%; UHRT − 70.9% to − 64.0%). NSCLC and bladder showed smaller but consistent HFRT savings ( − 22.9% to − 34.6%). Capacity per MVM increased substantially: breast 388 → 1,746, prostate 242 → 720, rectal 388 → 1,718, NSCLC 323 → 432, bladder 303 → 468,
Despite optimisation, major disparities persisted. LICs achieved 433/1,879 (23.0%) of maximal OS benefit; L- MICs 74.2%, U-MICs 79.5%, and HICs 98.4% (figure).
Conclusion: We report that HFRT/UHRT markedly reduce radiotherapy costs and expand machine capacity worldwide, but with substantial global disparities. LICs achieve only ~23% of maximal OS benefit despite optimisation, whereas HICs approach full coverage. These findings could guide coordinated global investment strategies, demonstrating that efficient fractionation alone is insufficient and must be paired with targeted infrastructure and financing to close radiotherapy survival gap. References: Abu Awwad D, Shafiq J, Delaney GP, Anacak Y, Bray F, Flores JA, Gondhowiardjo S, Minjgee M, Permata TBM, Pineda JC, Yusak S, Zubizarreta E, Yap ML. Current and projected gaps in the availability of radiotherapy in the Asia-Pacific region: a country income-group analysis. Lancet Oncol. 2024 Feb;25(2):225-234.
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