S1425
Interdisciplinary - Health economics & health services research
ESTRO 2026
fractions, enabling treatment of 101additional patients.For prostate and rectal cancers, combined savings reached 263,000 USD with 2,175 fractions avoided, allowing 49 extra patients. Globally, HFRT saved USD 416,000 and 5,435 fractions in one year.(Table 1)
those who live in the least deprived areas. Socio- demographic inequalities in access to care are more pronounced for patients eligible for surgery and NAC, than for radiotherapy. There is a need to identify the drivers of these inequalities and to assess the extent to which these inequalities impact survival and other outcomes. References: 1. National Institute for Health and Care Excellence. Bladder cancer: diagnosis and management, NICE guideline [NG2]. Available at: https://www.nice.org.uk/guidance/ng2 (Accessed 10 November 2025). Keywords: bladder, radiotherapy, inequalities Digital Poster 4122 Greener and Smarter Cancer Care: The dual environmental and economic positive impact of hypofractionated radiotherapy in LMIC Raouia Ben Amor 1,2 , Farah Ben Aissa 1,2 , Roua Toumi 1 , Zeineb Naimi 1,2 , Syrine Lahiouel 1,2 , Siwar Abdessaied 1,2 , Raja Oueslati 1 , Lotfi Kochbati 1,2 1 Radiation Oncology, Abderrahmen Mami Hospital, Ariana, Tunisia. 2 Faculty of Medecine of Tunis, Tunis El Manar University, Tunis, Tunisia Purpose/Objective: Hypofractionated radiotherapy (HFRT) reduces the number of treatment sessions, thereby lowering both environmental and financial burdens. This approach is particularly relevant in LMICs, where patient transport and limited healthcare resources amplify the ecological and economic impact of cancer care. This prospective study assessed the combined carbon and cost benefits of HFRT implementation for breast, prostate, and rectal cancers in a resource-limited setting. Material/Methods: Between January 2024 and January 2025, 400 consecutive patients were included: 276 with breast cancer, 65 with prostate cancer, and 59 with rectal cancer. HFRT regimens were compared to conventional fractionation (CF) protocols:Breast: 50 Gy/25 fx (CF) vs. 40 Gy/15 fx and 26 Gy/5 fxProstate: 76 Gy/38 fx (CF) vs. 68 Gy/25 fx and 60 Gy/20 fxRectum: 45 Gy/25 fx (CF) vs. 25 Gy/5 fxEconomic evaluation was based on the 2024 National Social Security reimbursement rates, while carbon footprint was estimated following ADEME “Base Carbone” emission factors, integrating transport, electricity, and consumables Results: For breast cancer, switching to 40 Gy/15 fx and 26 Gy/5 fx saved 320USD and 1,580USD per patient, respectively, totaling 152,000USDand sparing 3,260
With a median home-to-center distance of 22 km (range, 1–545 km), reflecting the geographic inequalities typical of LMIC healthcare infrastructure, patient transport was the predominant source of CO ₂ emissions, reaching 311 tones CO ₂ with conventional fractionation and 158 tones CO ₂ with hypofractionation so a reduction of 153 tones CO ₂ (49%). This finding highlights that reducing the number of treatment sessions is the main driver for lowering patients’ carbon footprint (Figure 1, Table 2).
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