Modern Radiotherapy Technology: Obstacles and Opportunities to Access in Low- and Middle-Income Countries

Maitre, Priyamvada; Krishnatry, Rahul; Chopra, Supriya; Gondhowiardjo, Soehartati; Likonda, Beda; Hussain, Qazi Mushtaq; Zubizarreta, Eduardo; Agarwal, Jai Prakash

doi:10.1200/go.21.00376

Cited by 18 publications

(8 citation statements)

References 49 publications

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“…Improved MV-CBCT using the MLI may also help expand radiation therapy access in under-resourced environments (Maitre et al 2022). Improved MV-CBCT could reduce the need for kV-CBCT imaging, reducing the initial investment burden as well as service costs both in terms of financial and uptime, without sacrificing quality care.…”

Section: Discussionmentioning

confidence: 99%

Impact of a novel multilayer imager on metal artifacts in MV-CBCT

et al. 2023

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Objective: Megavoltage cone-beam CT (MV-CBCT) imaging offers several advantages including reduced metal artifacts and accurate electron density mapping for adaptive or emergent situations. However, MV-CBCT imaging is limited by the poor efficiency of current detectors. Here we examine a new MV imager and compare CBCT reconstructions under clinically relevant scenarios. Approach: A multilayer imager (MLI), consisting of four vertically stacked standard flat-panel imagers, was mounted to a clinical linear accelerator. A custom anthropomorphic pelvis phantom with replaceable femoral heads was imaged using MV-CBCT and kV-CBCT. Bone, aluminum, and titanium were used as femoral head inserts. 8MU 2.5MV scans were acquired for all four layers and (as reference) the top layer. Prostate and bladder were contoured on a reference CT and transferred to the other scans after rigid registration, from which the structural similarity index measure (SSIM) was calculated. Prostate and bladder were also contoured on CBCT scans without guidance, and Dice coefficients were compared to CT contours.Main results: kV-CBCT demonstrated the highest SSIMs with bone inserts (prostate:0.86, bladder:0.94) and lowest with titanium inserts (0.32, 0.37). 4-layer MV-CBCT SSIMs were preserved with bone (0.75, 0.80) as compared to titanium (0.67, 0.74), outperforming kV-CBCT when metal is present. 1-layer MV-CBCT consistently underperformed 4-layer results across all phantom configurations. Unilateral titanium inserts and bilateral aluminum insert results fell between the bone and bilateral titanium results. Dice coefficients trended similarly, with 4-layer MV-CBCT reducing metal artifact impact relative to KV-CBCT to provide better soft-tissue identification. Significance: MV-CBCT with a 4-layer MLI showed improvement over single-layer MV scans, approaching kV-CBCT quality for soft-tissue contrast. In the presence of artifact-producing metal implants, four-layer MV-CBCT scans outperformed kV-CBCT by eliminating artifacts and single-layer MV-CBCT by reducing noise. MV-CBCT with a novel multi-layer imager may be a valuable alternative to kV-CBCT, particularly in the presence of metal.

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Section: Discussionmentioning

confidence: 99%

Impact of a novel multilayer imager on metal artifacts in MV-CBCT

et al. 2023

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“…It is expected that, by 2040, the increased incidence and mortality will be disproportionately higher in low (LIC) and middle-income countries (MIC), with an estimated 72% higher incidence and 76% higher mortality in countries with low-to-medium HDI (Peru or Indonesia). This imbalance in the cancer burden is compounded by current disparities in resources for combatting cancer, which must be addressed as a priority [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…The international atomic energy agency ideally recommends four units of RT per million people, with a minimum of at least 1.5 units per million. However, currently, one unit of RT helps 0.12 million people in HIC, in contrast to 1 million in MIC and 5 million in LIC [ 19 , 49 ]. The institute has an assigned population of approximately 3,681,400 with only two linear particle accelerators; therefore, it cannot provide special technical treatment to all of the patients due to the high demand.…”

Section: Discussionmentioning

confidence: 99%

Cost analysis of three-dimensional radiation therapy versus intensitymodulated chemoradiotherapy for locally advanced cervical cancer in Peruvian citizens

Díaz¹

2023

ecancer

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Background and objectives:The standard treatment for locally advanced cervical cancer (CC) is chemoradiotherapy (CTRT) followed by high-dose-rate brachytherapy (HDRBT). The ideal scenario would be under novel intensity-modulated radiation therapy (IMRT) volumetric-modulated arc therapy (VMAT) radiation techniques over three-dimensional (3D) radiation therapy. However, radiotherapy (RT) centres in low-and middle-income countries have limited equipment for teletherapy services like HDRBT. This is why the 3D modality is still in use. The objective of this study was to analyse costs in a comparison of 3D versus IMRT versus VMAT based on clinical staging. Materials and methods:From 02/01/2022 to 05/01/2023 a prospective registry of the costs for oncological management was carried out for patients with locally advanced CC who received CTRT ± HDRBT. This included the administration of radiation with chemotherapy. The cost associated with patient and family transfers and hours in the hospital was also identified. These expenses were used to project the direct and indirect costs of 3D versus IMRT versus VMAT. Results:The treatment regimens for stage IIIC2, including 3D and novel techniques, are those with the highest costs.

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“…The population in Africa is generally unaware and apprehensive of receiving radiation treatment (Maitre et al, 2022; Ndlovu, 2019). This is primarily caused by a lack of knowledge about cancer, its epidemiology and available therapeutic options (Maitre et al, 2022; Ndlovu, 2019). Some cultural traditions might encourage mysticism concerning cancer and how to treat it, which decrease radiotherapy's acceptability as a conventional method of cancer management.…”

Section: Discussionmentioning

confidence: 99%

“…Accessing radiotherapy services encompasses various aspects like awareness level among patients and healthcare providers, overnight accommodation, affordability, geographic proximity and service availability. The population in Africa is generally unaware and apprehensive of receiving radiation treatment (Maitre et al, 2022; Ndlovu, 2019). This is primarily caused by a lack of knowledge about cancer, its epidemiology and available therapeutic options (Maitre et al, 2022; Ndlovu, 2019).…”

Section: Discussionmentioning

confidence: 99%

Building a sustainable future: Closing the gap in radiotherapy and brachytherapy resources to achieve the sustainable development agenda 2030 goals for cervical cancer control in Africa

Drokow

Effah

Agboyibor

et al. 2023

Sustainable Development

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Though radiation therapy services have been launched or expanded in several countries, there have also existed brief or seemingly ongoing infrastructure gaps. The purpose of this health policy study is to provide an overview of the radiation therapy resources available in Africa and to assess how well they align with the agenda 2030 goals, with a specific focus on the role of radiation therapy (both radiotherapy and brachytherapy) in reducing the incidence of cervical cancer. The study consulted publicly accessible datasets to gather information on each nation's radiation therapy equipment, cervical cancer mortality and incidence, gross domestic product (GDP), gross national income (GNI) and population size. This information was used to generate a final dataset for analysis across various African nations, identifying any gaps or areas where improvement is needed. We compared the external beam units (or brachytherapy afterloaders) and unmet needs across nations that had access to either external beam radiation therapy or brachytherapy using a straightforward linear regression. R studio was used for the statistical analysis. Africa's overall unmet need for radiotherapy service was 71.5%. Megavoltage units per cancer incidence and megavoltage units per million population had a strong significant association with economic status (GDP [r2 = 0.83; p < .001]: and GNP [r = 0.83; p < .001]). Additionally, the unmet cervical cancer needs based on the available brachytherapy capacity is about 60%. Interestingly, there was a strong correlation between cervical cancer incidence and brachytherapy capacity. Overall, the study provides valuable insights that can inform policy and decision‐making related to the provision of radiation therapy services in Africa. We expect that international organisations, African Union entities and governments will utilise the Directory of Radiotherapy Centres (DIRAC) initiative as a blueprint for establishing benchmarks and invest in radiotherapy and brachytherapy services in Africa.

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Modern Radiotherapy Technology: Obstacles and Opportunities to Access in Low- and Middle-Income Countries

Cited by 18 publications

References 49 publications

Impact of a novel multilayer imager on metal artifacts in MV-CBCT

Impact of a novel multilayer imager on metal artifacts in MV-CBCT

Cost analysis of three-dimensional radiation therapy versus intensitymodulated chemoradiotherapy for locally advanced cervical cancer in Peruvian citizens

Building a sustainable future: Closing the gap in radiotherapy and brachytherapy resources to achieve the sustainable development agenda 2030 goals for cervical cancer control in Africa

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