Impact of War on Radiotherapy in Ukraine

Abstract

The full-scale Russian invasion of Ukraine on February 24th, 2022 brought the largest humanitarian disaster to the heart of Europe since the World War II. Ukraine has lost tens of thousands of civilian lives, with approximately a third of the population displaced. The Russian army is deliberately damaging and destroying hospitals and clinics. This study describes the impact of the full-scale Russian invasion on the radiation therapy (RT) services in Ukraine. An annual survey was conducted by Grigoriev Institute for Medical Radiology, Kharkiv for the IAEA DIRAC database. The survey was sent to 41 RT centers in Ukraine requesting information on equipment, staffing, and patient volume. Due to the war conditions the data provided in the survey is limited. The information on operation of RT centers during the war collected by a Ukrainian Association of Medical Physicists representative is reported here as well. After the initial Russian invasion of Ukraine in 2014 and occupation of Crimea and parts of Donbas, Ukraine lost access to 7 RT centers with 18 external beam radiotherapy (EBRT) machines (17% of total). Just before the full-scale invasion in 2022, there were a total of 44 Co-60 machines (57%) and 33 linear accelerators (43%) in the unoccupied territories. As a result of the full-scale invasion of Ukraine in 2022, almost all RT centers suspended operation in the first weeks of war. The most challenging period for RT in Ukraine was in March when Kyiv (where 20 EBRT machines are located) was partially surrounded by the occupiers. The situation improved after Ukrainians liberated approximately half of total occupied territory. Currently, 2 additional RT centers are under occupation; 3 RT centers sustained heavy shelling and equipment damage. The response rate to the survey was 63%. Compared to 2021 data, in 2022, the number of radiation oncologists decreased by 7.8%, medical physicists by 7.3%, and therapists by 10.0%. The workload in the RT centers close to the combat zone almost halved, while increasing by 10 - 60% in the western and central Ukraine. The total number of patients treated with EBRT decreased by 11% and brachytherapy by 21%. Age of the RT equipment in Ukraine is shown in Table 1. Despite the ongoing war, Ukrainian cancer centers installed 3 new linear accelerators, with 14 linear accelerators pending installation. Radiotherapy in Ukraine sustained significant damages since the 2014 Russian invasion, which was exacerbated further by the full-scale invasion in 2022. To support the vitality and absorptive capacity of RT services in Ukraine, the democratic world can help by donating equipment, hardware, software, and participating in training of Ukrainian RT professionals as they transition to modern and high-quality RT care for Ukrainian cancer patients.