Radiotherapy Resources in Latin America and the Caribbean: An International Atomic Energy Agency Analysis of Current and Projected Needs

Abstract

The inequitable access to radiotherapy (RT) is recognized to be a complex undertaking that will require sustained work identifying gaps and mobilizing efforts to fill in those gaps. Data can support policy-makers as they embark on programs to reduce premature mortality from cancer in their countries and regions. The purpose of this analysis is to identify the current gaps and needs in Latin America and the Caribbean (LAC). We created a database of 41 countries in LAC using open-source data, including data on population size (UN Department of Economic and Social Affairs data), gross national income per capita (GNIPC) (World Bank Data), current and projected cancer incidence and mortality (Globocan 2020). The International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centers (DIRAC) was used to identify the number and operational status of megavoltage (MV) teletherapy machines (Cobalt-60 and Linear Accelerators LINACs) and brachytherapy facilities (HDR and LDR). To calculate current and projected gaps in external beam RT (EBRT) facilities, we matched DIRAC data with Globocan cancer incidence data for 2020 and projections for 2025 and 2030 while applying a 64% optimal EBRT utilization rate (taking into account re-treatment). For brachytherapy, analysis took into account both HDR and LDR capacity and was primarily focused on needs based on current and projected incidence of cervical cancer cases in LAC. EBRT was available in 32 (76%) of 41 countries. There were 742 RT centers in 32 countries with a total of 1131 MV units. Average coverage in 2022 based on an optimal utilization rate of 64% was 64%. LINACs accounted for 87% of the total MV units and Cobalt-60 capacity decreased to 13% of total teletherapy capacity compared to capacity in 2018. Most countries clustered in the same range of GNIPC to teletherapy units per 1000 cases, however outliers were most notable in the Caribbean. The median GNIPC was $6340 and the median MV units per 1000 cancer cases were 1.4. The current deficit in MV units is estimated at 672 megavoltage units and projected to be 2455 units by 2030 representing more than double the current capacity. 28 out of 41 countries (68%) had brachytherapy including 279 installed services, both HDR and LDR. At a 75% optimal utilization rate of brachytherapy in locally advanced cervical cancer, the current brachytherapy capacity in LAC could treat 108,420 patients with cervical cancer/year, which meets the current needs in the region albeit with significant inequity in distribution of resources. There is 15% improvement in the current EBRT capacity in LAC compared to 2018. However, there is still shortage of at least 672 extra units needed. By 2030, the need for MV units will be double the current capacity. The current brachytherapy capacity meets needs albeit with inequitable distribution across the region primarily in the Caribbean.