Radiotherapy and theranostics : a Lancet Oncology Commission

Abdel-Wahab, May and Giammarile, Francesco and Carrara, Mauro and Paez, Diana and Hricak, Hedvig and Ayati, Nayyereh and Li, Jing Jing and Mueller, Malina and Aggarwal, Ajay and Al-Ibraheem, Akram and Alkhatib, Sondos and Atun, Rifat and Bello, Abubakar and Berger, Daniel and Delgado Bolton, Roberto C and Buatti, John M and Burt, Graeme and Bjelac, Olivera Ciraj and Cordero-Mendez, Lisbeth and Dosanjh, Manjit and Eichler, Thomas and Fidarova, Elena and Gondhowiardjo, Soehartati and Gospodarowicz, Mary and Grover, Surbhi and Hande, Varsha and Harsdorf-Enderndorf, Ekaterina and Herrmann, Ken and Hofman, Michael S and Holmberg, Ola and Jaffray, David and Knoll, Peter and Kunikowska, Jolanta and Lewis, Jason S and Lievens, Yolande and Mikhail-Lette, Miriam and Ostwald, Dennis and Palta, Jatinder R and Peristeris, Platon and Rosa, Arthur A and Salem, Soha Ahmed and Dos Santos, Marcos A and Sathekge, Mike M and Shrivastava, Shyam Kishore and Titovich, Egor and Urbain, Jean-Luc and Vanderpuye, Verna and Wahl, Richard L and Yu, Jennifer S and Zaghloul, Mohamed Saad and Zhu, Hongcheng and Scott, Andrew M (2024) Radiotherapy and theranostics : a Lancet Oncology Commission. Lancet Oncology, 25 (11). e545-e580. ISSN 1470-2045

Text (Revised_Lancet_Oncology_Commission_on_Radiotherapy_and_Theranostics_CLEAN_002_)
Revised_Lancet_Oncology_Commission_on_Radiotherapy_and_Theranostics_CLEAN_002_.pdf - Accepted Version
Available under License Creative Commons Attribution-NonCommercial-NoDerivs.
Download (2MB)

Abstract

Following on from the 2015 Lancet Oncology Commission on expanding global access to radiotherapy, Radiotherapy and theranostics: a Lancet Oncology Commission was created to assess the access and availability of radiotherapy to date and to address the important issue of access to the promising field of theranostics at a global level. A marked disparity in the availability of radiotherapy machines between high-income countries and low-income and middle-income countries (LMICs) has been identified previously and remains a major problem. The availability of a suitably trained and credentialled workforce has also been highlighted as a major limiting factor to effective implementation of radiotherapy, particularly in LMICs. We investigated initiatives that could mitigate these issues in radiotherapy, such as extended treatment hours, hypofractionation protocols, and new technologies. The broad implementation of hypofractionation techniques compared with conventional radiotherapy in prostate cancer and breast cancer was projected to provide radiotherapy for an additional 2·2 million patients (0·8 million patients with prostate cancer and 1·4 million patients with breast cancer) with existing resources, highlighting the importance of implementing new technologies in LMICs. A global survey undertaken for this Commission revealed that use of radiopharmaceutical therapy-other than 131I-was highly variable in high-income countries and LMICs, with supply chains, workforces, and regulatory issues affecting access and availability. The capacity for radioisotope production was highlighted as a key issue, and training and credentialling of health professionals involved in theranostics is required to ensure equitable access and availability for patient treatment. New initiatives-such as the International Atomic Energy Agency's Rays of Hope programme-and interest by international development banks in investing in radiotherapy should be supported by health-care systems and governments, and extended to accelerate the momentum generated by recognising global disparities in access to radiotherapy. In this Commission, we propose actions and investments that could enhance access to radiotherapy and theranostics worldwide, particularly in LMICs, to realise health and economic benefits and reduce the burden of cancer by accessing these treatments.