ESTRO 36 Abstract Book

S177 ESTRO 36 _______________________________________________________________________________________________

SP-0337 “From the ground up” – tackling challenges at the country level M.L. Yap 1 1 Liverpool Cancer Therapy Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia The global incidence of cancer is rising rapidly, particularly in low and middle-income countries (LMICs). Radiotherapy is a core component of cancer care and has been demonstrated to be cost effective. Despite this, there is a significant shortfall of services in LMICs, with 65% of low-income countries having no radiotherapy services available. Recently, an evidence-based case for investment in radiotherapy services in LMICs has been developed. The Collaboration for Cancer Outcomes, Research and Evaluation (CCORE) group have demonstrated that if the gap in radiotherapy services in LMICs were closed by 2035, millions of patients would derive local control and/or survival benefits as a result of radiotherapy. In addition, the Global Task Force for Radiotherapy in Cancer Control (GTFRCC)'s Lancet Oncology Commission paper demonstrated that although initial outlays are required to start up a radiotherapy service, economic net gains can be achieved in LMICs over a 20-year period. IT has been estimated that >5500 megavoltage machines would be required to meet the gap in radiotherapy services in LMICs. However the challenges pertaining to radiotherapy in LMICs are not just limited to the supply of radiotherapy machines, but also concern the safe and effective running of new and established radiotherapy departments. The breakdown of the solitary radiotherapy machine in Uganda was publicised in the mainstream media last year, as a stark image of the challenges facing LMIC radiotherapy departments. There is a severe shortage of trained radiotherapy and oncology staff in LMICs, with the GTFRCC report estimating that over 30 000 radiation oncologists, 22 000 medical physicists and 78 000 radiation therapists will need to be trained in LMICs by 2035 in order to meet the projected radiotherapy demand. Regional organisations such as RANZCR-FRO’s Asia Pacific Radiation Oncology Special Interest Group (APROSIG) aim to support LMIC radiotherapy departments in this endeavour, alongside international initiatives such as the International Cancer Experts Corp, and Medical Physicists without Borders. As well as regional/international support, the key factors on a local level imperative to success will be discussed, with examples such as Cambodia and Botswana used to illustrate these. With regards to technology use in these countries, the approach has been stratified to the needs and expertise on a local level. Collaboration between these local, regional and international initiatives, as well as the IAEA, PACT, ESTRO, ASTRO and other organisations is crucial to the safe and effective delivery of radiotherapy in LMICs. SP-0338 Access to radiotherapy: cancer-specific approaches to a global problem D.Rodin 1Princess Margaret Centre, Department of Radiation Oncologym Toronto, Canada

Canada, Latin America and the Caribbean (LAC) includes Mexico, Asia-Pacific (AP) includes Australia, New Zealand, and the Pacific islands, and all the post-Soviet states are included in Europe (EU). AP is bigger than all the other regions together in terms of population and also in terms of additional resources needed. The weighted GNI per capita is US$ 2,086 for AF, US$ 6,343 for AP, US$ 9,863 for LAC, US$ 25,225 for EU, and US$ 54,140 for NA. This is an important observation, as the scale of salaries and training costs used by the GTFRCC was fixed for each income group, but the reality shows that there are big differences between the same income group in different regions (Zubizarreta E et al. Analysis of global radiotherapy needs and costs by geographic region and income level. Clinical Oncology 2017, 29). According to IAEA-DIRAC there are 13,133 megavoltage machines worldwide, of which cobalt machines represent 15%, and the total number required is 16,666, but NA has near the double of machines needed. Assuming working days of 12 hs. AF covers 34% of its needs, AP 61%, EU 92%, and LAC 88%. Globally, 73% of the needs are covered worldwide. The table below summarises the main findings of the analysis. Around 40,000 additional professionals would be needed if the additional equipment needed would be installed: 8,732 RO, 6,122 MP, 21,100 RTT, and 3,787 dosimetrists. 70.5% of these correspond to AP. Operating costs will increase 23% globally, but the cost per patient will decrease 10%. By region, AF requires 239% (percent extra needs) additional investment (new or upgraded Mv machines, staff), AP 54%, EU 13%, LAC 23%, and NA 6%. The figure below shows the additional investment to obtain full access to RT in 2016, a total of US$ 17.6 billion. 12% correspond to AF, 59.4% to AP, 14.6% to EU, 5.2% to LAC, and 8.8% to NA. The main conclusion is that an additional investment of 25% is needed today worldwide to obtain full access to RT, US$ 17.6 billion, and that a separate analysis of each region provides a clearer picture, as the situation is totally different in all of them.

Abstract not received

Proffered Papers: Dose measurement and dose calculation for proton beams

OC-0339 Water calorimetry in a pulsed PBS proton beam S. Rossomme 1 , R. Trimaud 2 , V. Floquet 2 , M. Vidal 2 , A. Gerard 2 , J. Herault 2 , H. Palmans 3,4 , J.M. Denis 5 , D. Rodriguez Garcia 5 , S. Deloule 6 , S. Vynckier 1,5