ESTRO 36 Abstract Book

S48 ESTRO 36 _______________________________________________________________________________________________

and 62 linacs), 277 in 2010 (88 Co and 189 linacs), 278 in 2013 (84 Co and 194 linacs), and 291 in 2015 (86 Co and 205 linacs), representing an increase of 283% in almost 25 years (fig 1). The proportion of Co units decreased from 69% to 30% in that period (fig 1). A total of 813 Mv units are required to treat 438,000 cancer patients needing RT. Only 149,000 can be treated with the installed capacity, which represents a coverage of 34% of the needs. Low income countries can only treat 4,800 cases, 3% of the needs. The additional investment to bring full access is 2.12 billion US$, which includes additional infrastructure, equipment, and training (fig2). The investment in 26 low income countries (LIC) represents 52% of the total, 40% for 16 lower middle income countries (L-MIC), and 8% for 9 upper middle income countries (U-MIC) (fig 2). The annual operating costs should jump from 182 to 571 million US$, an increase of 214%, but the average cost per RT course would only from US$ 1,226 to US$ 1,306. Conclusion Only 3 to 4 out of 10 cancer patients needing radiotherapy in Africa have access to treatment, but only 3 out of 100 can receive treatment in LIC, where the situation is dramatic. The additional investment required to bring full access is 2.12 billion US$, half of it in LIC. If full capacity was obtained, operational costs will increase 214%. The cost per RT course will only increase 6%. SP-0094 Substantial and “for free” improvement of radiotherapy practice in high and low income countries B. Heijmen 1 1 Erasmus MC Cancer Institute, Radiation Oncology, Rotterdam, The Netherlands Radiotherapy is a highly technology driven medical field. Enormous amounts of money are spent on development and clinical use of advanced treatment units such as modern linear accelerators, robotic delivery systems, and units for particle therapy. Recently, evidence has been gathered pointing at massive and serious sub-optimal use of such equipment, related to problems with treatment plan generation. The current interactive trial-and-error planning approach, in which a planner iteratively tries to steer a treatment planning system towards an acceptable/optimal plan, results in variable and sub- optimal plan quality. A direct and painful consequence is that the expensive, and in principle highly potent treatment equipment is sub-optimally used. Much of the evidence for the planning problems has been provided in studies using fully automated treatment plan generation, instead of interactive trial-and-error planning. This lecture will discuss opportunities to “for free” substantially increase quality of radiotherapy practice in both high and low income countries by large-scale introduction of automated treatment plan generation. SP-0095 Brachytherapy physics developments: Look back in anger, grateful, and with hope J. Venselaar 1 1 Dr. Bernard Verbeeten Instituut, Tilburg, The Netherlands Brachytherapy (BT) is by nature a strong tool in cancer treatment. Numerous textbooks and scientific articles include the statement that bringing the source of radiation directly into the tumour is a very direct and reliable approach. The result is a dose distribution that is tailored Award Lecture: Van der Schueren Award lecture Award Lecture: Iridium Award Lecture

Conclusion While RTU for the selected tumor sites were 7-16% higher in the CBB communities than in all communities, they are still 30-65% below the estimated optimal RTU and differed significantly from Canadian CBB. CBB is based on the assumption that there is perfect service delivery in some parts of the health service that can be used to benchmark the whole service. This approach may be applicable in well resourced service delivery model in Canada, but until the feasibility of the CBB is tested and proved applicable in different geographical regions, the CBB approach does not seem reproducible in other jurisdictions and may not be recommended for benchmarking RT services. We recommend the evidence-based approach of optimal RTU. PV-0093 Availability of radiotherapy in Africa: past and present of an unsolved problem E.H. Zubizarreta 1 , A. Polo 1 1 IAEA, Radiation Oncology and Biology, Wien, Austria Purpose or Objective To present data on availability of megavoltage (Mv) units (cobalt machines (Co) and linacs) in Africa from 1991 to 2015 and the additional resources needed to reach full capacity, including a cost analysis. Material and Methods The list and income classification of countries were taken from the World Bank, Country and Lending Groups, 2017 fiscal year [1]. Data on population, number of cancer cases per country, and number of cancer cases for each cancer site was obtained from GLOBOCAN 2012 [2]. The number of radiotherapy courses needed to treat all patients with an indication for radiotherapy was calculated using the methodology form the Collaboration for Cancer Outcomes Research and Evaluation (CCORE) [3,4]. Data on availability of radiotherapy (RT)bequipment was obtained from the IAEA Directory of Radiotherapy Centres (DIRAC) [5]. For the cost analysis we used an internally produced Excel sheet with data from December 2013. 51 countries were included in the analysis. Historical data was obtained from different published data [6,7,8,9]. Most of the other variables used for the calculations were taken from the GTFRCC report [10]. Results The population in Africa is 1.07 billion, with a weighted GNI per capita of US$ 2,086, and it is calculated that 438,000 cancer cases need radiotherapy annually. Mv units were 103 in 1991 (71 Co and 32 linacs), 155 in 1998 (93 Co