Radiotherapy and theranostics: a Lancet Oncology Commission - 30/09/24

Doi : 10.1016/S1470-2045(24)00407-8

May Abdel-Wahab, ProfMD ^a,⁎ , Francesco Giammarile, ProfMD PhD ^a, Mauro Carrara, PhD ^a, Diana Paez, MD ^a, Hedvig Hricak, ProfMD PhD ^b,^c,^d,^f, Nayyereh Ayati, PhD ^g, Jing Jing Li, MCE ^g, Malina Mueller, PhD ^h, Ajay Aggarwal, ProfMD PhD ^j, Akram Al-Ibraheem, ProfMD ^k,^l, Sondos Alkhatib, MD ^m, Rifat Atun, ProfPhD ^n,^o,^p, Abubakar Bello, MD ^q, Daniel Berger, PhD ^a, Roberto C Delgado Bolton, ProfMD PhD ^r,^s, John M Buatti, ProfMD ^t, Graeme Burt, ProfPhD ^u, Olivera Ciraj Bjelac, PhD ^a, Lisbeth Cordero-Mendez, MD ^a, Manjit Dosanjh, ProfPhD ^v,^w, Thomas Eichler, MD ^x, Elena Fidarova, MD ^a, Soehartati Gondhowiardjo, ProfMD PhD ^y, Mary Gospodarowicz, ProfMD ^z, Surbhi Grover, MD MPH ^aa,^ab, Varsha Hande, PhD ^ac, Ekaterina Harsdorf-Enderndorf, MA ^a, Ken Herrmann, ProfMD ^ad,^ae, Michael S Hofman, ProfMBBS ^af,^ag, Ola Holmberg, PhD ^ah, David Jaffray, ProfPhD ^ai, Peter Knoll, PhD ^a, Jolanta Kunikowska, ProfMD PhD ^aj, Jason S Lewis, ProfPhD ^b,^c,^e, Yolande Lievens, ProfMD PhD ^ak, Miriam Mikhail-Lette, MD ^a, Dennis Ostwald, ProfPhD ^h,^al, Jatinder R Palta, ProfPhD ^am, Platon Peristeris, PhD ⁱ, Arthur A Rosa, MD ^an, Soha Ahmed Salem, MD ^a, Marcos A dos Santos, MD PhD ^ao, Mike M Sathekge, ProfMD PhD ^ap,^aq,^ar, Shyam Kishore Shrivastava, MD ^as, Egor Titovich, PhD ^a, Jean-Luc Urbain, ProfMD PhD ^at, Verna Vanderpuye, MD ^au, Richard L Wahl, ProfMD ^av, Jennifer S Yu, MD PhD ^aw, Mohamed Saad Zaghloul, ProfMD PhD ^ax, Hongcheng Zhu, MD PhD ^ay,^az, Andrew M Scott, ProfMD ^ba,^bb,^bc,^bd,⁎

^a Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria

^b Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

^c Molecular Pharmacology Program, Sloan Kettering Institute, New York, NY, USA

^d Department of Radiology, Weill Cornell Medical College, New York, NY, USA

^e Department of Pharmacology, Weill Cornell Medical College, New York, NY, USA

^f Gerstner Sloan Kettering Graduate School of Biomedical Sciences, New York, NY, USA

^g Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia

^h WifOR Institute, Darmstadt, Germany

ⁱ WifOR Institute, Athens, Greece

^j Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK

^k Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan

^l Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan

^m Department of Radiation Oncology, Henry Ford Health, Detroit, MI, USA

ⁿ Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA

^o Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA

^p Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

^q National Hospital, Abuja and Federal University of Health Sciences, Azare, Nigeria

^r Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja, Logroño, Spain

^s Servicio Cántabro de Salud, Santander, Spain

^t Department of Radiation Oncology, Holden Comprehensive Cancer Center, Carver College of Medicine, University of Iowa, Iowa City, IA, USA

^u University of Lancaster, Lancaster, UK

^v University of Oxford, Oxford, UK

^w European Organization for Nuclear Research, Geneva, Switzerland

^x Department of Radiation Oncology, Massey Cancer Center Virginia Commonwealth University, Richmond, VA, USA

^y Department of Radiotherapy, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

^z Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada

^aa Botswana–University of Pennsylvania Partnership, Gaborone, Botswana

^ab Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA

^ac Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan

^ad Department of Nuclear Medicine, University of Duisburg, Essen, Germany

^ae German Cancer Consortium, University Hospital Essen, Essen, Germany

^af Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

^ag Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

^ah Division of Radiation, Transport and Waste Safety, Department of Nuclear Safety and Security, International Atomic Energy Agency, Vienna, Austria

^ai Department of Radiation Physics and Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA

^aj Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland

^ak Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium

^al Steinbeis School of International Business and Entrepreneurship, Herrenberg, Germany

^am Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA

^an Radiation Oncology, Grupo Oncoclinicas, Salvador, Brazil

^ao Latin American Society of Radiation Oncology, Brasilia/DF, Brazil

^ap Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa

^aq Steve Biko Academic Hospital, Pretoria, South Africa

^ar Nuclear Medicine Research Infrastructure, Pretoria, South Africa

^as Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India

^at Department of Radiology, Division of Nuclear Medicine, Branford General Hospital, Ontario, Canada

^au National Center for Radiotherapy Oncology and Nuclear Medicine Department of the Korlebu Teaching Hospital, Accra, Ghana

^av Mallinckrodt Institute of Radiology, Department of Radiology, and Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA

^aw Department of Radiation Oncology and Department of Cancer Biology, Cleveland Clinic, Cleveland, OH USA

^ax Radiation Oncology Department, National Cancer Institute, Cairo University & Children’s Cancer Hospital, Cairo, Egypt

^ay Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China

^az Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

^ba Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia

^bb Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia

^bc School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia

^bd Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia

^* Correspondence to: Prof May Abdel-Wahab, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna 1400, Austria Division of Human Health Department of Nuclear Sciences and Applications International Atomic Energy Agency Vienna 1400 Austria ^** Prof Andrew M Scott, Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC 3084, Australia Department of Molecular Imaging and Therapy Austin Health Melbourne VIC 3084 Australia

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Monday 30 September 2024
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Summary

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.

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