Lancet Oncology Commission on Radiotherapy and Theranostics

Established in 2022, the Lancet Oncology Commission on Radiotherapy and Theranostics was led by the IAEA and includes experts from 44 academic institutions and medical centres across 23 different countries. Its report on the availability of radiotherapy and theranostics – published in September 2024 – identifies strategies to optimize patient care and health outcomes, proposing actions and investments that can enhance access to these two cancer therapies, realise health and economic benefits worldwide and reduce the global burden of cancer overall.

The Commission on Radiotherapy and Theranostics follows up on the 2015 Lancet Oncology Commission on expanding global radiotherapy access. Despite progress over the past decade, a disparity in equipment availability continues to be a challenge as does the paucity of suitably trained and credentialled medical professionals. Looking ahead to 2050, the projected surge in new cancer cases would require the 2022 workforce to expand by more than 60 percent for a total of over 84 000 radiation oncologists, 47 000 medical physicists and 141 000 radiotherapy technologists.

Against this backdrop, the Commission investigates mitigating radiotherapy initiatives such as the optimisation of workflows, the use of resource-sparing approaches and the adoption of advanced techniques. It draws on data obtained from a survey of 200 radiotherapy centres spanning 55 countries.

The report shows that implementing hypofractionation (fewer but higher doses of radiation per daily treatment session over a shorter time frame) for prostate and breast cancer for example, can provide radiotherapy for an additional 2.2 million patients. A 50 per cent substitution of conventional radiotherapy with hypofractionated radiotherapy can result in $1.28 billion in potential cost-savings for prostate cancer and $1.48 billion for breast cancer. At 80 per cent substitution, these figures grow to $2.04 billion and $2.37 billion, respectively. Stereotactic body radiation therapy (a type of hypofractionation that delivers precise, high doses but requires more advanced equipment) per full course of treatment from diagnosis to all possible outcomes is more cost-effective than conventionally fractionated radiotherapy over the same time period, even in a low- and middle-income country like Mongolia, the report shows.

In light of recent and rapid advances in radiopharmaceutical therapies beyond traditional radiotherapy, the commission also addresses access to theranostics (the combination of radionuclides to diagnose and treat cancer patients). Like conventional radiotherapy theranostics requires knowledge of radiation principles and radiation biology, as well as expertise in imaging technologies and radiopharmaceutical use for effective cancer treatment approaches.

The commission’s global survey of nuclear medicine facilities across 82 countries along with IAEA data from an additional 84 countries reveals that supply chains, workforces and regulatory challenges all affect the use of radiopharmaceutical therapies across the board, with the exception of one. Health economics modelling of prostate-specific membrane antigen treatment for prostate cancer in nine nations representative of high-income, upper-middle-income and lower-middle-income countries shows a social impact totalling $725 million over a seven-year period.

International efforts which focus on sustainability, strengthen infrastructure and build cancer care capacities – such as the IAEA’s flagship Rays of Hope initiative – can help address global gaps, the report notes.

Better coordination, collaboration and planning can help accelerate momentum towards equitable access to cancer care. To that end, the commission outlines eight actions for increased access.

• Action 1: Coordinate to optimise the use of resources and increase healthcare delivery efficiencies
• Action 2: Align human resources with patient needs to accelerate the deployment of additional capacity
• Action 3: Develop and adopt global standards for infrastructure and the optimal deployment of advanced radiotherapy and theranostic services
• Action 4: Ensure the global availability of radioisotopes for theranostics and the reliability of supply chains
• Action 5: Support clinical trials for theranostics and radiotherapy techniques to define best clinical uses and facilitate implementation
• Action 6: Support the regulatory infrastructure in countries to ensure the safe and effective delivery of radiopharmaceutical therapies to patients
• Action 7: Develop innovative financial solutions as well as reimbursement approaches and include radiotherapy and theranostic services in universal health coverage
• Action 8: Collaborate and coordinate between countries and health-care providers to avoid waste and overlap