2904 - Global Radiotherapy Demand in Cervical Cancer: A Scoping Review of Optimal Utilization Modeling

Purpose/Objective(s): Cervical cancer remains a major global health burden, particularly in low- and middle-income countries where access to radiotherapy (RT) infrastructure is critical for disease control. The optimal radiotherapy utilization rate (ORUR), defined as the proportion of patients who should receive RT at least once according to evidence-based guidelines, represents a key benchmark for capacity planning. We hypothesized that published ORUR estimates for cervical cancer consistently demonstrate very high radiotherapy demand across modeling frameworks and regions, reinforcing RT—particularly brachytherapy—as an essential component of cancer control strategies.

Materials/Methods: A scoping review was conducted following PRISMA-ScR methodology. PubMed was searched for English-language studies published between January 2015 and July 2025 using terms related to optimal radiotherapy utilization, radiation demand modeling, brachytherapy, and cervical cancer. Eligible studies reported ORUR estimates derived from guideline-based decision models, population-level modeling, or benchmark analyses. Extracted variables included modeling approach, radiotherapy components considered (external beam and/or brachytherapy), incidence dataset year, and reported ORUR values. The study protocol was prospectively registered on the Open Science Framework https://doi.org/10.17605/OSF.IO/5YJHQ.

Results: Among 683 screened records, 12 studies met inclusion criteria. Major global modeling initiatives, including ESTRO-HERO and CCORE frameworks, consistently estimated lifetime ORUR between 80% and 85%, placing cervical cancer among malignancies with the highest radiotherapy requirements. Global health modeling studies similarly reported ORUR near this range. Alternative models incorporating comorbidity adjustments reported lower estimates (approximately 70–75%). Regional studies across Europe, Latin America, Africa, and Asia showed broadly similar values. Across all modeling approaches, brachytherapy was identified as an indispensable component of curative treatment for locally advanced disease, contributing substantially to total radiotherapy demand.

Conclusion: Published evidence consistently indicates that >75% of patients with cervical cancer require radiotherapy at least once during their disease course, with most estimates converging near 80–85%. These findings confirm cervical cancer as one of the malignancies with the highest radiotherapy demand and highlight the critical role of brachytherapy availability in achieving guideline-concordant care. Robust ORUR benchmarks may support national cancer planning, infrastructure development, and global radiotherapy capacity strategies.