Presenter(s)
Z. Shepil1, V. Buryk2, R. Zelinsky3, L. Stadnyk4, S. Brovchuk5,6, Y. Lozko3, L. Mytsak7, Y. Romalis8, N. Suchowerska9, V. Iakovenko10, and N. Kovalchuk11; 1National Institute "O.O. Shalimov National Scientific Center of Surgery and Transplantology", Kyiv, Ukraine, 2Stereotactic Radiotherapy Center, Sigulda, Latvia, 3National Cancer Institute, Kyiv, Ukraine, 4SO «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine», Kharkiv, Ukraine, 5LISOD Israeli Oncology Hospital, Pliuty, Ukraine, 6O.O. Shalimov National Scientific Center of Surgery and Transplantation, Kyiv, Ukraine, 7Precarpathian clinical oncological center, ?????-??????????, Ivano-Fran, Ukraine, 8Medical College of Wisconsin, Milwaukee, WI, 9School of Physics, The University of Sydney, Sydney, Australia, 10Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 11Department of Radiation Oncology, Stanford University, Stanford, CA
Purpose/Objective(s):
Armed conflict disrupts cancer care, with radiotherapy (RT) especially vulnerable because it depends on fixed infrastructure, reliable electricity, technical maintenance, supply chains, and a specialized workforce. We aimed to evaluate the impact of the ongoing war on national RT capacity, access, and workforce sustainability in Ukraine.Materials/Methods:
This mixed-methods national study combined a 38-question survey conducted by Help Ukraine Group across Ukrainian RT departments (August 2025) with longitudinal IAEA DIRAC-aligned datasets (2022-2025). We analyzed changes in RT availability, equipment inventory, radiotherapy patient volume, waiting times, staffing deficits, Co-60 source replacement feasibility, and operational disruptions.Results:
In January 2022, Ukraine operated 45 RT departments with 82 MV machines (44 LINACs, 38 Co-60), 53 orthovoltage units, and 36 brachytherapy afterloaders. During the first three months of war, two centers were occupied, service disruptions averaged 26 days, and patient volume declined by 27.5%, with brachytherapy most affected due to halted source procurement. By the end of 2022, RT volume decreased by 8% (-3,905 patients), recovered in 2023, and increased by 9% in 2024 (+4,327 patients), although one destroyed center remains closed. By end-2025, 43 RT departments operated 92 MV machines (61 LINACs, 31 Co-60), 2.3 MV per million population. Despite modernization, 56% of departments still rely on Co-60, 94.1% report source exchange is not feasible; 78.6% are transitioning to LINAC-based IMRT. Since 2022, 61.3% installed new LINACs and 66.7% plan further installations by 2028. Staffing deficits were reported at 41.4% for medical physicists, 33.6% for RTTs, and 21.1% for radiation oncologists. Mean RT waiting time increased from 6.4 days (2021) to 10.3 days (2025).Conclusion:
Despite large-scale displacement and infrastructure damage, Ukraine preserved national MV RT capacity, accelerated transition toward LINAC-based radiotherapy. A distributed network supported by coordinated national leadership from the Ministry of Health of Ukraine and international collaboration mitigated system collapse. Future resilience planning must address maintenance continuity, workforce training and retention, and safe scale-up of advanced techniques to sustain RT delivery during prolonged conflict.