2919 - Impact of War on Radiotherapy Services in Ukraine: Challenges, Resilience, and the Need for International Support
Presenter(s)
S. Brovchuk1, R. Zelinskyi2, L. Stadnyk3, V. Iakovenko4, Z. Shepil5, Y. Lozko6, N. Suchowerska7, A. Beznosenko8, A. Kacharian9, and N. Kovalchuk10; 1LISOD Israeli Oncology Hospital, Pliuty, Ukraine, 2Spizhenko Clinic, Kyiv, Ukraine, 3Grigoriev Institute for Medical Radiology, Kharkiv, Kharkiv Region, Ukraine, 4Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 5Kyiv Regional Oncology Dispensary, Kyiv, Ukraine, 6Stanford University, Stanford, CA, 7School of Physics, The University of Sydney, Sydney, Australia, 8National Cancer Institute, Kyiv, Ukraine, 9Ministry of Health of Ukraine, Kyiv, Ukraine, 10Department of Radiation Oncology, Stanford University, Stanford, CA
Purpose/Objective(s): To assess the impact of the war on radiotherapy (RT) services in Ukraine and identify the key areas of need for maintaining RT capacity during the ongoing Russian invasion.
Materials/Methods: Data on RT center operations during the war was gathered by the Grigoriev Institute for Medical Radiology in Kharkiv for the IAEA DIRAC database between 2022 and 2024. This data covered equipment, staffing, and patient volumes.
Results: Ukraine has one of the lowest rates of MV RT machines in Europe, with only 1.7 machines per million people. Since 2014, the Russian occupation has resulted in the loss of 12 RT centers and 26 external beam radiotherapy (EBRT) machines. The 2022 full-scale invasion caused widespread RT center closures, halted linear accelerator operations, and disrupted radioactive source exchanges. A significant challenge is reliance on 32 aging Co-60 machines, primarily manufactured in Russia, with sources irreplaceable under current circumstances. Additionally, 16 HDR afterloaders are over 25 years old and need replacement, 13 RT centers lack CT scanners, and the entire country has only 3 PET/CT scanners.
In 2022, RT patient volume dropped by 5,500 patients (-11%) compared to 2021, with significant declines in LDR brachytherapy (47.3%), orthovoltage (26.4%), and HDR brachytherapy patient volumes (16.5%). Staffing was also redistributed, with 68% of regions reporting staffing changes exceeding 25%. Despite challenges, by 2023, RT patient volumes had returned to pre-invasion levels, demonstrating the resilience of the radiotherapy workforce. Also, modernization efforts continued, with 16 linear accelerators installed since the full-scale invasion and plans for installing 24 more. Hence, there is an urgent need to train RT professionals in transitioning from Co-60 to IMRT technology.Conclusion: The war in Ukraine has severely impacted RT services, creating significant challenges in equipment, staffing, and patient care. Despite these setbacks, the RT workforce has demonstrated remarkable resilience, with efforts to restore patient volumes and continue modernization. However, urgent action is required to address the aging infrastructure, including the need for equipment upgrades, training in advanced technologies like IMRT, and international support to sustain RT services. Collaborative global efforts are essential to ensure the continuity of cancer care during and after the conflict, highlighting the critical need for solidarity in times of crisis.