3127 - Proton Therapy in Latin America: Urgent Need for Investment and Strategic Implementation

05:00pm - 06:00pm PT

Hall F

Screen: 28

POSTER

Presenter(s)

Marcos Santos, MD, PhD - ALATRO, Brasilia, DF

M. A. Santos¹, V. J. Bourel Sr², A. Mazal³, V. C. Figueroa⁴, G. J. Sarria Sr⁵, C. Deville Jr⁶, J. A. Solis⁷, C. Salata⁸, J. Serrano⁹, and G. Santa Cruz¹⁰; ¹President of ALATRO - Latin Americar Socity of Radiation Oncology, Brasilia, Brazil, ²Nuclear Control, Buenos Aires, Argentina, ³Centro de Protonterapia Quironsalud, Madrid, Spain, ⁴Universidad Evangélica de El Salvador, San Salvador, El Salvador, ⁵ONCOSALUD SAC, Lima, Lima, Peru, ⁶Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, ⁷Departamento Oncología, Universidad de Valparaíso, Valparaiso, Chile, ⁸Brazilian Nuclear Regularly Authority (CNEN), Rio de Janeiro, Brazil, ⁹Sociedad Española de Onclogía Radioterapica (SEOR), Madrid, Spain, ¹⁰Atomic Energic National Comission (CNEA), Buenos Aires, Argentina

Purpose/Objective(s): Cancer remains a leading cause of morbidity and mortality in Latin America (LA), with radiotherapy (RT) utilized in approximately 50% of oncology cases. Proton therapy (PT) offers significant clinical advantages for specific indications. However, PT is underdeveloped in the region due to high costs, with establishment expenses around 52 million USD and annual operations costing 3-6 million USD. Currently, there are no fully operational PT centers in LA. Economic and logistical barriers hinder its adoption, necessitating a structured implementation plan. This study aimed to develop a sustainable strategy for introducing PT in LA, focusing on geography, tumor incidence, and prioritizing tumors where PT offers the most benefit, while also considering the need to expand access to conventional treatments.

Materials/Methods: A structured, multi-phase methodology was employed to establish a consensus on implementing PT in LA. Initially, a multidisciplinary panel of experts was convened. This panel conducted a comprehensive literature review focusing on clinical outcomes, cost-effectiveness, and implementation strategies pertinent to the Latin American context. Subsequently, facilitated discussions were held to collaboratively develop unified recommendations, addressing disagreements and considering practical constraints. Finally, a consensus statement was drafted, validated by all panelists, to be disseminated throughout the region, to guide stakeholders in integrating PT into LA's oncology care framework.

Results:

PT is particularly effective for pediatric tumors, central nervous system malignancies, and tumors adjacent to critical structures. Evidence supports its cost-effectiveness in pediatric brain tumors. Additionally, PT improves outcomes in skull base chordomas, uveal melanoma, and reirradiation cases.

Implementation Strategy for Latin America: A three-phase approach is proposed:

Phase 1: Establish regional reference centers in Argentina, Brazil, Chile, and Mexico, to optimize patient capacity (~750 patients/year per center).
Phase 2: Expand PT indications to include head and neck, thoracic, and hepatocellular carcinoma in selected cases.
Phase 3: Assess further expansion based on emerging evidence for prostate and breast cancer.

Economic Sustainability and Collaborative Models: Regionalization and cross-border patient referrals can optimize PT utilization. Hybrid funding models, including public-private partnerships and international financial support, can facilitate sustainability. Integrating PT into national health policies is crucial to ensuring equitable access.

Conclusion: Latin America requires an urgent, evidence-based investment strategy for PT as part of a comprehensive plan that includes providing accessibility and upgrading conventional RT equipment. A phased, cost-effective, and regionally coordinated approach will maximize clinical benefits while maintaining financial sustainability.