King's College London

A new collaborative study between King’s and Queen’s University Canada, highlights the urgent need for global investment in radiotherapy. The study published in The Lancet Oncology estimates that more than 16,000 new linear accelerators (LINACs)—medical devices used in radiotherapy to treat cancer—will be required by 2045 to meet rising treatment demands. The need is particularly critical in low- and middle-income countries, where access remains most limited.

Radiotherapy is essential for treating more than half of the world’s cancer patients. However, the study reveals a 30% global shortage of linear accelerators (LINACs). Data analysed in the study from 181 countries highlights significant disparities in the availability and distribution of these critical devices.

To investigate this issue, the researchers used the Linear Accelerator Shortage Index (LSI), a tool that helps to prioritise the deployment of LINACs based on countries’ radiotherapy needs. Previously, LSI-based research focused on single-country analysis. However, this study, supported by Professor Richard Sullivan and Professor Ajay Aggarwal, introduces a more comprehensive approach, using the LSI as a practical tool to evaluate and forecast LINAC requirements worldwide.

Using the LSI, researchers classified countries into shortage grades from 0 (no shortage) to 4 (no LINACs available), providing a clear framework to track disparities and guide investment. By 2045, countries ranked grades 3 and 4 will require significant support, with grade 4 nations urgently needing funding to establish basic radiotherapy services.

The research estimates that a total investment of $123.9 billion will be required to install new LINACs and replace aging machines worldwide. Despite the urgency, financial constraints remain a major barrier. Aside from the cost, some countries are continuing to struggle with the expenses of training and insufficient machine maintenance support.

The study also emphasises the impact of rapid technological advancements in cancer treatment. For example, while addressing LINAC shortages is crucial, future planning must also consider emerging innovations such as stereotactic radiotherapy, which can improve treatment accuracy and efficiency.

The LSI and LINAC shortage grade system are effective tools for forecasting global radiotherapy needs, highlighting disparities in LINAC access and emphasising the need for investment in radiotherapy infrastructure. This research paves the way for a more strategic approach to tackling the issue of global radiotherapy shortages, enabling policy makers and health-care providers to address disparities in linear accelerator access.