Infrastructure and Equipment for Radiation Oncology in the Spanish National Health System: Analysis of External Beam Radiotherapy 2015-2020

Overview

Journal Clin Transl Oncol

Specialty Oncology

Date 2017 Aug 5

PMID 28776310

Citations 5

Authors

A Rodriguez

M Algara

D Monge

J Lopez-Torrecilla

F Caballero

R Morera

R Esco

H Perez-Montero

C Ferrer

P C Lara

Affiliations

Soon will be listed here.

Abstract

Purpose: Planning for radiation oncology requires reliable estimates of both demand for radiotherapy and availability of technological resources. This study compares radiotherapy resources in the 17 regions of the decentralised Spanish National Health System (SNHS).

Materials And Methods: The Sociedad Española de Oncología Radioterápica (SEOR) performed a cross-sectional survey of all Spanish radiation oncology services (ROS) in 2015. We collected data on SNHS radiotherapy units, recording the year of installation, specific features of linear accelerators (LINACs) and other treatment units, and radiotherapeutic techniques implemented by region. Any machine over 10 years old or lacking a multileaf collimator or portal imaging system was considered obsolete. We performed a k-means clustering analysis using the Hartigan-Wong method to test associations between the gross domestic regional product (GDRP), the number of LINACs per million population and the percentage of LINACs over 10 years old.

Results: The SNHS controls 72 (61%) of the 118 Spanish ROS and has 180 LINACs, or 72.5% of the total public and private resources. The mean rate of LINACs per million population is 3.9 for public ROS, and 42% (n = 75) of the public accelerators were obsolete in 2015: 61 due to age and 14 due to technological capability. There was considerable regional variation in terms of the number and technological capacity of radiotherapy units; correlation between GRDP and resource availability was moderate.

Conclusion: Despite improvements, new investments are still needed to replace obsolete units and increase access to modern radiotherapy. Regular analysis of ROS in each Spanish region is the only strategy for monitoring progress in radiotherapy capacity.

Citing Articles

Challenges in assessing national radiotherapy costs: application of the ESTRO-HERO model in Spain.

Corral J, Algara M, Munoz-Montplet C, Eraso A, Giralt J, Defourny N Front Public Health. 2025; 12:1474376.

PMID: 39749236 PMC: 11694224. DOI: 10.3389/fpubh.2024.1474376.

Cancer Survival in Adults in Spain: A Population-Based Study of the Spanish Network of Cancer Registries (REDECAN).

Guevara M, Molinuevo A, Salmeron D, Marcos-Gragera R, Carulla M, Chirlaque M Cancers (Basel). 2022; 14(10).

PMID: 35626046 PMC: 9139549. DOI: 10.3390/cancers14102441.

100% peer review in radiation oncology: is it feasible?.

Martin-Garcia E, Celada-Alvarez F, Perez-Calatayud M, Rodriguez-Pla M, Prato-Carreno O, Farga-Albiol D Clin Transl Oncol. 2020; 22(12):2341-2349.

PMID: 32557395 PMC: 7299249. DOI: 10.1007/s12094-020-02394-8.

Are there enough radiation oncologists to lead the new Spanish radiotherapy?.

Rodriguez A, Arenas M, Lara P, Lopez-Torrecilla J, Algara M, Conde A Clin Transl Oncol. 2019; 21(12):1663-1672.

PMID: 30941701 DOI: 10.1007/s12094-019-02095-x.

Multiparametric MRI for prostate cancer: a national survey of patterns of practice among radiation oncologists in Spain.

Counago F, Sancho G, Gomez-Iturriaga A, Henriquez I Clin Transl Oncol. 2018; 20(11):1484-1491.

PMID: 29992463 DOI: 10.1007/s12094-018-1919-z.

References

Prades J, Algara M, Espinas J, Farrus B, Arenas M, Reyes V . Understanding variations in the use of hypofractionated radiotherapy and its specific indications for breast cancer: A mixed-methods study. Radiother Oncol. 2017; 123(1):22-28. DOI: 10.1016/j.radonc.2017.01.014. View

Arenas M, Gomez D, Sabater S, Rovirosa A, Biete A, Colomer J . Decentralisation of radiation therapy. Is it possible and beneficial to patients? Experience of the first 5 years of a satellite radiotherapy unit in the province of Tarragona, Spain. Rep Pract Oncol Radiother. 2015; 20(2):141-4. PMC: 4338286. DOI: 10.1016/j.rpor.2014.10.008. View

Borras J, Lievens Y, Barton M, Corral J, Ferlay J, Bray F . How many new cancer patients in Europe will require radiotherapy by 2025? An ESTRO-HERO analysis. Radiother Oncol. 2016; 119(1):5-11. DOI: 10.1016/j.radonc.2016.02.016. View

Grau C, Defourny N, Malicki J, Dunscombe P, Borras J, Coffey M . Radiotherapy equipment and departments in the European countries: final results from the ESTRO-HERO survey. Radiother Oncol. 2014; 112(2):155-64. DOI: 10.1016/j.radonc.2014.08.029. View

Palacios Eito A, Espinosa Calvo M, Manas Rueda A, Heras M . Radiation oncology: future needs and equipment. Current situation in Spain. Clin Transl Oncol. 2008; 10(8):478-85. DOI: 10.1007/s12094-008-0236-3. View

Delaney G, Jacob S, Featherstone C, Barton M . The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer. 2005; 104(6):1129-37. DOI: 10.1002/cncr.21324. View

Esco R, Palacios A, Pardo J, Biete A, Carceller J, Veiras C . Infrastructure of radiotherapy in Spain: a minimal standard of radiotherapy resources. Int J Radiat Oncol Biol Phys. 2003; 56(2):319-27. DOI: 10.1016/s0360-3016(02)04580-7. View

Slotman B, Vos P . Planning of radiotherapy capacity and productivity. Radiother Oncol. 2013; 106(2):266-70. DOI: 10.1016/j.radonc.2013.02.006. View

Barton M, Jacob S, Shafiq J, Wong K, Thompson S, Hanna T . Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012. Radiother Oncol. 2014; 112(1):140-4. DOI: 10.1016/j.radonc.2014.03.024. View

10.

Rodriguez A, Borras J, Lopez-Torrecilla J, Algara M, Palacios-Eito A, Gomez-Caamano A . Demand for radiotherapy in Spain. Clin Transl Oncol. 2016; 19(2):204-210. DOI: 10.1007/s12094-016-1525-x. View

11.

Datta N, Samiei M, Bodis S . Radiotherapy infrastructure and human resources in Europe - present status and its implications for 2020. Eur J Cancer. 2014; 50(15):2735-43. DOI: 10.1016/j.ejca.2014.06.012. View

12.

Borras J, Lievens Y, Dunscombe P, Coffey M, Malicki J, Corral J . The optimal utilization proportion of external beam radiotherapy in European countries: An ESTRO-HERO analysis. Radiother Oncol. 2015; 116(1):38-44. DOI: 10.1016/j.radonc.2015.04.018. View

13.

Lievens Y, Defourny N, Coffey M, Borras J, Dunscombe P, Slotman B . Radiotherapy staffing in the European countries: final results from the ESTRO-HERO survey. Radiother Oncol. 2014; 112(2):178-86. DOI: 10.1016/j.radonc.2014.08.034. View

14.

Borras J, Barton M, Grau C, Corral J, Verhoeven R, Lemmens V . The impact of cancer incidence and stage on optimal utilization of radiotherapy: Methodology of a population based analysis by the ESTRO-HERO project. Radiother Oncol. 2015; 116(1):45-50. DOI: 10.1016/j.radonc.2015.04.021. View

15.

Bentzen S, Heeren G, Cottier B, Slotman B, Glimelius B, Lievens Y . Towards evidence-based guidelines for radiotherapy infrastructure and staffing needs in Europe: the ESTRO QUARTS project. Radiother Oncol. 2005; 75(3):355-65. DOI: 10.1016/j.radonc.2004.12.007. View

16.

Shakespeare T, Turner M, Chapman A . Is rural radiation oncology practice quality as good as the big smoke? Results of the Australian radiotherapy single machine unit trial. Australas Radiol. 2007; 51(4):381-5. DOI: 10.1111/j.1440-1673.2007.01754.x. View

17.

Slotman B, Cottier B, Bentzen S, Heeren G, Lievens Y, Van den Bogaert W . Overview of national guidelines for infrastructure and staffing of radiotherapy. ESTRO-QUARTS: work package 1. Radiother Oncol. 2005; 75(3):349-54. DOI: 10.1016/j.radonc.2004.12.005. View

18.

Rosenblatt E, Izewska J, Anacak Y, Pynda Y, Scalliet P, Boniol M . Radiotherapy capacity in European countries: an analysis of the Directory of Radiotherapy Centres (DIRAC) database. Lancet Oncol. 2013; 14(2):e79-86. DOI: 10.1016/S1470-2045(12)70556-9. View