Author: Samuel O. Adeneye, Victoria Susan Ainsworth, Azeezat Ajose, Stephen M. Avery, Munir Awol, Kavuma Awusi, Onyinye Balogun, Rohini Bhatia, Frank Chinegwundoh, Jumaa Dachi Kisukari, Curtiland Deville, Katy Graef, Yao Hao, M. Saiful Huq, Luca Incrocci, Adedayo O. Joseph, Solomon Kibudde, Joerg Lehmann, Heng Li, Abba Mallum, Thokozani Mkhize, Twalib Ngoma, Wilfred Ngwa, Christopher F. Njeh, Janine Simons, William Swanson, Maureen Bilinga Tendwa, Joseph Weygand, Krishni Wijesooriya 👨🔬
Affiliation: Uganda Cancer Institute, Johns Hopkins University, BIO Ventures for Global Health, Weill Cornell Medicine, Washington University School of Medicine, South Africa Health Product Regulatory Authority, University of Pennsylvania, University of Massachusetts Lowell, NSIA-LUTH Cancer Center, University of Lagos, Indiana University School of Medicine, Department of Radiation Oncology, Erasmus Medical Center, Department of Radiation Oncology and Applied Science, Dartmouth Health, Addis Ababa University, Ocean Road Cancer Institute, Emory University, Barts Health NHS Trust, Inkosi Albert Luthuli Central Hospital, Lagos University Teaching Hospital, UPMC Hillman Cancer Center and University of Pittsburgh School of Medicine, University of Virginia School of Medicine, University of Newcastle 🌍
Purpose: Sub-Saharan Africa continues to face a critical shortage in radiotherapy resources, exacerbating the region’s growing cancer burden. One potential strategy that can partially offset this problem is the increased adoption of ultra-hypofractionated radiotherapy (UHFRT), whereby a smaller number of treatment sessions are required since each session administers higher doses of radiation (to an equivalent biological dose) compared to conventional fractionation. UHFRT techniques have been widely adopted in Europe and North America, particularly for prostate and breast treatments, but differences in the available technology and demographics and biology in sub-Saharan Africa necessitate rigorous evaluation of the existing infrastructure and clinical workflows before its widespread implementation in these settings.
Methods: This study makes a first attempt to interrogate the readiness of six leading sub-Saharan African institutions for the transition towards UHFRT treatment regimens. The survey was structured into five sections which assessed (1) general clinical capacity and infrastructure, (2) the clinical breast cancer treatment program, (3) the clinical prostate cancer treatment program, (4) medical physics support and quality management, and (5) research capacity.
Results: The survey responses revealed a strong willingness among African clinicians to adopt UHFRT and generally sufficient supporting infrastructure (i.e., equipment, staffing, quality assurance programs, and research support) already in place. However, some technical gaps were identified such as the lack of employment of breath-hold techniques in treating breast cancer and non-utilization of fiducial markers and perirectal spacers in treating prostate cancer. All six responding institutions expressed enthusiasm to participate in a training course aimed at addressing these technical gaps.
Conclusion: These findings underscore the potential for the successful implementation of breast and prostate UHFRT in sub-Saharan Africa, provided that targeted training and technical support are delivered. Addressing identified gaps will be critical in ensuring the safe and effective adoption of this advanced treatment technique across the region.