Radiotherapy and brachytherapy capacity, treatment timelines, and barriers to guideline-concordant curative care for cervical cancer in Latin America: the LATAM-CxRT study.

چکیده اصلی

OBJECTIVE: To describe national radiotherapy and brachytherapy capacity, treatment delivery, and barriers to guideline-concordant curative treatment among women with cervical cancer requiring definitive or adjuvant radiotherapy in Latin America. METHODS: We conducted a cross-sectional survey of national radiation oncology coordinators from 14 Latin American countries using a standardized Research Electronic Data Capture questionnaire covering institutional mix, radiotherapy and brachytherapy infrastructure, imaging capacity, cervical cancer caseloads, external beam radiotherapy and brachytherapy practice, treatment timelines, and barriers and needs as perceived by coordinators. Data were cross-checked against International Atomic Energy Agency and vendor data where available. RESULTS: Fourteen countries contributed data: all completed general characteristics, 13 completed the resources and workforce module, and 12 completed the full equipment and timelines module. Among these 12 countries, the median number of linear accelerators was 33.5 per country (interquartile range 9 to 101.75), reflecting a right skew driven by Brazil. The median annual caseload was 680.5 patients for International Federation of Gynecology and Obstetrics stages I to II disease and 800 patients for stages III to IV disease. Nearly all countries reported intensity-modulated radiotherapy, image-guided radiotherapy, and volumetric-modulated arc therapy capabilities. Gynecologic high-dose-rate brachytherapy was available in all 12 countries, although several reported insufficient coverage, with services concentrated in reference centers; magnetic resonance imaging-guided brachytherapy, interstitial techniques, and anesthesia support were available in only a subset. Half of countries reported 91% to 100% brachytherapy completion among women initiating curative chemoradiation, but overall treatment time from external beam radiotherapy start to brachytherapy completion exceeded 56 days in most countries. Coordinators identified limited brachytherapy and imaging capacity, workforce shortages, anesthesia constraints, and financial barriers as key impediments. These findings describe installed capacity and self-reported practice rather than direct measures of patient-level access. CONCLUSIONS: This 14-country survey demonstrates that, despite widespread availability of advanced external beam radiotherapy, cervical cancer care in Latin America remains constrained by heterogeneous and often insufficient brachytherapy and imaging resources and by treatment delays exceeding guideline recommendations. Targeted investment, workforce development, service organization, and financing reforms are needed to deliver guideline-concordant chemoradiation for women with cervical cancer in the region.

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