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PURPOSE The limited radiotherapy resources for global cancer control have resulted in increased interest in developing time- and cost-saving innovations to expand access to those resources. Hypofractionated regimens could minimize cost and increase access for limited-resource countries. In this investigation, we estimated the percentage cost-savings per radiotherapy course and increased radiotherapy access in African countries after adopting hypofractionation for breast and prostate radiotherapy. For perspective, results were compared with high-income countries. METHODS The cost and course of breast and prostate radiotherapy for conventional and hypofractionated regimens in low-resource facilities were calculated using the Radiotherapy Cost Estimator tool developed by the International Atomic Energy Agency (IAEA) and then compared with another activity-based costing model. The potential maximum cost savings in each country over 7 years for breast and prostate radiotherapy were then estimated using cancer incidence data from the Global Cancer Observatory database with use rates applied. The increase in radiotherapy access was estimated by current national capacities from the IAEA directory. RESULTS The estimated cost per course of conventional and hypofractionated regimens were US$2,232 and $1,339 for breast treatment, and $3,389 and $1,699 for prostate treatment, respectively. The projected potential maximum cost savings with full hypofractionation implementation were $1.1 billion and $606 million for breast and prostate treatment, respectively. The projected increase of radiotherapy access due to implementing hypofractionation varied between +0.3% to 25% and +0.4% to 36.0% for breast and prostate treatments, respectively. CONCLUSION This investigation demonstrates that adopting hypofractionated regimens as standard treatment of breast and prostate cancers can result in substantial savings and increase radiotherapy access in developing countries. Given reduced delivery cost and treatment times, we anticipate a substantial increase in radiotherapy access with additional innovations that will allow progressive hypofractionation without compromising quality.

More than 60 years ago, the effect whereby radiotherapy at one site may lead to regression of metastatic cancer at distant sites that are not irradiated was described and called the abscopal effect (from ‘ab scopus’, that is, away from the target). The abscopal effect has been connected to mechanisms involving the immune system. However, the effect is rare because at the time of treatment, established immune-tolerance mechanisms may hamper the development of sufficiently robust abscopal responses. Today, the growing consensus is that combining radiotherapy with immunotherapy provides an opportunity to boost abscopal response rates, extending the use of radiotherapy to treatment of both local and metastatic disease. In this Opinion article, we review evidence for this growing consensus and highlight emerging limitations to boosting the abscopal effect using immunotherapy. This is followed by a perspective on current and potential cross-disciplinary approaches, including the use of smart materials to address these limitations.

Purpose: This study explores the effectiveness of remote contouring training for therapeutic radiology in three Sub-Saharan African countries (Nigeria, Tanzania, Cameroon) using a web-based platform (ProKnow). Methods and Materials: A 2-hour real-time video didactic lecture and demonstration of the left parotid tumor contouring on axial CT images was delivered using the ProKnow system and a video conferencing software. Participants were granted week-long access to practice contouring of the left parotid volume after the session. Effectiveness of the remote training was evaluated with a self-assessment questionnaire administered before and after the training. Areas of competence assessed included: (i) ability to identify anatomic structure on axial CT; (ii) ability to contour a parotid volume; (iii) ability to delineate tissues; (iv) dose-volume histogram evaluation (DVH); (v) plan evaluation; (vi) port film evaluation; (vii) cone-beam CT evaluation (CBCT). A comparative statistical analysis was undertaken to evaluate for significant changes in the average self-competence score for the various competency areas before and after intervention. The post-class survey also contained questions to determine the acceptability of the ProKnow system for training and image-guided radiotherapy planning among the participants and their access to the necessary internet services. Results: There was statistically significant improvement in all skill parameters needed to contour parotid volumes on axial CT scan. Percent improvement in average self-competency scores ranged from +14.3% for DVH evaluation to +32.8% for treatment plan evaluation. Although in varying degree, 95% of participants indicated the remote training session was relevant to their clinical practice and training. Also, in varying degrees, all indicated that the web-based tool will be helpful to their professional development; that the web-based platform (ProKnow) was easy to navigate and use; and that they would recommend the resource. Most respondents (84%) had access to strong or moderate internet connectivity to integrate the web-based tools into their clinical practice and training. Conclusion: Web-based interactive contouring atlases have utility in global health, as they can serve as self-directed and remote training tools for oncology and radiology staff, which could improve the accuracy of their treatment planning and ultimately impact the quality of therapeutic radiology.

A major contributor to the disparity in cancer outcome across the globe is the limited health care access in low- and middle-income countries that results from the shortfall in human resources for health (HRH), fomented by the limited training and leadership capacity of low-resource countries. In 2012, Seed Global Health teamed up with the Peace Corps to create the Global Health Service Partnership, an initiative that has introduced a novel model for tackling the HRH crises in developing regions of the world. The Global Health Service Partnership has made global health impacts in leveraging partnerships for HRH development, faculty activities and output, scholarship engagement, adding value to the learning environment, health workforce empowerment, and infrastructure development.