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• The cancer burden, radiotherapy availability and mortality-incidence ratio in Arabic countries showed a shortage of radiotherapy service especially in low income and politically unstable countries. Arab countries share a common location, history, language and culture with different economic characteristics. In this study, we analyze the availability and factors influencing radiotherapy services and cancer mortality incidence ratio (MIR) in Arabic countries. Data were collected from GLOBOCAN report, World Health Organization, World Bank, United Nation and Directory of Radiotherapy Centre databases. The average number of megavoltage machines (MVM) in Arab countries is 0.84 machine per 1000 cancer patients. The number of MVM per 1000 cancer patients was found to be significantly correlated with gross domestic product (GDP) per capita ( r = 0.583, P = 0.006). In addition, it was found to be significantly more in politically stable countries compared to unstable ones ( P = 0.004) and more in high and upper-middle income countries (median 0.94 ± 1.0) compared to lower-middle and low income countries (median 0.3 ± 0.51) ( P = 0.013). MIR was found to be significantly correlated with GDP per capita, physicians per 1000 population, MVM per 1000 cancer patients and absolute MVM deficit ( r = −0.555, −0.625, −0.42, −0.436 and P = 0.009, 0.006, 0.047, 0.043, respectively). On multivariate regression analysis, the number of physicians per 1000 population had the strongest prediction of MIR in Arabic countries ( P = 0.01). Although the economic status is of paramount importance, it is not the only factor determining the quantity and quality of radiotherapy services in the Arab world. More efforts are urgently needed to improve the status of radiation oncology and fill its gap in the Arab countries. [ABSTRACT FROM AUTHOR]