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Radiotherapy in Cancer Care: Facing the Global Challenge

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Radiotherapy in Cancer Care: Facing the Global Challenge FACING THE GLOBAL CHALLENGE FACING RADIOTHERAPY IN CANCER CARE: This publication presents a comprehensive overview of the major topics and issues to be taken into consideration when planning and implementing radiotherapy services. It provides an introduction to the challenges associated with radiotherapy and its achievements as a cancer treatment modality around the world. Written with health care managers in mind, it contains data on the status of radiotherapy services around the world, established and novel technologies, social and economic factors, current issues and the role of international organizations. Dedicated chapters focus on proton therapy, carbon ion radiotherapy, intraoperative radiotherapy, radiotherapy for children, HIV/AIDS related malignancies, and costing and quality management issues. RADIOTHERAPY IN CANCER CARE: FACING THE GLOBAL CHALLENGE Edited by: Eduardo Rosenblatt Eduardo Zubizarreta INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA ISBN 978–92–0–115013–4 @ RADIOTHERAPY IN CANCER CARE: FACING THE GLOBAL CHALLENGE The following States are Members of the International Atomic Energy Agency: AFGHANISTAN GEORGIA OMAN ALBANIA GERMANY PAKISTAN ALGERIA GHANA PALAU ANGOLA GREECE PANAMA ANTIGUA AND BARBUDA GUATEMALA PAPUA NEW GUINEA ARGENTINA GUYANA PARAGUAY ARMENIA HAITI PERU AUSTRALIA HOLY SEE PHILIPPINES AUSTRIA HONDURAS POLAND AZERBAIJAN HUNGARY PORTUGAL BAHAMAS ICELAND QATAR BAHRAIN INDIA REPUBLIC OF MOLDOVA BANGLADESH INDONESIA ROMANIA BARBADOS IRAN, ISLAMIC REPUBLIC OF RUSSIAN FEDERATION BELARUS IRAQ RWANDA BELGIUM IRELAND SAN MARINO BELIZE ISRAEL SAUDI ARABIA BENIN ITALY SENEGAL BOLIVIA, PLURINATIONAL JAMAICA SERBIA STATE OF JAPAN SEYCHELLES BOSNIA AND HERZEGOVINA JORDAN SIERRA LEONE BOTSWANA KAZAKHSTAN SINGAPORE BRAZIL KENYA SLOVAKIA BRUNEI DARUSSALAM KOREA, REPUBLIC OF SLOVENIA BULGARIA KUWAIT SOUTH AFRICA BURKINA FASO KYRGYZSTAN SPAIN BURUNDI LAO PEOPLE’S DEMOCRATIC SRI LANKA CAMBODIA REPUBLIC SUDAN CAMEROON LATVIA SWAZILAND CANADA LEBANON SWEDEN CENTRAL AFRICAN LESOTHO SWITZERLAND REPUBLIC LIBERIA SYRIAN ARAB REPUBLIC CHAD LIBYA TAJIKISTAN CHILE LIECHTENSTEIN THAILAND CHINA LITHUANIA THE FORMER YUGOSLAV COLOMBIA LUXEMBOURG REPUBLIC OF MACEDONIA CONGO MADAGASCAR TOGO COSTA RICA MALAWI TRINIDAD AND TOBAGO CÔTE D’IVOIRE MALAYSIA TUNISIA CROATIA MALI TURKEY CUBA MALTA TURKMENISTAN CYPRUS MARSHALL ISLANDS UGANDA CZECH REPUBLIC MAURITANIA UKRAINE DEMOCRATIC REPUBLIC MAURITIUS UNITED ARAB EMIRATES OF THE CONGO MEXICO UNITED KINGDOM OF DENMARK MONACO GREAT BRITAIN AND DJIBOUTI MONGOLIA NORTHERN IRELAND DOMINICA MONTENEGRO UNITED REPUBLIC DOMINICAN REPUBLIC MOROCCO OF TANZANIA ECUADOR MOZAMBIQUE UNITED STATES OF AMERICA EGYPT MYANMAR URUGUAY EL SALVADOR NAMIBIA UZBEKISTAN ERITREA NEPAL VANUATU ESTONIA NETHERLANDS VENEZUELA, BOLIVARIAN ETHIOPIA NEW ZEALAND REPUBLIC OF FIJI NICARAGUA VIET NAM FINLAND NIGER YEMEN FRANCE NIGERIA ZAMBIA GABON NORWAY ZIMBABWE The Agency’s Statute was approved on 23 October 1956 by the Conference on the Statute of the IAEA held at United Nations Headquarters, New York; it entered into force on 29 July 1957. The Headquarters of the Agency are situated in Vienna. Its principal objective is “to accelerate and enlarge the contribution of atomic energy to peace, health and prosperity throughout the world’’. RADIOTHERAPY IN CANCER CARE: FACING THE GLOBAL CHALLENGE EDITED BY: E. ROSENBLATT E. ZUBIZARRETA INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA, 2017 COPYRIGHT NOTICE All IAEA scientific and technical publications are protected by the terms of the Universal Copyright Convention as adopted in 1952 (Berne) and as revised in 1972 (Paris). The copyright has since been extended by the World Intellectual Property Organization (Geneva) to include electronic and virtual intellectual property. Permission to use whole or parts of texts contained in IAEA publications in printed or electronic form must be obtained and is usually subject to royalty agreements. Proposals for non-commercial reproductions and translations are welcomed and considered on a case-by-case basis. Enquiries should be addressed to the IAEA Publishing Section at: Marketing and Sales Unit, Publishing Section International Atomic Energy Agency Vienna International Centre PO Box 100 1400 Vienna, Austria fax: +43 1 2600 29302 tel.: +43 1 2600 22417 email: [email protected] http://www.iaea.org/books © IAEA, 2017 Printed by the IAEA in Austria June 2017 STI/PUB/1638 IAEA Library Cataloguing in Publication Data Names: International Atomic Energy Agency. Title: Radiotherapy in cancer care: facing the global challenge / International Atomic Energy Agency. Description: Vienna : International Atomic Energy Agency, 2017. | Includes bibliographical references. Identifiers: IAEAL 17-01089 | ISBN 978–92–0–115013–4 (hardback : alk. paper) Subjects: LCSH: Cancer — Radiotherapy. | Cancer — Treatment. | Medical care — Developing countries. Classification: UDC 616-006:615.849 | STI/PUB/1638 COPYRIGHT NOTICE FOREWORD All IAEA scientific and technical publications are protected by the terms of Yukiya Amano the Universal Copyright Convention as adopted in 1952 (Berne) and as revised Director General in 1972 (Paris). The copyright has since been extended by the World Intellectual Property Organization (Geneva) to include electronic and virtual intellectual Cancer affects people in all countries regardless of age, gender or social property. Permission to use whole or parts of texts contained in IAEA publications class. In developed countries, access to radiotherapy and other advanced forms of in printed or electronic form must be obtained and is usually subject to royalty treatment is taken for granted. However, the picture is very different in developing agreements. Proposals for non-commercial reproductions and translations are countries. It is estimated that there is a shortage of around 5000 radiotherapy welcomed and considered on a case-by-case basis. Enquiries should be addressed machines in the developing world. In Africa and some countries in Southeast to the IAEA Publishing Section at: Asia, millions of people have no access to diagnostic services or treatment. Too many die of conditions that are treatable. This is an immense human tragedy. Marketing and Sales Unit, Publishing Section Consequently, the IAEA’s work in cancer control and radiation medicine will International Atomic Energy Agency always be a high priority for me as Director General. Vienna International Centre Thanks to early detection and modern treatment methods, millions of men PO Box 100 and women in developed countries now live normal lives for decades after a 1400 Vienna, Austria cancer diagnosis. The IAEA works to help developing countries in their fight fax: +43 1 2600 29302 against cancer. Through our technical cooperation programme, we support over tel.: +43 1 2600 22417 130 projects in cancer diagnosis, management and treatment. We provide Member email: [email protected] States with technical support in radiation medicine in general, and radiotherapy http://www.iaea.org/books in particular. We help countries to establish oncology and radiotherapy centres. We provide extensive training for medical and technical staff. The IAEA has delivered cancer related assistance totalling over US $260 million to developing countries over the past three decades. But the need is great and we cannot transform cancer care on our own. Only through partnerships with international organizations, universities, cancer centres, financial institutions and non-governmental organizations can the strengthening of radiotherapy services be addressed effectively throughout the world. The World Health Organization is a particularly important partner in this area. This publication, Radiotherapy in Cancer Care: Facing the Global Challenge, presents an overview of the major issues to be taken into account by countries planning and implementing radiotherapy services. It has been written with the health care manager in mind. The book contains data on the current status of radiotherapy services around the world, established and novel technologies, social and economic factors, current issues and the role of international organizations. Frequently asked questions, such as whether developing countries should consider introducing proton therapy, are addressed. Readers will obtain an overview of the current state of the art in radiotherapy from recognized experts in each area. I hope this publication will make a valuable contribution to improving the lives of cancer patients in developing countries. EDITORIAL NOTE Although great care has been taken to maintain the accuracy of information contained in this publication, neither the IAEA nor its Member States assume any responsibility for consequences which may arise from its use. The designations employed and the presentation of material in this document do not imply the expression of any opinion whatsoever on the part of the Secretariat concerning the legal status of any country or territory or of its authorities, or concerning the delimitation of its frontiers. This publication does not address questions of responsibility, legal or otherwise, for acts or omissions on the part of any person. Guidance provided here, describing good practices, represents expert opinion but does not constitute recommendations made on the basis of a consensus of Member States. The mention of names of specific companies or products (whether or not indicated as registered) does not imply any intention to infringe proprietary rights, nor should it be construed as an
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