Global Assessment of Megavoltage External Beam Radiotherapy Facilities: Current Status and Projections for 2030–2050

Abstract Purpose This study evaluates the worldwide distribution of radiotherapy (RT) facilities, focusing on current accessibility and projected needs at multiple future time points (2025, 2030, 2035, 2040, 2045, and 2050). Methods and Materials Data were obtained from the World Bank, GLOBOCAN, and the International Atomic Energy Agency Directory of Radiotherapy Centres (IAEA-DIRAC). A comprehensive projection model was developed that incorporates: (1) sensitivity analysis of machine throughput (patients per machine per year), (2) reirradiation rates stratified by country income level, (3) both country-specific and cancer-specific radiotherapy utilization rates (RURs), and (4) adjustments for the contribution of brachytherapy facilities. Results Globally, there were 18.7 million new cancer patients in 2022, of whom an estimated 11.2 million required RT. Of 215 countries and territories listed by the World Bank, 35 reported no data or zero radiotherapy facilities in DIRAC, corresponding to a need for 362 MV RT machines by 2045. For the 146 countries with available data, 16,941 MV RT machines were reported, yielding a global patient coverage of 68% and a deficit of 7,944 machines in 2022. Only 5.8% of the operating equipment is younger than five years. Projections indicate that by 2045, 16.7 million patients will require RT, necessitating 20,255 MV additional therapy units. Conclusions This study underscores the persistent challenges in achieving equitable RT accessibility globally. The identified gaps extend beyond economic classifications, emphasizing the necessity for targeted interventions and strategic resource allocation to address the growing demand for radiotherapy and ensure comprehensive cancer care worldwide.