Barriers to the use of brachytherapy for treatment of cervical cancer and prostate cancer in low- and middle-income countries

INTRODUCTION: Rising cancer incidence disproportionately affects low- and middle-income countries (LMICs). Brachytherapy (BT), a form of radiotherapy (RT), is an important modality in the treatment of cervical cancer and prostate cancer. Given its unique resource requirements, barriers to the use of BT are present, especially in LMIC settings. AREAS COVERED: This nonsystematic review aims to describe the role of BT in the treatment of cervical and prostate cancer, discuss barriers in the implementation and use of BT in LMIC settings, share suggested solutions, and highlight cases from global settings. Barriers are discussed in categories including infrastructure, financial, geographic, and human resources and training. Cases presented highlight barriers and facilitators to implementing BT. EXPERT OPINION: With BT a required component of treatment for locally advanced cervical cancer, and an important treatment modality in prostate cancer, understanding the barriers present to BT and the impact on real-world outcomes, is crucial. A critical part of ongoing research will be the continued study of resource-stratified guidelines for brachytherapy and particularly image guidance. The cases presented here may serve as models for other settings, with the goal of increasing access to this essential treatment modality for patients around the globe.