Impact of Russian invasion on radiation therapy capacity in Ukraine: a national survey study

INTRODUCTION: This study evaluated the operational status of Ukrainian radiotherapy (RT) centres to characterise wartime capacity following the Russian invasion and to identify priorities for improving RT delivery and resilience. METHODS: This cross-sectional study integrated two data sources: (1) a 38-item survey conducted by Help Ukraine Group (HUG) in August 2025 across all Ukrainian RT departments, assessing patient volumes, waiting times, equipment status, cobalt-60 (Co-60) source replacement, staffing, training needs and operational challenges; and (2) International Atomic Energy Agency DIRAC datasets collected by the Grigoriev Institute (2021-2025), tracking equipment, staffing and patient volumes. Descriptive and comparative analyses were performed. RESULTS: In December 2021, before the full-scale invasion, Ukraine operated 41 RT departments with 82 megavoltage (MV) machines (38 linear accelerators, 44 Co-60 units), 53 orthovoltage units and 36 brachytherapy afterloaders. During the first 3 months of war, four centres were occupied, most departments experienced service disruptions averaging 26 days and patient volume declined by 27.5%. Volumes recovered to baseline in 2023 and increased by 8.9% in 2024 and 9.3% in 2025 relative to 2021.In December 2025, Ukraine operated 42 RT departments with 96 MV machines (68 linear accelerators, 28 Co-60 units), 38 orthovoltage units and 34 afterloaders. However, 56% of departments still relied on Co-60 and 94.1% reported future source replacement would be unfeasible because sources were historically procured from Russia. Consequently, 78.6% of Co-60 users planned the transition to linear accelerators. Workforce shortages remain critical, with reported deficits of 41.4% for medical physicists, 33.6% for RTTs and 21.1% for radiation oncologists. Average waiting times increased from 6.4 days in 2021 to 10.3 days in 2025. CONCLUSION: Despite ongoing war, Ukraine is actively modernising RT services, with a rapid transition from Co-60 to linear accelerators. Workforce development and targeted training are now urgently needed to convert equipment investment into sustainable clinical capacity.