Eduardo Zubizarreta

International Atomic Energy Agency (IAEA) | IAEA · Applied Radiation Biology and Radiotherapy Section

PURPOSE Hypofractionated breast radiotherapy has been found to be equivalent to conventional fractionation in many clinical trials. Using data from the European Society for Radiotherapy and Oncology Global Impact of Radiotherapy in Oncology survey, we identified preferences for hypofractionation in breast cancer across World Bank income groups and...

Background In 2015, the Global Task Force on Radiotherapy for Cancer Control (GTFRCC) called for 80% of National Cancer Control Plans (NCCP) to include radiotherapy by 2020. As part of the ongoing ESTRO Global Impact of Radiotherapy in Oncology (GIRO) project, we assessed whether inclusion of radiotherapy in NCCPs correlates with radiotherapy machi...

Importance Radiotherapy is critical for comprehensive cancer care, but there are large gaps in access. Within Ghana, data on radiotherapy availability and on the relationship between distance and access are unknown. Objectives To estimate the gaps in radiotherapy machine availability in Ghana and to describe the association between distance and ac...

Background & purpose: To report disease-free survival (DFS) for volume-based and point-A based brachytherapy (BT) in locally advanced cervical cancer. Materials & methods: We conducted a meta-analysis of studies assessing the effects of point-A and volume-based brachytherapy on 3-year DFS. Studies including stage I-IVA cervical cancer patients w...

Purpose/Objective(s) Radiotherapy (RT) is a crucial component of comprehensive cancer care, but there are large global gaps in access. Within Ghana, a West African country with a population of 31 million, there are only 3 RT centers with 5 external-beam (EBRT) and 2 high-dose rate (HDR) brachytherapy (BT) machines located in 2 cities in the south....

The number of patients with cancer in Africa has been predicted to increase from 844 279 in 2012 to more than 1·5 million in 2030. However, many countries in Africa still lack access to radiotherapy as a part of comprehensive cancer care. The objective of this analysis is to present an updated overview of radiotherapy resources in Africa and to ana...

Recognizing the increase in cancer incidence globally and the need for effective cancer control interventions, several organizations, professional bodies, and international institutions have proposed strategies to improve treatment options and reduce mortality along with minimizing overall incidence. Despite these efforts, an estimated 9.6 million...

Aims We describe the absolute and per capita numbers of megavoltage radiotherapy machines (MVMs) in Western Africa from 1969 to 2019. Materials and methods Western Africa was defined in accordance with the United Nations' delineation and inclusive of 16 countries. A literature search for publications detailing the number of cobalt-60 machines (COs...

Background Hypofractionated post-prostatectomy radiotherapy is emerging practice, however with no randomized evidence so far to support it’s use. Additionally, patients with persistent PSA after prostatectomy may have aggressive disease and respond less well on standard salvage treatment. Herein we report outcomes for conventionally fractionated (C...

In partnership with the Regional Co-operative Agreement for Research, Development and Training Related to Nuclear Science and Technology (RCA), the IAEA has been supporting Member States in the Asia and Pacific region to prepare, initiate and expand radiotherapy services safely and effectively. Education and training are essential components in IAE...

Introduction Predicting the risk of early distant brain failure (DBF) is in demand for management decisions in patients who are candidates to local treatment of brain metastases. This study aims to analyze the association between circulating tumor cells (CTC) and brain disease control after stereotactic radiotherapy/radiosurgery (SRT) for breast ca...

Background and purpose Multiple large trials have established the non-inferiority of hypofractionated radiotherapy compared to conventional fractionation. This study will determine real-world hypofractionation adoption across different geographic regions for breast, prostate, cervical cancer, and bone metastases, and identify barriers and facilitat...

A search for effective methods for the assessment of patients' individual response to radiation is one of the important tasks of clinical radiobiology. This review summarizes available data on the use of ex vivo cytogenetic markers, typically used for biodosimetry, for the prediction of individual clinical radiosensitivity (normal tissue toxicity,...

Aims Childhood cancer survival is suboptimal in most low- and middle-income countries (LMICs). Radiotherapy plays a significant role in the standard care of many patients. To assess the current status of paediatric radiotherapy, the International Atomic Energy Agency (IAEA) undertook a global survey and a review of practice in eight leading treatme...

Purpose: Brachytherapy (BT) is an essential component of definitive therapy for locally advanced cervical cancer. Despite the advantages of the dose distribution with BT in cervical cancer, there is paucity of specific skills required for good-quality BT applications. Furthermore, replacing BT with other modern external beam techniques as a boost...

This manuscript represents a collaboration from an international group of quality and safety expert radiation oncologists. It is a position/review paper with the specific aim of defining the role of the radiation oncologist in quality and safety management. This manuscript is unique in that we recommend specific quality assurance/control tasks and...

Topical Overview and Conclusions of an International Conference

Background and purpose The Global Quality Assurance of Radiation Therapy Clinical Trials Harmonization Group (GHG) is a collaborative group of Radiation Therapy Quality Assurance (RTQA) Groups harmonizing and improving RTQA for multi-institutional clinical trials. The objective of the GHG OAR Working Group was to unify OAR contouring guidance acros...

Background: A high cancer burden exists among indigenous populations worldwide. Canada and Greenland have similar geographic features that make health service delivery challenging. We sought to describe geographic access to radiotherapy for indigenous populations in both regions. Methods: We used geospatial analyses to calculate distance and tra...

Background and purpose: Canada is a high-income country with universal healthcare. In international comparisons, its overall level of access to radiotherapy appears sufficient. However, challenges exist due to Canada's large geographic area and small population density. The association between access and cancer outcomes nationally has not yet been...

Background: The section promotes and coordinates research in clinical radiation oncology and applied radiation biology. Aim: to solve a well-defined problem by creating a critical mass of expertise in the area of radiotherapy and applied radiation biology, which would have a tangible outcome at the international level. Methods: Coordinated research...

Appl Rad Oncol. 2019;8(2):34-40

Despite the advances in the primary prevention of cervical cancer, there is an absolute increase in the incidence of cervical cancer as a result of an increase in world population. A vast majority of patients in low and low–middle income countries continue to present at a locally advanced stage, necessitating treatment with chemoradiation and brach...

Background: Radiotherapy is standard of care for cervical cancer, but major global gaps in access exist, particularly in low-income and middle-income countries. We modelled the health and economic benefits of a 20-year radiotherapy scale-up to estimate the long-term demand for treatment in the context of human papillomavirus (HPV) vaccination. Me...

Background The annual global incidence of cancer is projected to rise in 2035 to 25 million cases (13 million deaths) with 70% occurring in low- and middle-income countries (LMICs) where there is a severe shortfall in the availability of radiotherapy (RT) - an essential component of overall curative and palliative cancer care. A 2015 report by the...

Radiation oncology is one of the three main therapeutic disciplines of clinical oncology, along with medical and surgical oncology. There are gaps in radiotherapy access worldwide—to equipment and human resources. This chapter discusses novel solutions to address these gaps with the intent of reducing the global burden of cancer.

Background The evolution of radiotherapy over recent decades has reintroduced the hypofractionation for many tumor sites with similar outcomes to those of conventional fractionated radiotherapy. The use of hypofractionation in locally advanced head and neck cancer (LAHNC) has been already used, however, its use has been restricted to only a few cou...

Background and context: In 2012, 560,000 women were diagnosed with cervical cancer (CXCA) worldwide and 266,000 women died of the disease: 86% of cases and 88% of deaths occurred in low- and middle-income countries (LMICs), and two thirds of the cases are locally advanced. For locally advanced CXCA the evidence-based treatment is a combination of e...

Background and context: Fifty-three countries are members of the Commonwealth. These countries span Africa, Asia, the Americas, Europe and the Pacific and are diverse - they are among the world's largest, smallest, richest and poorest countries. Thirty-one of these members are classified as small states - countries with a population size of 1.5 mil...

Aim and purpose: The session aims at outlining actions that the healthcare community can take to improve the current situation and inform cervix cancer control plans. Highlighting the need to address opportunities in the prevention and management of cervix cancer, the session will provide guidance on primary, secondary and tertiary prevention and m...

Background The recent activity of the International Atomic Energy Agency (IAEA) in Biological Dosimetry inspired the search for new potential applications of biological markers beyond their use in radiological emergencies. A new IAEA Coordinated Research Project (CRP) "Applications of biological dosimetry methods in radiation oncology (RT), nuclear...

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Background: The planning of national radiotherapy (RT) services requires a thorough knowledge of the country's cancer epidemiology profile, the radiotherapy utilization (RTU) rates and a future projection of these data. Previous studies have established RTU rates in high-income countries. Methods: Optimal RTU (oRTU) rates were determined for nin...

Background: The quality of radiotherapy services in post-Soviet countries has not yet been studied following a formal methodology. The IAEA conducted a survey using two sets of validated radiation oncology quality indicators (ROIs). Methods: Eleven post-Soviet countries were assessed. A coordinator was designated for each country and acted as th...

Purpose or Objective: One of the challenges in modern radiotherapy (RT) is variability in contouring of target volumes (TVs) and organs at risk (OARs). Interactive online teaching has shown immediate improvement of homogeneity of delineation but the long-term effect is unknown. The aim of the present multicenter study was to evaluate the short- and...

Dose-response Relationships in the Context of Standards for Radiation Protection

Ion Beam Therapy (IBT) was always in the focus of work of the International Atomic Energy Agency (IAEA). Several reports were published by IAEA and the International Commission on Radiation Units and measurements (ICRU) during the last decade.

Background and purpose: The IAEA has developed a methodology for comprehensive quality audits of radiotherapy practices called Quality Assurance Team for Radiation Oncology (QUATRO). This study explores the factors that impacted quality of care among QUATRO audited centres in the IAEA Europe Region. Materials and methods: The 31 QUATRO reports c...

During the past six decades, the International Atomic Energy Agency (IAEA) has helped to address the growing cancer burden, by delivering substantial cancer-related assistance to low-income and middle-income member states. IAEA assistance has primarily been facilitated through sustainable radiotherapy and nuclear medicine programmes to establish sa...

Aim To examine the availability of radiotherapy in small countries. Methods A small country was defined as a country with a population less than one million persons. The economic status of each country was defined using the World Bank Classification. The number of cancers in each country was obtained from GLOBOCAN 2012. The number of cancer cases...

Background: With increasing recognition of growing cancer incidence globally, efficient means of expanding radiotherapy capacity is imperative, and understanding the factors impacting human and financial needs is valuable. Materials and methods: A time-driven activity-based costing analysis was performed, using a base case of 2-machine departmen...

Although not a new concept in itself, competency-based education has set the trend for the globally accepted standard norm for education and training of medical professionals including postgraduate education in radiation oncology. Societal needs demand from radiation oncologists that they be not only competent in the knowledge and skills relevant...

Recent years have seen various reviews on the lack of access to radiotherapy often based on geographic regions of the world such as Africa, Asia Pacific, Europe, Latin America and North America. Countries are often defined by their national income per capita levels based on World Bank definitions of high income, upper middle income, lower middle in...

Background: Radiotherapy technology continues to advance and the expectation of improved outcomes requires greater accuracy in various radiotherapy steps. Different factors affect the overall accuracy of dose delivery. Institutional comprehensive quality assurance (QA) programs should ensure that uncertainties are maintained at acceptable levels....

The International Atomic Energy Agency (IAEA) has been involved in radiation therapy since soon after its creation in 1957. In response to the demands of Member States, the IAEA′s activities relating to radiation therapy have focused on supporting low and middle income countries to set up radiation therapy facilities, expand the scope of treatments...

Tissue engineering is revolutionising medicine by shifting the focus from addressing symptoms to repair and regeneration. Regenerative medicine is an emerging field that seeks to combine the knowledge and expertise of diverse disciplines towards the aim of restoring impaired organ functions in the body. These developments will have a significant im...

EP-1944: Lessons from the findings of 31 QUATRO audits in Europe

Purpose The global incidence of cancer is rising, particularly in low- and middle-income countries. Radiotherapy is an important cancer treatment in the curative and palliative setting. We aimed to estimate the global demand for and supply of radiotherapy megavoltage machines (MVMs) and assess the changes in supply and demand during the past decade...

In Latin America radiotherapy quality varies significantly among hospitals, where highly equipped academic centers coexist with others not meeting minimal requirements. In 2007, the International Atomic Energy Agency published guidelines for auditing radiotherapy centers, known as the "Quality Assurance Team for Radiation Oncology" (QUATRO) audits....

Radiotherapy is a critical and inseparable component of comprehensive cancer treatment and care. For many of the most common cancers in low-income and middle-income countries, radiotherapy is essential for effective treatment. In high-income countries, radiotherapy is used in more than half of all cases of cancer to cure localised disease, palliate...