A new study published in The Lancet Oncology calls for significant investment in radiotherapy infrastructure to address a critical global shortage of linear accelerators (LINACs) for cancer treatment.

The research, a collaboration between King’s College London and Queen’s University Canada, estimates that more than 16,000 new LINACs will be needed by 2045 to meet growing demand, with the most severe shortages affecting low- and middle-income countries. The study estimates that $123.9 billion will be required to install new LINACs and replace aging machines worldwide.

Radiotherapy plays a role in treating more than half of all cancer patients, yet the study identifies a 30% global shortage of LINACs. Researchers analyzed data from 181 countries, revealing stark disparities in availability and distribution.

To assess and prioritize need, the study utilized the Linear Accelerator Shortage Index (LSI), a tool that categorizes countries into shortage grades ranging from 0 (no shortage) to 4 (no LINACs available). The findings indicate that countries ranked in grades 3 and 4 will require substantial investment, with the most underserved regions needing urgent funding to establish even basic radiotherapy services.

“The radiotherapy community is aware of the global challenges; however, sustainable economic solutions remain a significant hurdle,” said professor Richard Sullivan, one of the study’s authors. "There has been a focus on new technology rather than on national rollouts, resulting in delays, cost overruns, and staff shortages. We need to shift the focus toward practical implementation to better support both local and international health planning."

While addressing LINAC shortages is a priority, researchers stress that future planning must also account for emerging technologies like stereotactic radiotherapy, which can enhance treatment precision and efficiency.

“Deciding what radiotherapy treatments to adopt in a health system is a complex consideration given the capital costs and human resource requirements,” said professor Ajay Aggarwal. "We are co-leading with partners at the European Society of Radiation Oncology (ESTRO) a value-based radiation oncology program to develop a policy toolkit to support health ministries in deciding which technologies to invest in, such that they deliver the greatest benefits at an individual patient and health system level."

The study’s findings provide policymakers and healthcare providers with a framework to strategically allocate resources, ensuring that investment in radiotherapy infrastructure effectively addresses disparities and improves cancer treatment access worldwide.