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Infrastructure and equipment for radiation oncology in the Spanish National Health System: analysis of external beam radiotherapy 2015–2020

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Abstract

Purpose

Planning for radiation oncology requires reliable estimates of both demand for radiotherapy and availability of technological resources. This study compares radiotherapy resources in the 17 regions of the decentralised Spanish National Health System (SNHS).

Materials and methods

The Sociedad Española de Oncología Radioterápica (SEOR) performed a cross-sectional survey of all Spanish radiation oncology services (ROS) in 2015. We collected data on SNHS radiotherapy units, recording the year of installation, specific features of linear accelerators (LINACs) and other treatment units, and radiotherapeutic techniques implemented by region. Any machine over 10 years old or lacking a multileaf collimator or portal imaging system was considered obsolete. We performed a k-means clustering analysis using the Hartigan–Wong method to test associations between the gross domestic regional product (GDRP), the number of LINACs per million population and the percentage of LINACs over 10 years old.

Results

The SNHS controls 72 (61%) of the 118 Spanish ROS and has 180 LINACs, or 72.5% of the total public and private resources. The mean rate of LINACs per million population is 3.9 for public ROS, and 42% (n = 75) of the public accelerators were obsolete in 2015: 61 due to age and 14 due to technological capability. There was considerable regional variation in terms of the number and technological capacity of radiotherapy units; correlation between GRDP and resource availability was moderate.

Conclusion

Despite improvements, new investments are still needed to replace obsolete units and increase access to modern radiotherapy. Regular analysis of ROS in each Spanish region is the only strategy for monitoring progress in radiotherapy capacity.

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Acknowledgements

We thank Josep M Borrás M.D. and Ramon Cleries Ph.D. (Universidad de Barcelona) for their valuable advice and assistance in writing the manuscript.

Dra. Mª José Ortiz del Hospital Universitario Virgen del Rocío (Sevilla). Dr. José Expósito del Hospital Universitario Virgen de las Nieves (Granada). Dra. Amalia Palacios del Hospital Universitario Reina Sofia (Córdoba). Dr. Ismael Herruzo del Hospital Regional Universitario Carlos Haya (Málaga). Dr. José Antonio Medina del Hospital Universitario Virgen de la Victoria (Málaga). Dr. Miguel Martinez del Complejo Hospitalario de Jaén (Jaén). Dra. Eloisa Bayo del Hospital Juan Ramón Jiménez (Huelva) y Hospital Virgen Macarena (Sevilla). Dr. Javier Jaén del Hospital Puerta del Mar (Cádiz). Dr. Francisco José Peracaula del Hospital Punta Europa (Cádiz). Dra. Carolina Pérez del Complejo Hospitalario Torrecárdenas (Almería). Dra. Mª Isabel Ramos de Clinica Infanta Luisa (Sevilla). Dr. José Antonio González del Instituto Oncológico Cartuja (Sevilla). Dra. Escarlata López de Oncosur (Granada). Dr. José Begara de Clínica Xanit Limonar (Málaga). Dra. Cristina Nuño de Clínica Xanit Benalmádena (Málaga). Dra. Ana Belén Bezares de Clinica Radón Algeciras (Cádiz). Dra. Ana Serradilla de Clínica Radón Jerez de la Frontera (Cádiz). Dr. Antonio Lazo de Oncosur San Juan de Dios (Córdoba). Dr. Martin Tejedor del Hospital Universitario Miguel Servet (Zaragoza). Dra. Lucía Méndez del IMOMA (Oviedo). Dr. Germán Juan de la Fundación Hospital de Jove (Asturias). Dr. Luis Olay del Hospital Universitario Central de Asturias. Dr. José Pardo del Hospital Universitario Son Espases (Palma de Mallorca). Dr. Francisco Mestre de Policlinica Miramar (Palma de Mallorca). Dr. Claudio Otón del Hospital Universitario de Canarias (Tenerife). Dr. Claudio Fuentes del Hospital Universitario Nuestra Sra de la Candelaria (Tenerife). Dr. Pedro Prada del Hospital Universitario Marqués de Valdecilla (Santander). Dr. Leopoldo Pérez de Clínica Mompía (Santander). Dra. Eva Lozano del Hospital General de Ciudad Real. Dra. Mª Victoria Villas del Complejo Hospitalario Universitario de Albacete. Dra. Juana Tripero del Grupo IMO (Guadalajara). Dra. Rosabel Lobo del Grupo IMO (Toledo). Dr. Manuel Muñoz del Grupo IMO Talavera (Toledo). Dr. José Luis Tisaire del Grupo IMO Alcázar (Ciudad Real). Dr. Jesús Fernández del IVO (Cuenca). Dra. Mercedes Teijeira del Hospital Universitario de Burgos. Dr. José Reyes Rodríguez del Complejo Asistencial de León. Dr. Luis Pérez del Hospital Clinico Universitario de Salamanca. Dr. Francisco López del Hospital Clínico Universitario de Valladolid. Dra. Amelia Ceballos del Complejo Asistencial de Zamora. Dra. Rocio Cantalapiedra del Hospital Campo Grande (Valladolid). Dr. Albert Biete del Hospital Clinic Universitario (Barcelona). Dr. Jordi Craven del Hospital de la Santa Creu i Sant Pau y Clinica Corachan (Barcelona). Dr. Agustí Pedro del Hospital PLATÓ (Barcelona). Dr. Jordi Giralt del Hospital Valle Hebrón (Barcelona). Dr. Ferrán Guedea del Hospital Durán i Reinals ICO (Barcelona). Dr. Salvador Villá del Hospital de Badalona (Barcelona). Dr. Josep M Solé del Hospital General de Cataluña (Barcelona). Dra. Arantxa Eraso del Hospital Universitario de Gerona. Dr. José Antonio Carceller del Hospital Universitario Arnau Vilanova (Lérida). Dra. Meritxell Arenas del Hospital Sant Joan de Reus (Tarragona). Dr. Benjamín Guix del IMOR (Barcelona). Dr. Ramón Miralbell del centro Médico Teknon (Barcelona). Dr. Joan Casals del Hospital Quirón (Barcelona). Dra. Julia Muñoz del Hospital Universitario Infanta Cristina (Badajoz). Dr. Pedro González del Hospital de Mérida (Badajoz). Dra. Mª Isabel Duarte del Hospital Virgen del Puerto (Cáceres). Dr. Juan Pablo Jerez de la Clínica San Miguel (Cáceres). Dr. Alfonso Mariño del Centro Oncológico de Galicia (La Coruña). Dr. Antonio Gómez del Hospital Universitario de Santiago de Compostela (La Coruña). Dr. Victor Muñoz del Hospital do Mexoeiro de Vigo (Pontevedra). Dra. Mª Dolores López del Complejo Hospitalario de Orense . Dr. Luis Zugazabeitia de POVISA, Vigo (Pontevedra). Dr. Gustavo Ossola del Hospital de San Pedro (Logroño). Dra. Ana Mañas del Hospital Universitario de la Paz (Madrid). Dra. Laura Cerezo del Hospital Universitario de la Princesa (Madrid). Dr. Alfredo Ramos del Hospital Universitario Ramón y Cajal (Madrid). Dr. José Pérez-Regadera del Hospital Universitario Doce de Octubre (Madrid). Dr. Miguel Angel Lozano del Hospital Universitario Gregorio Marañón (Madrid). Dr. Manuel de las Heras del Hospital Clinico San Carlos (Madrid). Dra. Ana Pérez de la Fundación Jiménez Diaz (Madrid). Dr. Alejandro de la Torre del Hospital Universitario Puerta de Hierro (Madrid). Dra. Pilar Samper del Hospital Rey Juan Carlos (Madrid). Dra. Blanca Ludeña del Hospital Universitario de Fuenlabrada (Madrid). Dr. Juan de Dios Sáez del Hospital Central de la Defensa Gómez Ulla (Madrid). Dr. Ignacio Azinovic del Grupo IMO. Dra. Carmen Rubio de CIOCC (Madrid). Dra. Elia del Cerro del Hospital de Quirón (Madrid). Dra. Rosa Meiriño del Hospital de la Luz (Madrid). Dr. Rodrigo García-Alejo del Hospital de la Beata (Madrid). Dra. Natalia Carballo del MD Anderson (Madrid). Dr. Ramón García del Hospital Universitario Virgen de la Arrixaca (Murcia). Dr. Juan Salinas del Hospital General Universitario de Cartagena (Murcia). Dra. Adriana Fondevilla del Instituto Oncológico del Sudeste (Murcia). Dr. Rafael Martinez de la Clinica Universitaria de Navarra. Dr. Enrique Martinez del Complejo Hospitalario de Navarra. Dr. Avelino Alia del Hospital de Txagorritxu (Alava). Dr. Juan Pablo Ciria del Hospital Universitario de Donostia (Guipúzcoa). Dr. Jesús Rosa del Instituto Oncológico de San Sebastián (Guipúzcoa). Dr. Pedro Bilbao del Hospital Universitario de Cruces (Bilbao). Dr. Juan Carlos Martin del Hospital Universitario de Basurto (Bilbao). Dr. Francisco Casquero del Hospital Quirón (Bilbao). Dr. Leo Arribas del Instituto Valenciano de Oncología (Comunidad Valenciana). Dr. Alejandro Tormo del Hospital Universitario de la Fe (Valencia). Dra. Amparo Algas del Hospital Clínico de Valencia. Dr. Luis Larrea de la Clinica Virgen del Consuelo (Valencia). Dr. Miguel Soler del Hospital Universitario de la Ribera (Valencia). Dr. Enrique Garcia del Hospital Universitario de Elche (Alicante). Dr. Pablo Soler del Hospital IMED Elche (Alicante). Dr. Manuel Santos del Hospital Clinica Benidorm (Alicante). Dr. Gabriel Vázquez del Hospital Universitario San Juan de Alicante. Dra. Rosa Mª Cañón del Hospital Quirón Torrevieja (Alicante). Dr. Antonio Miró del Instituto Oncológico de Alicante.

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Spanish Society of Oncology and Radiotherapy (SEOR) Analysis Group saying: Members of The Spanish Society of Oncology and Radiotherapy (SEOR) Analysis Group are listed in the Acknowledgements.

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Rodríguez, A., Algara, M., Monge, D. et al. Infrastructure and equipment for radiation oncology in the Spanish National Health System: analysis of external beam radiotherapy 2015–2020. Clin Transl Oncol 20, 402–410 (2018). https://doi.org/10.1007/s12094-017-1727-x

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