Effect of war on radiotherapy in Ukraine and how to help.
Authors: Kovalchuk Nataliya , Zelinskyi Ruslan , Suchowerska Natalka , Lozko Yuliia , Brovchuk Serhii , Shepil Zoia , Melnitchouk Nelya , Iakovenko Viktor , Beznosenko Andriy 
Published: June 2024

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Background: The full-scale Russian invasion of Ukraine on February 24th, 2022 brought the largest humanitarian disaster to the heart of Europe since the World War II. In this work, we describe the impact of the full-scale Russian invasion on the radiation therapy (RT) services in Ukraine and suggest how to help. Methods: We collected the information on operation of RT centers in Ukraine during the war. In addition, in 2023 an annual survey was conducted by Grigoriev Institute for Medical Radiology in Kharkiv for the IAEA DIRAC database. The survey was sent to 41 RT centers in Ukraine requesting information on equipment, staffing, and patient volume. Due to the war conditions the data provided in the survey is limited to the un-occupied territories. Results: After the initial Russian invasion of Ukraine in 2014 and occupation of Crimea and parts of Donbas, Ukraine lost access to 7 RT centers with 18 external beam radiotherapy (EBRT) machines (17% of total). Just before the full-scale invasion in 2022, there were a total of 44 Co-60 machines (57%) and 33 linear accelerators (43%) in the unoccupied territories. As a result of the full-scale invasion of Ukraine in 2022, almost all RT centers suspended operation in the first weeks of war. The most challenging period for RT in Ukraine was in March when Kyiv (where 20 EBRT machines are located) was partially surrounded by the occupiers. Based on the DIRAC survey, compared to 2021 data, in 2022 the number of radiation oncologists decreased on average by 2.9%, medical physicists by 6.7%, and therapists by 6.5% but there was a large variation in staffing levels depending on the region and its proximity to war. The workload in the RT centers close to the combat zone almost halved, while increasing by 10 - 60% in the western and central Ukraine. The total number of patients treated with EBRT decreased by 11% and brachytherapy by 21%. Brachytherapy services sustained the most interruption (47% decrease in LDR and 18% decrease in HDR patient volume) due to inability to perform source exchanges. Overall, approximately 5,500 less patients were treated in 2022 compared to 2021. Despite the ongoing war, Ukrainian cancer centers installed 8 new linear accelerators, with 5 linear accelerators pending installation. In addition, the Ministry of Heath of Ukraine has recently purchased 15 linear accelerators to replace the aging Co-60 machine fleet as the future source exchanges might not be possible. There is an acute need in helping Ukraine transition from Co-60 to modern IMRT/VMAT linear accelerators. Conclusions: Radiotherapy in Ukraine sustained significant damages since the 2014 Russian invasion, which was exacerbated further by the full-scale invasion in 2022. To support the vitality and absorptive capacity of RT services in Ukraine, the democratic world can help by donating equipment, hardware, software, and participating in training of Ukrainian RT professionals as they transition to modern and high-quality RT care for Ukrainian cancer patients.