中低收入国家的质子治疗:从事实和现实到愿望、挑战和限制

S. Álvarez, F. L. Ruiz, F. M. Magos, A. M. García
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引用次数: 1

摘要

大约50%的癌症患者需要放射治疗(RT),其中10-15%的患者可以接受质子束放射治疗(PBT)。剂量学的优势是不可否认的,主要是在儿科和再照射的情况下。然而,PBT设施在世界范围内是稀缺的,国际原子能机构报告了116个功能粒子设施,其中98个是PBT,在低收入和中等收入国家(LMIC)几乎没有。拉丁美洲和加勒比地区为PBT中心提供了一个独特的机会,因为目前没有功能性设施,目前的RT需求很大。挑战可以概括为高初始投资和维护、地理覆盖、所需的基线技术和认证、过于乐观的工作量、不明确的费率和报销、未满足的业务计划和收入预期,以及缺乏训练有素的人力资源。PBT设施的投资成本估计约为1.4亿欧元;因此,这似乎不适合LMIC。墨西哥的地理优势、国内生产总值、基线技术和对RT的高需求使其成为理想的候选国。然而,到2020年,PBT中心将占墨西哥年度卫生支出的三分之一。私营部门和政府当局都必须作出巨大努力,提供资金。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Proton Therapy in Lower-Middle-Income Countries: From Facts and Reality to Desire, Challenges and Limitations
Around 50% of cancer patients will require radiotherapy (RT) and 10–15% of these patients could be eligible for proton beam radiotherapy (PBT). Dosimetric advantages are undeniable, mainly in pediatric and reirradiation scenarios. Though, PBT facilities are scarce worldwide and the IAEA has reported 116 functional particle facilities, of which 98 are PBT, virtually absent in low- and middle-income countries (LMIC). The Latin America and Caribbean region represent a unique opportunity for a PBT center, as there are currently no functional facilities and current RT needs are significant. The challenges can be summarized as high initial investment and maintenance, geographic coverage, required baseline technology and certification, over-optimistic workload, unclear rates and reimbursement, unmet business plan and revenue expectations, and lack of trained human resources. Investment costs for a PBT facility are estimated to be at around 140 million euros; therefore, this seems unsuitable for LMIC. Mexico’s geographical advantage, GDP, baseline technologies and high demand for RT makes it an ideal candidate. Nevertheless, a PBT center would account for a third of Mexico’s annual health expenditure for 2020. Enormous efforts must be made by both the private sector and governmental authorities to provide funding.
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