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PurposeThe 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.Materials and MethodsCancer incidences for 27 cancer types in 184 countries were extracted from the International Agency for Research on Cancer GLOBOCAN database. The Collaboration for Cancer Outcomes Research and Evaluation radiotherapy utilization rate (RTU) model was used to estimate the number of patients in each country with an indication for radiotherapy for each cancer type and estimate the demand for MVMs. The radiotherapy supply data were accessed from Directory of Radiotherapy Centres database maintained by the International Atomic Energy Agency.ResultsRTU varied by country, from 32% in Mongolia to 59% in Comoros. The average optimal world RTU was 50%, equating to 7 million people in 2012 who would benefit from radiotherapy. There remains a deficit of more than 7,000 machines worldwide. During the past decade, the gap between radiotherapy demand and supply has widened in low-income countries.ConclusionRTU varies significantly between countries. Approximately half of all patients with cancer worldwide should receive radiotherapy; however, more than 2 million people are unable to access it because of a lack of MVMs. Low- and middle-income countries are particularly disadvantaged by this deficit.

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Vulvar squamous cell carcinomas (VSCC) represent the most common carcinoma of the female external genitalia, with increasing incidence. Although high-risk human papillomavirus (HPV) infection has long been implicated in the majority of cervical and anal squamous cell carcinomas, there is uncertainty about its prevalence and prognostic impact in VSCC. In this study, we conducted a retrospective integrated morphologic and multimodal HPV analysis of a cohort of 114 VSCC cases treated at the Princess Margaret Cancer Centre/University Health Network, Toronto, Canada between 2000 and 2010. VSCC histology was reviewed. We analyzed the cohort for HPV using polymerase chain reaction based method, and tissue microarray DNA and RNA in situ hybridization (ISH), and p16 immunohistochemistry. Among the 114 cases (age 70±16 yr), 36.7% of cases were classified as having histomorphology of HPV infection. HPV was detected in 31.9% (polymerase chain reaction), 14.0% (DNA ISH), and 27.3% (RNA ISH) of cases. p16 immunohistochemistry was positive in 37.8% of cases. On univariate analysis, HPV morphology (P=0.009), p16+ (P=0.00013), DNA ISH+ (P=0.021), and RNA ISH+ (P=0.00061) were associated with better 5-yr progression-free survival. DNA ISH+ (P=0.049) was associated with better 5-yr overall survival. On multivariate analysis, HPV morphology (P=0.033), p16+ (P=0.01), and RNA ISH+ (P=0.035) were associated with better 5-yr progression-free survival. In conclusion, a subset of VSCC is associated with HPV, which correlates with better outcome. Relatively inexpensive tests such as histomorphologic evaluation, p16 immunohistochemistry, and HPV RNA ISH can be used to predict outcome in VSCC. Therefore, routine reporting of HPV status in VSCC is recommended.

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SBRT in patients with prior pneumonectomy poses challenges because of limited lung reserve. However, local control and long-term survival can be achieved using SBRT in this inoperable population. Careful consideration must be given to radiation planning to minimize the risk of radiation pneumonitis.