Questionnaire-based Survey on Radiation Treatment Planning using Multimodality Facilities in Radiotherapy Centres across India: A Cross-sectional Study

Introduction: India is a low-middle-income country, and there is an increase in the burden of cancer under Non Communicable Diseases (NCD) in past decades. Around 60% of cancer patients require Radiotherapy (RT), either definitive or palliative in conjunction with other modalities. Considering the present requirements in the field of RT, data has been presented about centres providing both basic and advanced RT facilities.

Aim: To give an overview of current facilities available and to identify the multimodality-based planning in RT centres across India.

Materials and Methods: A cross-sectional questionnaire-based survey was conducted in centres having RT facilities in India, from March 2021 to April 2022. A systemic list of the current existing RT centres was taken from the Atomic Energy Regulatory Board (AERB) website. From the database list, 100 participants were selected randomly, with their contact information such as E-mail and WhatsApp. A Google survey form with a questionnaire was created for the study. The survey link forms were circulated across the RT centres in India.

Results: A total of 65 centres participated in the study. The percentage of responses found to be from North India 17 (26%), South India 24 (36.9%), West India 7 (10.8%), East India 9 (13.8%) and central India 7 (10.8%) with one centre (1.5%) not disclosed. The number of government, semi-private, private and not disclosed types of hospitals participated in the survey were 19 (29.2%), 5 (7.7%), 38 (58.5%) and 3 (4.6%), respectively. The average number of functional teletherapy machines, telecobalt and linear accelerators per centre was found to be 1.24±1.33, 0.34±0.54, and 1.11±1.06, respectively. The multimodality imaging facility for RT planning was found to be 36 (55.4%) MRI and 23 (35.4%) Positron Emission Tomography-Computed Tomography (PET-CT). The median cost of Intensity Modulated Radiotherapy (IMRT), Intensity Guided Radiotherapy (IGRT), 4-Dimensional IMRT (4-D IMRT), and 4-Dimensional IGRT (4-D IGRT) in Lakhs (L) was found to be 1.20 L (0.00-3.00), 1.50 L (0.00-3.30), 1.50 L (0.00-4.00), 1.50 L (0.00-4.00), respectively. For advance PET-CT based RT planning the median cost was found to be, for IMRT treatment 1.20 L (0.00-3.50) and for IGRT treatment 1.60 L (0.00-4.00).

Conclusion: There is a significant increase in radiation facilities in the recent millennium, especially in the private sector. The latest RT centres are equipped with multiple imaging modalities to accommodate the advanced RT planning features.