Radiotherapy infrastructure for brain metastasis treatment in Africa: practical guildelines for implementation of a stereotactic radiosurgery (SRS) program

Purpose: Radiosurgery with the Gamma Knife is the golden standard for the treatment of brain metastasis cases but its accessibility however in many countries is limited. Modern radiotherapy has made this treatment possible using other equipment such as linear accelerator and Cyberknife. The objective of this study was to explore the distribution of available radiotherapy equipment for brain metastasis treatment in Africa and provide practical guidelines to the establishment of a Stereotactic Radiosurgery (SRS) Program. Materials and methods: The International Atomic Energy Agency (IAEA)’s Division of Human Health’s Directory for Radiotherapy Centres (DIRAC), served as the primary source for the distribution of radiotherapy equipment throughout Africa and worldwide. Data on megavoltage radiotherapy equipment for the 54 African countries were extracted from this database. Cancer incidence and brain metastasis assumption were made using data from the GLOBOCAN 2020 database and country’s income was assessed using the Gross Domestic Product (GDP) per capita on the world economics database. Further literature search was also carried out in PubMed on the price and availability of dedicated equipment for brain metastasis management in Africa. All these searches were done in April, 2023. Results: There was increase in the number of brain metastasis cases. There were only two Gamma Knife machines in Africa. Three Cyberknife; two in Egypt and one in Kenya and 432 other megavoltage units (66 Cobalt-60s, 366 Linacs) distributed across the continent. The cost of a Gamma Knife machine could be up to 7 million United States Dollars (USD) compared to that of Linac between 2.4 and 2.8 million USD and Cyberknife between 3 and 5 million USD. A country’s (GDP) per capita was a vital determinant of the number of these machines in countries which did not have any machines to ones which have at least one machine. Conclusion: Access to radiosurgery treatment for brain metastasis with the Gamma Knife or Cyberknife is limited due to the low number of these equipment. With the increase in radiotherapy expansion with linear accelerators, it is likely that the continent will be able to increase its stereotactic radiosurgery treatment centers by implementing Linac-based SRS following suitable guidelines. This will help provide comprehensive care to patients and promote quality of life.