Dual benefits of new radiotherapy units: Improved access and reduced emissions.

Abstract

Radiotherapy accessibility varies significantly within countries. Radiotherapy has a significant carbon footprint, primarily driven by patient transportation emissions in Europe. This study aimed to determine if strategically located new Radiotherapy Units (RUs) and Linear Accelerator (LINAC) reallocation could simultaneously improve accessibility and reduce the carbon footprint of External Beam Radiotherapy (EBRT) in France. A national-scale Location-Allocation (LA) model, incorporating accessibility efficiency and equity, resource density, and greenhouse gas emissions, was used. Sensitivity analysis was used to assess the robustness of the results. We identified 27 potential locations for new RUs across 13 geographically independent clusters. Increase in emissions for the creation and maintenance is compensated with a mean carbon Return on Investment (ROI) of 4.6 years. Implementing the optimal RU within each cluster and reallocating LINACs would save an estimated 26,050 tons of CO2eq over a 10-year period, corresponding to ≈326 years in good health (DALYs) saved in the future. Public transport accessibility to an RU within 45 min would be gained for 405,487 individuals (0.6 %), and driving duration would improve for 3,301,705 (4.8 %). An additional 912 patients annually who currently do not receive radiotherapy due to excessive travel times (decay effect) would be treated. Strategically located new Radiotherapy Units and LINAC reallocation can improve both accessibility and reduce the carbon footprint of EBRT. However, this latter benefit is limited and other more effective mitigation strategies should be considered concurrently.