Evaluating the readiness for ultra-hypofractionated prostate and breast radiotherapy in sub-Saharan Africa: a strategic needs-assessment of six leading African institutions

Sub-Saharan Africa (sSA) continues to face a critical shortage in radiotherapy resources, exacerbating the region’s growing cancer burden. One potential strategy that can partially offset this problem is the increased adoption and broader implementation of ultra-hypofractionated radiotherapy (UHFRT), whereby a smaller number of treatment sessions are required since each session administers higher doses of radiation (to an equivalent biological dose) compared to conventional fractionation. UHFRT techniques have been widely adopted in Europe and North America, particularly for prostate and breast treatments, but differences in the available technology and demographics and biology in sSA necessitate rigorous evaluation of the existing infrastructure and clinical workflows before its widespread implementation in these settings. This study makes a first attempt to interrogate the readiness of six leading sSA institutions for the transition toward UHFRT treatment regimens. The survey was structured into five sections which assessed (1) general clinical capacity and infrastructure, (2) the clinical breast cancer treatment program, (3) the clinical prostate cancer treatment program, (4) medical physics support and quality management and (5) research capacity. The survey responses revealed a strong willingness among African clinicians to adopt UHFRT treatment regimens and generally sufficient supporting infrastructure (i.e., equipment, staffing, quality assurance programs and research support) already in place. However, some technical gaps were identified such as the lack of employment of breath-hold techniques in treating breast cancer and nonutilisation of fiducial markers and perirectal spacers in treating prostate cancer. All six responding institutions expressed enthusiasm to participate in a training course aimed at addressing these technical gaps. These findings underscore the potential for the successful implementation of breast and prostate cancer UHFRT in sSA, provided that targeted training and technical support are delivered. Addressing the identified gaps will be critical in ensuring the safe and effective adoption of this advanced treatment technique across the region.