Bridging Access Gaps in Radiotherapy: Knowledge-Based Planning in a Resource-Constrained Clinical Setting

Area of Science:

• Radiation Oncology
• Medical Physics
• Health Equity

Background:

• Access to radiotherapy in low- and middle-income countries (LMICs) is limited by personnel shortages and high patient volumes.
• Knowledge-based planning (KBP) shows promise in high-income settings but its feasibility in resource-limited environments is underexplored.

Purpose of the Study:

• To evaluate the feasibility of adapting a KBP model from a high-income institution for gynecological radiotherapy planning in an LMIC.
• To assess the clinical quality and efficiency of KBP-generated plans compared to manual plans at Liga Nacional Contra el Cáncer (LNCC) in Guatemala.

Main Methods:

• A Varian RapidPlan KBP model was adapted using data from high-income and Guatemalan gynecological cases.
• Cases were stratified by planning target volume (PTV) geometry.
• KBP plans were compared against manual plans from junior and senior dosimetrists using a dosimetric scorecard, assessing PTV coverage, organ at risk (OAR) sparing, and planning time.

Main Results:

• KBP-generated and manual plans showed comparable overall quality, target coverage, and OAR sparing.
• KBP significantly reduced plan creation time, leading to higher plan quality efficiency scores.
• All plans achieved high gamma passing rates (mean 99.6%), with KBP showing improved rectal dose metrics.

Conclusions:

• Knowledge-based planning is feasible for adaptation in LMICs, maintaining clinical quality.
• KBP substantially reduces radiotherapy planning time, enhancing throughput and access to care.
• This approach supports equitable access to high-quality radiotherapy in resource-constrained settings despite contouring variability.