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Global Disparities in Pediatric Radiotherapy Infrastructure and Access: A Scoping Review With a Focused Analysis of
Amal Ben Lachger1, Redouane El Baydaoui1
1Hassan First University of Settat, High Institute of Health Sciences, Laboratory of Sciences and Engineering of Biomedicals, Biophysics and Health, Settat, Morocco.
Insights
Global pediatric radiotherapy (RT) infrastructure is unevenly distributed, with advanced technologies concentrated in high-income countries. This limits access and timely treatment for childhood cancer patients in low- and middle-income countries.
Area of Science:
- Oncology
- Radiation Oncology
- Global Health
Background:
- Radiotherapy (RT) is vital for childhood cancer care but faces global disparities in availability and technology.
- Limited comprehensive analyses exist on pediatric RT infrastructure across diverse economic settings.
Purpose of the Study:
- To characterize the global landscape of pediatric RT infrastructure and technologies.
- To identify operational challenges in pediatric RT delivery.
- To use Morocco as a case study for a low- and middle-income country (LMIC).
Main Methods:
- A scoping review following PRISMA-ScR guidelines.
- Systematic search of 1361 records, including 41 studies (2016-2025).
- Analysis of study origin (LMIC vs. high-income country - HIC) and reported technologies.
Main Results:
- Over half of the studies (51.2%) originated from LMICs, but only 19.5% from HICs.
- Advanced RT modalities (IMRT, VMAT, proton therapy) are predominantly in HICs.
- LMICs often rely on limited infrastructure and resources, potentially delaying treatment.
Conclusions:
- Significant disparities exist in global pediatric RT infrastructure and technology access.
- Structural limitations in LMICs hinder equitable access to essential cancer care.
- Addressing these inequities is crucial for improving outcomes in childhood cancer globally.
Abstract:
Radiotherapy (RT) is a crucial component of childhood cancer management; however, its global availability and technological capacity remain highly heterogeneous. Despite increasing international attention to childhood cancer care, comprehensive analyses of pediatric RT infrastructure across different economic settings remain limited. This scoping review aimed to characterize the global landscape of pediatric RT infrastructure, treatment technologies, and operational challenges, while highlighting Morocco as an illustrative low- and middle-income country (LMIC) case study. A systematic search identified 1361 records, of which 41 studies published between 2016 and 2025 were included following PRISMA-ScR methodological guidance. Of these, 51.2% originated from LMICs, whereas only 19.5% were conducted in high-income countries (HIC). Advanced treatment modalities, such as intensity-modulated RT, volumetric modulated arc therapy, and proton therapy, remain largely concentrated in HICs, whereas many LMICs continue to rely on limited infrastructure and constrained technical resources. These structural limitations may contribute to delayed treatment initiation and restricted access to pediatric RT. The Moroccan context illustrates both ongoing national efforts to modernize RT services and the persistent scarcity of pediatric-specific data in the literature. Addressing these disparities will be essential to improving equitable access to pediatric RT worldwide.
