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Infrastructure and equipment for radiation oncology in the Spanish National Health System: analysis of external beam radiotherapy 2015–2020

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Planning for radiation oncology requires reliable estimates of both demand for radiotherapy and availability of technological resources. This study compares radiotherapy resources in the 17 regions of the decentralised Spanish National Health System (SNHS).

Materials and methods

The Sociedad Española de Oncología Radioterápica (SEOR) performed a cross-sectional survey of all Spanish radiation oncology services (ROS) in 2015. We collected data on SNHS radiotherapy units, recording the year of installation, specific features of linear accelerators (LINACs) and other treatment units, and radiotherapeutic techniques implemented by region. Any machine over 10 years old or lacking a multileaf collimator or portal imaging system was considered obsolete. We performed a k-means clustering analysis using the Hartigan–Wong method to test associations between the gross domestic regional product (GDRP), the number of LINACs per million population and the percentage of LINACs over 10 years old.


The SNHS controls 72 (61%) of the 118 Spanish ROS and has 180 LINACs, or 72.5% of the total public and private resources. The mean rate of LINACs per million population is 3.9 for public ROS, and 42% (n = 75) of the public accelerators were obsolete in 2015: 61 due to age and 14 due to technological capability. There was considerable regional variation in terms of the number and technological capacity of radiotherapy units; correlation between GRDP and resource availability was moderate.


Despite improvements, new investments are still needed to replace obsolete units and increase access to modern radiotherapy. Regular analysis of ROS in each Spanish region is the only strategy for monitoring progress in radiotherapy capacity.

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  1. Bentzen SM, Heeren G, Cottier B, Slotman B, Glimelius B, Lievens Y, et al. Towards evidence-based guidelines for radiotherapy infrastructure and staffing needs in Europe: the ESTRO QUARTS Project. Radiother Oncol. 2005;75:355–65.

    Article  PubMed  Google Scholar 

  2. Delaney G, Jacob S, Featherstone C, Barton MB. The role of radiotherapy in cancer treatment. Estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer. 2005;104:1129–37.

    Article  PubMed  Google Scholar 

  3. Barton MB, Jacob S, Shafiq J, Wong K, Thompson SR, Hanna TP, et al. Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012. Radiother Oncol. 2014;112:140–4.

    Article  PubMed  Google Scholar 

  4. Borrás JM, Barton M, Grau C, Corral J, Verhoeven R, Lemmens V, et al. The impact of cancer incidence and stage on optimal utilization of radiotherapy: methodology of a population based analysis by the ESTRO-HERO project. Radiother Oncol. 2015;116(1):45–50.

    Article  PubMed  Google Scholar 

  5. Borrás JM, Lievens Y, Duscombe P, Coffey M, Malicki J, Corral J, et al. The optimal utilization proportion of external beam radiotherapy in European countries: an ESTRO-HERO analysis. Radiother Oncol. 2015;116(1):38–44.

    Article  PubMed  Google Scholar 

  6. Rodríguez A, Borrás JM, López-Torrecilla JL, Algara M, Palacios-Eito A, Gómez-Caamaño A, et al. Demand for radiotherapy in Spain. Clin Transl Oncol. 2017;19(2):204–10.

    Article  PubMed  Google Scholar 

  7. Aproximación al cálculo del coste del abordaje del cáncer en España. Informe SEOM octubre. 2013.

  8. Accessed 27 Feb 2017.

  9. Grau C, Defourney N, Malicki J, Dunscombe P, Borras JM, Coffey M, et al. Radiotherapy equipment and departments in the European countries: final results from the ESTRO-HERO survey. Radiother Oncol. 2014;112:155–64.

    Article  PubMed  Google Scholar 

  10. Lievens Y, Defourny N, Coffey M, Borras JM, Dunscombe P, Slotman B, et al. Radiotherapy staffing in the European countries: final results from the ESTRO-HERO survey. Radiother Oncol. 2014;112:178–86.

    Article  PubMed  Google Scholar 

  11. Comisión de las Sociedades Oncológicas para la Planificación Oncológica en España. Libro Blanco de la Oncología en España. Informe para la Planificación Global de la Oncología. Ed. Jims, Barcelona. 1988.

  12. Escó R, Palacios A, Pardo J, Biete A, Carceller JA, Veiras C, et al. Infrastructure of radiotherapy in Spain: a minimal standard of radiotherapy resources. Int J Radiat Oncol Biol Phys. 2003;56(2):319–27.

    Article  PubMed  Google Scholar 

  13. Palacios A, Espinosa M, Mañas A, de Las Heras M. Radiation oncology: future needs and equipment. Current situation in Spain. Clin Transl Oncol. 2008;10:478–85.

    Article  Google Scholar 

  14. Slotman BJ, Cottier B, Bentzen SM, Heeren G, Lievens Y, van den Bogaert W. Overview of national guidelines for infrastructure and staffing of radiotherapy. ESTRO-QUARTS: work package 1. Radiother Oncol. 2005;75(3):349–54.

    Article  PubMed  Google Scholar 

  15. Ismael Herruzo Cabrera, María Espinosa Calvo, José López Torrecilla, Miquel Maciá, Amalia Palacios Eito, Jose Antonio Sánchez Calzado et al. Cálculo de necesidades e infraestructura en España. Cap 4.2 en Libro Blanco SEOR XXI; 2010. p. 65–85. ISBN:978-84-7714-344-4.

  16. Rosenblatt E, Izewska J, Anacak Y, Pynda Y, Scaillet P, Boniol M. Radiotherapy capacity in European countries: an analysis of the Directory of Radiotherapy Centres (DIRAC) database. Lancet Oncol. 2013;14(2):e79–86.

    Article  PubMed  Google Scholar 

  17. Fernández JL, Parapar C. Ruiz M El envejecimiento de la población, Lychnos 2, Cuadernos de la Fundación general CSIC. 2015. ISSN:2174-5102.

  18. Borrás JM, Lievens Y, Barton M, Corral J, Ferlay J, Bray F, et al. How many new cancer patients in Europe will require radiotherapy by 2025? An ESTRO-HERO analysis. Radiother Oncol. 2016;119(1):5–11.

    Article  PubMed  Google Scholar 

  19. Datta NR, Samiei M, Bodis S. Radiotherapy infrastructure and human resources in Europe—present status and its implications for 2020. Eur J Cancer. 2014;50:2735–43.

    Article  PubMed  Google Scholar 

  20. Prades J, Algara M, Espinàs JA, Farrus B, Arenas M, Reyes V, et al. Understanding variations in the use of hypofractionated radiotherapy and its specific indications for breast cancer. A mixed-methods study. Radiother Oncol. 2017;123(1):22–8.

    Article  PubMed  Google Scholar 

  21. Slotman BJ, Vos PH. Planning of radiotherapy capacity and productivity. Radiother Oncol. 2013;106:266–70.

    Article  PubMed  Google Scholar 

  22. Arenas M, Gómez D, Sabater S, Rovirosa A, Biete A, Colomer J. Decentralisation of radiation therapy. Is it possible and beneficial to patients? Experience of the first 5 years of a satellite radiotherapy unit in the province of Tarragona, Spain. Rep Pract Oncol Radiother. 2014;20(2):141–4.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Shakespeare TP, Turner M, Chapman A. Is rural radiation oncology practice quality as good as the big smoke? Results of the Australian radiotherapy single machine unit trial. Australas Radiol. 2007;51:381–5.

    Article  CAS  PubMed  Google Scholar 

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We thank Josep M Borrás M.D. and Ramon Cleries Ph.D. (Universidad de Barcelona) for their valuable advice and assistance in writing the manuscript.

Dra. Mª José Ortiz del Hospital Universitario Virgen del Rocío (Sevilla). Dr. José Expósito del Hospital Universitario Virgen de las Nieves (Granada). Dra. Amalia Palacios del Hospital Universitario Reina Sofia (Córdoba). Dr. Ismael Herruzo del Hospital Regional Universitario Carlos Haya (Málaga). Dr. José Antonio Medina del Hospital Universitario Virgen de la Victoria (Málaga). Dr. Miguel Martinez del Complejo Hospitalario de Jaén (Jaén). Dra. Eloisa Bayo del Hospital Juan Ramón Jiménez (Huelva) y Hospital Virgen Macarena (Sevilla). Dr. Javier Jaén del Hospital Puerta del Mar (Cádiz). Dr. Francisco José Peracaula del Hospital Punta Europa (Cádiz). Dra. Carolina Pérez del Complejo Hospitalario Torrecárdenas (Almería). Dra. Mª Isabel Ramos de Clinica Infanta Luisa (Sevilla). Dr. José Antonio González del Instituto Oncológico Cartuja (Sevilla). Dra. Escarlata López de Oncosur (Granada). Dr. José Begara de Clínica Xanit Limonar (Málaga). Dra. Cristina Nuño de Clínica Xanit Benalmádena (Málaga). Dra. Ana Belén Bezares de Clinica Radón Algeciras (Cádiz). Dra. Ana Serradilla de Clínica Radón Jerez de la Frontera (Cádiz). Dr. Antonio Lazo de Oncosur San Juan de Dios (Córdoba). Dr. Martin Tejedor del Hospital Universitario Miguel Servet (Zaragoza). Dra. Lucía Méndez del IMOMA (Oviedo). Dr. Germán Juan de la Fundación Hospital de Jove (Asturias). Dr. Luis Olay del Hospital Universitario Central de Asturias. Dr. José Pardo del Hospital Universitario Son Espases (Palma de Mallorca). Dr. Francisco Mestre de Policlinica Miramar (Palma de Mallorca). Dr. Claudio Otón del Hospital Universitario de Canarias (Tenerife). Dr. Claudio Fuentes del Hospital Universitario Nuestra Sra de la Candelaria (Tenerife). Dr. Pedro Prada del Hospital Universitario Marqués de Valdecilla (Santander). Dr. Leopoldo Pérez de Clínica Mompía (Santander). Dra. Eva Lozano del Hospital General de Ciudad Real. Dra. Mª Victoria Villas del Complejo Hospitalario Universitario de Albacete. Dra. Juana Tripero del Grupo IMO (Guadalajara). Dra. Rosabel Lobo del Grupo IMO (Toledo). Dr. Manuel Muñoz del Grupo IMO Talavera (Toledo). Dr. José Luis Tisaire del Grupo IMO Alcázar (Ciudad Real). Dr. Jesús Fernández del IVO (Cuenca). Dra. Mercedes Teijeira del Hospital Universitario de Burgos. Dr. José Reyes Rodríguez del Complejo Asistencial de León. Dr. Luis Pérez del Hospital Clinico Universitario de Salamanca. Dr. Francisco López del Hospital Clínico Universitario de Valladolid. Dra. Amelia Ceballos del Complejo Asistencial de Zamora. Dra. Rocio Cantalapiedra del Hospital Campo Grande (Valladolid). Dr. Albert Biete del Hospital Clinic Universitario (Barcelona). Dr. Jordi Craven del Hospital de la Santa Creu i Sant Pau y Clinica Corachan (Barcelona). Dr. Agustí Pedro del Hospital PLATÓ (Barcelona). Dr. Jordi Giralt del Hospital Valle Hebrón (Barcelona). Dr. Ferrán Guedea del Hospital Durán i Reinals ICO (Barcelona). Dr. Salvador Villá del Hospital de Badalona (Barcelona). Dr. Josep M Solé del Hospital General de Cataluña (Barcelona). Dra. Arantxa Eraso del Hospital Universitario de Gerona. Dr. José Antonio Carceller del Hospital Universitario Arnau Vilanova (Lérida). Dra. Meritxell Arenas del Hospital Sant Joan de Reus (Tarragona). Dr. Benjamín Guix del IMOR (Barcelona). Dr. Ramón Miralbell del centro Médico Teknon (Barcelona). Dr. Joan Casals del Hospital Quirón (Barcelona). Dra. Julia Muñoz del Hospital Universitario Infanta Cristina (Badajoz). Dr. Pedro González del Hospital de Mérida (Badajoz). Dra. Mª Isabel Duarte del Hospital Virgen del Puerto (Cáceres). Dr. Juan Pablo Jerez de la Clínica San Miguel (Cáceres). Dr. Alfonso Mariño del Centro Oncológico de Galicia (La Coruña). Dr. Antonio Gómez del Hospital Universitario de Santiago de Compostela (La Coruña). Dr. Victor Muñoz del Hospital do Mexoeiro de Vigo (Pontevedra). Dra. Mª Dolores López del Complejo Hospitalario de Orense . Dr. Luis Zugazabeitia de POVISA, Vigo (Pontevedra). Dr. Gustavo Ossola del Hospital de San Pedro (Logroño). Dra. Ana Mañas del Hospital Universitario de la Paz (Madrid). Dra. Laura Cerezo del Hospital Universitario de la Princesa (Madrid). Dr. Alfredo Ramos del Hospital Universitario Ramón y Cajal (Madrid). Dr. José Pérez-Regadera del Hospital Universitario Doce de Octubre (Madrid). Dr. Miguel Angel Lozano del Hospital Universitario Gregorio Marañón (Madrid). Dr. Manuel de las Heras del Hospital Clinico San Carlos (Madrid). Dra. Ana Pérez de la Fundación Jiménez Diaz (Madrid). Dr. Alejandro de la Torre del Hospital Universitario Puerta de Hierro (Madrid). Dra. Pilar Samper del Hospital Rey Juan Carlos (Madrid). Dra. Blanca Ludeña del Hospital Universitario de Fuenlabrada (Madrid). Dr. Juan de Dios Sáez del Hospital Central de la Defensa Gómez Ulla (Madrid). Dr. Ignacio Azinovic del Grupo IMO. Dra. Carmen Rubio de CIOCC (Madrid). Dra. Elia del Cerro del Hospital de Quirón (Madrid). Dra. Rosa Meiriño del Hospital de la Luz (Madrid). Dr. Rodrigo García-Alejo del Hospital de la Beata (Madrid). Dra. Natalia Carballo del MD Anderson (Madrid). Dr. Ramón García del Hospital Universitario Virgen de la Arrixaca (Murcia). Dr. Juan Salinas del Hospital General Universitario de Cartagena (Murcia). Dra. Adriana Fondevilla del Instituto Oncológico del Sudeste (Murcia). Dr. Rafael Martinez de la Clinica Universitaria de Navarra. Dr. Enrique Martinez del Complejo Hospitalario de Navarra. Dr. Avelino Alia del Hospital de Txagorritxu (Alava). Dr. Juan Pablo Ciria del Hospital Universitario de Donostia (Guipúzcoa). Dr. Jesús Rosa del Instituto Oncológico de San Sebastián (Guipúzcoa). Dr. Pedro Bilbao del Hospital Universitario de Cruces (Bilbao). Dr. Juan Carlos Martin del Hospital Universitario de Basurto (Bilbao). Dr. Francisco Casquero del Hospital Quirón (Bilbao). Dr. Leo Arribas del Instituto Valenciano de Oncología (Comunidad Valenciana). Dr. Alejandro Tormo del Hospital Universitario de la Fe (Valencia). Dra. Amparo Algas del Hospital Clínico de Valencia. Dr. Luis Larrea de la Clinica Virgen del Consuelo (Valencia). Dr. Miguel Soler del Hospital Universitario de la Ribera (Valencia). Dr. Enrique Garcia del Hospital Universitario de Elche (Alicante). Dr. Pablo Soler del Hospital IMED Elche (Alicante). Dr. Manuel Santos del Hospital Clinica Benidorm (Alicante). Dr. Gabriel Vázquez del Hospital Universitario San Juan de Alicante. Dra. Rosa Mª Cañón del Hospital Quirón Torrevieja (Alicante). Dr. Antonio Miró del Instituto Oncológico de Alicante.

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Spanish Society of Oncology and Radiotherapy (SEOR) Analysis Group saying: Members of The Spanish Society of Oncology and Radiotherapy (SEOR) Analysis Group are listed in the Acknowledgements.

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Rodríguez, A., Algara, M., Monge, D. et al. Infrastructure and equipment for radiation oncology in the Spanish National Health System: analysis of external beam radiotherapy 2015–2020. Clin Transl Oncol 20, 402–410 (2018).

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