A landmark International Atomic Energy Agency (IAEA) study has found that image-guided brachytherapy (IGBT) — a more precise and effective treatment for advanced cervical cancer — can be successfully implemented in hospitals with limited resources, potentially narrowing one of the starkest gaps in global cancer care.
The findings, presented at the 2025 annual meeting of the European Society for Radiation Oncology, suggest that with careful planning and workflow optimisation, even resource-constrained centres can transition to the advanced technique without crippling treatment capacity.
Cervical Cancer’s Heavy Toll
Cervical cancer remains the fourth most common cancer among women globally and is a leading cause of cancer death in many low- and middle-income countries. In these regions, most patients are diagnosed at an advanced stage, when the disease has already spread to surrounding tissues.
While conventional brachytherapy — placing a radioactive source inside or near the tumour — is a cornerstone of treatment, 3D image-guided brachytherapy (IGBT) significantly improves tumour control and survival rates.
Using advanced imaging to guide radiation placement, IGBT:
However, the technique traditionally requires specialised staff, imaging equipment, advanced applicators, and longer procedure times — often up to three times longer than conventional 2D methods — raising concerns about feasibility in overstretched health systems.
Bridging Technology and Reality
To address these concerns, the IAEA launched a coordinated research project (CRPE33042) in 2019 to evaluate how IGBT could be scaled in resource-challenged settings.
Fifteen cancer institutions across 14 countries — including India, Brazil, Morocco, Pakistan, Tanzania, Ukraine and Zambia — contributed workflow data for 365 patients over three months.
Researchers analysed every step of treatment delivery, from operating room entry to applicator placement, collecting detailed information on:
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Infrastructure and equipment
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Staff shifts and operating hours
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Imaging modalities and anaesthesia techniques
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Treatment planning methods
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Machine demand and patient throughput
“Implementation studies like this one help to bridge the gap between technology and practice by accounting for local health systems and their complexities,” said May Abdel-Wahab, Director of the IAEA’s Division of Human Health.
Practical Pathways for Different Capacity Levels
The study did not recommend a one-size-fits-all approach. Instead, it outlined tailored transition strategies based on institutional capacity:
Centres with low to moderate demand per brachytherapy machine→ Recommended to transition directly to advanced IGBT workflows, supported by training, infrastructure upgrades and peer mentorship.
Centres with limited capacity→ Advised to adopt a phased transition, including:
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Pre-defined dose distributions
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Streamlined decision-making
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Fewer implants with multiple smaller radiation fractions
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Improved workspace layouts separating planning and treatment areas
Centres with high demand→ Encouraged to strengthen existing workflows through increased investment and specialised staff training before transitioning.
Evidence of Clinical Benefit
Beyond operational feasibility, the research project also produced:
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A meta-analysis of 5,488 patient records demonstrating improved outcomes with 3D planning
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Workflow scenario analyses across 19 countries
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A national impact assessment warning that poorly planned transitions could reduce capacity and increase waiting times
“Through on-the-ground data on existing workflows, the feasibility study offers context-specific recommendations to guide institutional and national strategies,” said Supriya Chopra of India’s Tata Memorial Centre.
Global Implications
The findings arrive as eliminating cervical cancer gains momentum as a global health priority under WHO’s strategy. While vaccination and screening are key prevention pillars, improving treatment access for advanced cases remains critical in low-resource settings.
“For healthcare providers and policymakers alike, these insights help ensure that patients in resource-limited settings receive timely and effective care,” Abdel-Wahab said.
By demonstrating that advanced, life-saving radiotherapy techniques can be adapted — rather than abandoned — in low-resource environments, the study offers a roadmap for more equitable global cancer care.