Cobalt-60 Radiotherapy Units, Assessment of the Utilization or Disinvestment in Latin America

Objectives: To assess whether the criteria for disinvestment in health technologies—clinical, technological advantage, safety, lifecycle, human factor and costs—are applicable for the withdrawal of cobalt-60 radiotherapy units (Co-60 RTUs) in Latin America, considering health outcomes, and that the economic context, replacing this technology with linear accelerators (LINACs) is not always feasible. Methods: A systematic review of articles published between 2003 and 2017 in PubMed, Cochrane Library and CRD on the current use of Co-60 RTUs and publications comparing them with LINACs has been made. With a manual search of the references of selected articles. Results: The clinical results indicate that Co-60 RTUs have a significant role in treatment of patients with tumors of head, neck, breast and some types of superficial soft tissue sarcomas of the extremities. The comparison between Co-60 RTUs and LINACs results in advantages for linear accelerators in: the variety of cancer type that can be treated, the delivery of treatment, lifecycle and safety. In terms of acquisition costs, although Co-60 RTUs are comparable to a low-energy LINACs. Considering the number of existing Co-60 RTUs in Latin America, their effectivity and safety in the treatment of some types of cancer and the shortage of skilled professionals, its use can still be beneficial. Conclusions: Whereas in Latin America more than 26% of radiotherapy equipment are Co-60 RTUs, available economic resources and staff are limited. A recommendation is to continue utilizing such equipment in some types of cancer where they can be used: head, neck, breast and superficial sarcomas extremity soft tissue and allocate the use of existing LINACs for other types of cancer and in special cases like pediatric patients.