Impact of Russian invasion on radiation therapy capacity in Ukraine: a national survey study.

INTRODUCTION

This study evaluated the operational status of Ukrainian radiotherapy (RT) centres to characterise wartime capacity following the Russian invasion and to identify priorities for improving RT delivery and resilience.

METHODS

This cross-sectional study integrated two data sources: (1) a 38-item survey conducted by Help Ukraine Group (HUG) in August 2025 across all Ukrainian RT departments, assessing patient volumes, waiting times, equipment status, cobalt-60 (Co-60) source replacement, staffing, training needs and operational challenges; and (2) International Atomic Energy Agency DIRAC datasets collected by the Grigoriev Institute (2021-2025), tracking equipment, staffing and patient volumes. Descriptive and comparative analyses were performed.

RESULTS

In December 2021, before the full-scale invasion, Ukraine operated 41 RT departments with 82 megavoltage (MV) machines (38 linear accelerators, 44 Co-60 units), 53 orthovoltage units and 36 brachytherapy afterloaders. During the first 3 months of war, four centres were occupied, most departments experienced service disruptions averaging 26 days and patient volume declined by 27.5%. Volumes recovered to baseline in 2023 and increased by 8.9% in 2024 and 9.3% in 2025 relative to 2021.In December 2025, Ukraine operated 42 RT departments with 96 MV machines (68 linear accelerators, 28 Co-60 units), 38 orthovoltage units and 34 afterloaders. However, 56% of departments still relied on Co-60 and 94.1% reported future source replacement would be unfeasible because sources were historically procured from Russia. Consequently, 78.6% of Co-60 users planned the transition to linear accelerators. Workforce shortages remain critical, with reported deficits of 41.4% for medical physicists, 33.6% for RTTs and 21.1% for radiation oncologists. Average waiting times increased from 6.4 days in 2021 to 10.3 days in 2025.

CONCLUSION

Despite ongoing war, Ukraine is actively modernising RT services, with a rapid transition from Co-60 to linear accelerators. Workforce development and targeted training are now urgently needed to convert equipment investment into sustainable clinical capacity.