Current and Future Challenges of Radiation Oncology in Iran: A Report from the Iranian Society of Clinical Oncology

Published:January 15, 2018DOI:


      • This is the first comprehensive study of radiotherapy infrastructure in Iran.
      • There is a significant gap between available facilities for radiation therapy in Iran and international standards.
      • Unequal distribution of equipment restricts access to cancer treatment, remarkably.
      • International economic sanctions endngered cancer treatment, by restrcting access to cobalt-60.



      Growth of the cancer incidence rate in Iran has been very high in recent years. Therefore, the Iranian health care system should be prepared for the treatment of a huge number of patients in the foreseeable future. One of the most important treatment options for cancer is radiation. However, there is no comprehensive information on infrastructure for radiation oncology in this country.

      Materials and methods

      In 2015, a questionnaire was designed by the Iranian Society of Clinical Oncology (ISCO) and all radiation oncology centres in the country were visited to determine four important components of radiation oncology services, including facilities, equipment, personnel and patients.


      In 2015, 94 radiotherapy centres were identified in Iran. Sixty-one centres were fully operational, six centres were commissioning, 26 centres were under construction and one was inactive. Among the fully operational radiotherapy centres, 54 offered three-dimensional conformal radiotherapy and two-dimensional radiotherapy, eight offered brachytherapy, two intensity-modulated radiotherapy, two intraoperative radiotherapy, ostereotactic radiosurgery, two hyperthermia and 59 chemotherapy. Moreover, the survey identified 110 linear accelerators, 25 cobalt-60, one gamma knife, 21 remote brachytherapy afterloaders and six orthovoltage units. Treatment planning equipment included 15 graphy simulators, 19 dedicated computed tomography simulators, 22 multileaf collimator and 12 electronic portal imaging devices. Moreover, in 2015, 243 clinical oncologists participated in the treatment of 42 350 cancer patients in need of radiotherapy, which is about one radiation oncologist for 175 patients. During 2010–2015, number of cobalt-60 reduced 70%, from 25 units to 8 units.


      There is a significant gap between Iran's available facilities for radiation therapy and international standards. Moreover, during international economic sanctions against Iran this gap widened.

      Key words

      To read this article in full you will need to make a payment


      Subscribe to Clinical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stewart B.W.
        • Wild C.P.
        World cancer report 2014.
        World Health Organization, 2014
        • Saadat S.
        • Yousefifard M.
        • Asady H.
        • Jafari A.M.
        • Fayaz M.
        • Hosseini M.
        The most important causes of death in Iranian population; a retrospective cohort study.
        Emergency. 2015; 3: 16
      1. Akbari ME. The SBMU Cancer Research Center (CRC). Available at: Accessed 11 July 2016 (in Persian).

      2. Hadizadeh M. Iranian Students News Agency. Available at: Accessed 11 July 2016 (in Persian).

        • Shafeei J.
        Cancer: the future features in Iran.
        J Commun Health Res. 2015; 3: 225
      3. International Agency for Research on Cancer. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence in 2012. Available at: Accessed 15 February 2016.

        • Amori N.
        • Aghajani M.
        • Asgarian F.S.
        • Jazayeri M.
        Epidemiology and trend of common cancers in Iran (2004–2008).
        Eur J Cancer Care. 2016; 26
        • Rafiemanesh H.
        • Mehtarpoor M.
        • Mohammadian-Hafshejani A.
        • Salehiniya H.
        • Enayatrad M.
        • Khazaei S.
        Cancer epidemiology and trends in Sistan and Baluchestan province, Iran.
        Med J Islamic Repub Iran. 2015; 29: 254
        • Zahedi A.
        • Rafiemanesh H.
        • Enayatrad M.
        • Ghoncheh M.
        • Salehiniya H.
        Incidence, trends and epidemiology of cancers in north west of Iran.
        Asian Pac J Cancer Prev. 2015; 16: 7189-7193
        • Amoori N.
        • Mirzaei M.
        • Cheraghi M.
        Incidence of cancers in Kuzestan province of Iran: trend from 2004 to 2008.
        Asian Pac J Cancer Prev. 2014; 15: 8345-8349
        • Keyghobadi N.
        • Rafiemanesh H.
        • Mohammadian-Hafshejani A.
        • Enayatrad M.
        • Salehiniya H.
        Epidemiology and trend of cancers in the province of Kerman: southeast of Iran.
        Asian Pac J Cancer Prev. 2015; 16: 1409-1413
        • Rafiemanesh H.
        • Rajaei-Behbahani N.
        • Khani Y.
        • Hosseini S.
        Incidence trend and epidemiology of common cancers in the center of Iran.
        Glob J Health Sci. 2016; 8: 146
        • Slotman B.J.
        • Cottier B.
        • Bentzen S.M.
        • 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: 349-354
      4. Radiation oncology discipline inspection project report.
        2010 (Available at:) (in Persian)
        • Mousavi S.M.
        • Gouya M.M.
        • Ramazani R.
        • Davanlou M.
        • Hajsadeghi N.
        • Seddighi Z.
        Cancer incidence and mortality in Iran.
        Ann Oncol. 2009; 20: 556-563
      5. Harirchi I. General Deputy Minister of Health. Available at: Accessed 20 August 2017 (in Persian).

        • Rosenblatt E.
        • Barton M.
        • Mackillop W.
        • et al.
        Optimal radiotherapy utilisation rate in developing countries: an IAEA study.
        Radiother Oncol. 2015; 116: 35-37
        • Murphy J.D.
        • Nelson L.M.
        • Chang D.T.
        • Mell L.K.
        • Le Q.T.
        Patterns of care in palliative radiotherapy: a population-based study.
        J Oncol Pract. 2013; 9: e220-e227
        • Datta N.R.
        • Samiei M.
        • Bodis S.
        Radiation therapy infrastructure and human resources in low- and middle-income countries: present status and projections for 2020.
        Int J Radiat Oncol Biol Phys. 2014; 89: 448-457
        • Dunscombe P.
        • Grau C.
        • Defourny N.
        • et al.
        Guidelines for equipment and staffing of radiotherapy facilities in the European countries: final results of the ESTRO-HERO survey.
        Radiother Oncol. 2014; 112: 165-177
        • Yin W.
        • Chen B.
        • Tian F.
        • Yu Y.
        • Kong F.M.
        The growth of radiation oncology in mainland China during the last 10 years.
        Int J Radiat Oncol Biol Phys. 2008; 70: 795-798
        • Reinfuss M.
        • Byrski E.
        • Malicki J.
        Radiotherapy facilities, equipment, and staffing in Poland: 2005–2011.
        Rep Pract Oncol Radiother. 2013; 18: 159-172
        • Khan F.M.
        • Gibbons J.P.
        Khan's the physics of radiation therapy.
        Lippincott Williams & Wilkins, 2014
        • Zubizarreta E.H.
        • Fidarova E.
        • Healy B.
        • Rosenblatt E.
        Need for radiotherapy in low and middle income countries – the silent crisis continues.
        Clin Oncol. 2015; 27: 107-114
        • Abdel-Wahab M.
        • Fidarova E.
        • Polo A.
        Global access to radiotherapy in low-and middle-income countries.
        Clin Oncol. 2017; 29: 99-104
        • Rosenblatt E.
        Planning national radiotherapy services.
        Front Oncol. 2014; 4: 315
        • van der Merwe D.
        Planning a radiotherapy department.
        Clin Oncol. 2017; 29: 105-109
        • AlDuhaiby E.Z.
        • Breen S.
        • Bissonnette J.P.
        • et al.
        A national survey of the availability of intensity-modulated radiation therapy and stereotactic radiosurgery in Canada.
        Radiat Oncol. 2012; 7: 18
        • Mell L.K.
        • Mehrotra A.K.
        • Mundt A.J.
        Intensity-modulated radiation therapy use in the US, 2004.
        Cancer. 2005; 104: 1296-1303