Wartime pressure reshaped Ukraine’s radiotherapy network
Russia’s invasion did not simply interrupt cancer care in Ukraine; it forced a structural reset of the country’s radiation therapy system. A national survey of radiotherapy departments, paired with International Atomic Energy Agency DIRAC data from 2021 through 2025, shows a service network that was damaged, partially restored, and then pushed into a rapid modernization cycle under extreme constraints. The scale of adaptation is striking, but so is the fragility that remains embedded in everyday care delivery.
Before the full-scale invasion in December 2021, Ukraine operated 41 radiotherapy departments with 82 megavoltage machines, including 38 linear accelerators and 44 cobalt-60 units. The system also included 53 orthovoltage units and 36 brachytherapy afterloaders. Within months of war, four centres were occupied, most departments experienced service disruptions averaging 26 days, and patient volume fell by 27.5%. The shock was immediate and measurable at the bedside: fewer machines functioning, fewer patients treated, and longer delays for cancers that depend on timely radiation.
Capacity recovered, but not evenly
By 2023, treatment volume had returned to baseline, and it then rose further by 8.9% in 2024 and 9.3% in 2025 relative to 2021. This rebound matters because radiotherapy access is not a static metric; it is a moving balance between machine availability, staff coverage, referral patterns, and the ability to keep treatment schedules intact when infrastructure is damaged. In a war setting, recovery does not mean normalization. It means that departments found ways to restart, redistribute, and keep moving while the health system remained under pressure.
By December 2025, Ukraine had 42 radiotherapy departments and 96 megavoltage machines, including 68 linear accelerators and 28 cobalt-60 units. Orthovoltage capacity had fallen to 38 units, and 34 afterloaders remained in operation. The change in machine mix is clinically meaningful. Linear accelerators generally offer greater flexibility and are less dependent on the sourcing model that historically supported cobalt-60 systems. In a country facing supply chain disruption and geopolitical isolation from former procurement channels, equipment choice becomes a resilience strategy, not just a technology preference.
Modernization, however, has not erased dependency risk.
Cobalt-60 remains a vulnerability in the system
Despite the expansion in linear accelerator use, 56% of departments still relied on cobalt-60 in 2025. Even more concerning, 94.1% reported that future source replacement would be unfeasible because the sources had historically been procured from Russia. That is not a theoretical procurement problem. Cobalt-60 systems require reliable source replacement to remain functional, and any interruption can turn a treatment machine into stranded capital. In practical terms, a department that cannot replace its source may lose the very capacity it was counting on to treat patients through the next year.
The shift already underway reflects that reality. Among cobalt-60 users, 78.6% planned a transition to linear accelerators. The direction of travel is clear: Ukraine is moving away from a technology pathway that is operationally brittle in wartime and toward one that can better support continuity of treatment. Still, replacing cobalt systems with linear accelerators requires more than procurement. Facilities need shielding, maintenance support, quality assurance, service contracts, and technicians who can keep machines calibrated under demanding conditions.
Staffing gaps may limit the value of new equipment
The workforce data are as consequential as the equipment figures. Reported shortages reached 41.4% for medical physicists, 33.6% for radiation therapy technologists, and 21.1% for radiation oncologists. Those gaps constrain planning, treatment delivery, verification, image guidance, and machine uptime. A new linear accelerator cannot create a treatment team where one does not exist. Nor can it compensate for absent physics support when dose calculation, commissioning, and quality control are essential to safe care.
Waiting times rose from 6.4 days in 2021 to 10.3 days in 2025. The increase may appear modest on paper, but in radiotherapy every added day can matter for rapidly proliferating tumors, postoperative sequencing, and patient anxiety. Delays also compound system strain: longer queues push departments to extend hours, stretch staff, and narrow the margin for maintenance downtime. The result is a service network that may have regained volume while still operating under chronic stress.
Training and resilience now sit at the center of cancer care delivery
The study makes a practical case for the next phase of cancer system rebuilding. Ukraine’s radiotherapy capacity is no longer defined only by wartime loss; it is increasingly defined by the ability to convert equipment investment into functioning, durable clinical service. Targeted training for medical physicists, RTTs, and radiation oncologists is central to that goal. Without it, machine growth can outpace human capacity, leaving departments with hardware they cannot fully use.
The survey design also gives this analysis unusual operational depth. A 38-item national survey captured patient volumes, waiting times, equipment status, staffing, training needs, and ongoing challenges across all Ukrainian radiotherapy departments in August 2025, while DIRAC data provided the longer arc from 2021 through 2025. Together, those sources trace a system under attack that still adapted in real time. The wartime disruption was severe, but the recovery was also measurable, and the modernization is already visible in the machine mix and service volume.
The remaining weakness is concentration risk: reliance on cobalt-60, dependence on a workforce that is still too small, and the need for training that can keep pace with new technology. Those constraints will shape whether Ukraine’s radiotherapy network can sustain the gains already achieved or whether capacity erodes again under the next operational shock.