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Advances in Oncology and Radiotherapy / Radiation Dose and Imaging · Journal article
Frontiers in Oncology · August 10, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a single-centre retrospective analysis documenting institutional radiation therapy service patterns across overlapping crises in Lebanon from 2018 to 2025. The study reports non-linear fluctuations in patient volume, shifts toward advanced techniques (IMRT, SBRT, SRS) and hypofractionation, and identifies workforce deficits relative to international benchmarks, but provides no causal evidence that crises directly drove these changes or comparative data to support generalization.
Retrospective observational cohort study. All patients treated with radiation therapy at Mount Lebanon Hospital during 2018–2025; Lebanese national RT workforce.. Intervention: No intervention; observational analysis of service delivery during successive crises (financial collapse, Beirut Port explosion, armed conflict).. Compared with: Pre-crisis baseline (2017–2018) and international ESTRO-HERO and IAEA workforce benchmarks.. Mount Lebanon Hospital, Lebanon; national workforce and infrastructure data from Lebanon..
RT patient volume at MLH increased from 1,186 (2018) to peak of 1,498 (2022), declined to 1,328 (2023), then recovered to 1,399 (2024) and 1,479 (2025) 3D-CRT use declined from 80% (2018) to 50% (2025), with shift to IMRT, SBRT, and SRS Hypofractionated breast radiotherapy increased from 34.1% (2023) to 73.0% (2025), with marked inflection in 2024
No data on treatment completion rates, disease outcomes, toxicity, or equity of access across population subgroups during crises.
Clinicians and planners in fragile or conflict-affected settings may view this as evidence that cancer RT services can maintain modest throughput despite severe systemic strain, but the single-centre, uncontrolled design and lack of patient outcome data limit actionability. The proposed RT System Resilience Score remains conceptual and unvalidated.
A single-centre retrospective observational study describing longitudinal service patterns during crises, without control group or randomisation; reports institutional volumes and technique shifts but lacks comparative effectiveness or causal inference.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and planners in fragile or conflict-affected settings may view this as evidence that cancer RT services can maintain modest throughput despite severe systemic strain, but the single-centre, uncontrolled design and lack of patient outcome data limit actionability. The proposed RT System Resilience Score remains conceptual and unvalidated.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background Lebanon’s radiation therapy (RT) system has been exposed to successive, overlapping crises since 2019, including financial collapse, the Beirut Port explosion, and armed conflict in 2024. This study analyzes the impact of compounded crises on RT access and practice patterns using longitudinal institutional data from Mount Lebanon Hospital (MLH) as a sentinel cohort. Methods A retrospective observational study was conducted at MLH (2018–2025). Annual treated patient volumes, treatment technique distributions (3D-CRT, IMRT, SBRT, SRS), and hypofractionation adoption patterns were analyzed. Crisis phases were defined as: pre-crisis baseline (2017–2018), acute economic collapse (2019–2020), subacute adaptive phase (2021–2022), and chronic/war-related phase (2023–2025). National RT workforce and infrastructure data were assessed against ESTRO-HERO and IAEA benchmarks. Results RT patient volume exhibited non-linear evolution: initial increase from 1,186 (2018) to 1,498 (2022), a modest decline to 1,328 (2023), with recovery to 1,399 (2024) and 1,479 (2025) coinciding with war-related patient centralization. A sustained shift occurred from 3D-CRT ( 80% in 2018) to IMRT, SBRT, and SRS ( 50% by 2025). Hypofractionated breast radiotherapy increased from 34.1% (2023) to 73.0% (2025), with a marked inflection point in 2024. Lebanon’s RT workforce falls below ESTRO benchmarks for radiation therapists (3.9 vs. 5–7 per LINAC) and medical physicists (0.8 vs. 1.2–1.7 per LINAC). Conclusion RT systems in fragile settings do not fail linearly but fluctuate under sustained strain, and apparent volume stability at a single resilient center can mask systemic national contraction. Crisis conditions accelerated hypofractionation adoption and technique modernization. We further identify the need for a structured Radiation Therapy System Resilience Score (RT-SRS) and define its candidate domains as a conceptual, hypothesis-generating framework to guide proactive vulnerability detection in fragile settings; its operationalization and validation are designated as future work.
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