Background: Radiotherapy is a core component of comprehensive cancer care, but access is frequently constrained by high capital costs, complex regulatory requirements, and workforce shortages—often worsening geographic inequities in large middle-income countries. In Brazil, published estimates have suggested that insufficient access to radiotherapy may be associated with roughly 5,000 potentially avoidable cancer deaths, underscoring the urgency of system-level expansion. Brazil’s Unified Health System (SUS) launched the Radiotherapy Expansion Plan (PER-SUS) as a national strategy to expand and modernize radiotherapy capacity while strengthening governance, regulation, and service readiness.

Objectives: To describe PER-SUS as an implementation strategy to expand equitable access to radiotherapy in Brazil and summarize program progress and early system-level outputs.

Methods: We conducted a descriptive implementation analysis using routine program monitoring and project-tracking data (2012–2025), structured with the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). RE-AIM constructs were operationalized as: Reach (expansion toward underserved macroregions and population/need-based coverage), Adoption (participating institutions/sites), Implementation (delivery status, commissioning milestones, and regulatory steps involving national partners), Effectiveness (proxy outputs such as commissioned capacity and modeled gains in adequate coverage), and Maintenance (continuity planning and subsequent cycles). To strengthen the Reach/Effectiveness assessment, we incorporated geospatial monitoring of radiotherapy equipment availability, mapping the number of radiotherapy devices per 1,000 new cancer cases for 2022 (baseline), 2024, and projected 2026.

Results: By December 2025, PER-SUS reported 92 total actions (solutions plus equipment): 65 radiotherapy solutions completed and 7 under execution; 18 equipment deliveries completed (including replacements and deliveries to ready bunkers) and 2 under execution. Among 83 commissioned radiotherapy solutions, 3 were awaiting completion of regulatory procedures for operation licensing. Based on the 34-equipment subset analyzed (2022–2026), geospatial monitoring indicates growth in radiotherapy equipment from 312 devices (2022) to 324 (2024), with a projection of 358 (2026), accompanied by an increase in macroregion coverage from 74 (62.7%) in 2022 and 75 (63.3%) in 2024 to 85 (72.0%) by 2026. For the 2025 delivery schedule, modeled equity-oriented outputs indicate 59,553,223 people located in identified care gaps within macroregions targeted for benefit; 2,283,239 people expected to newly achieve adequate coverage; and an estimated 20,400 new cancer cases additionally served through expanded radiotherapy access.

Conclusions/Implications: PER-SUS illustrates how a national, multi-partner implementation approach can scale a capital-intensive oncology technology within a middle-income health system by aligning infrastructure, procurement, regulation, governance, and capacity-building. Using RE-AIM, early progress is most visible in Adoption and Implementation outputs (deliveries and commissioning), while the documented expansion in service coverage and modeled gains in adequate access support equity-oriented Reach. By increasing timely access to radiotherapy and reducing geographic and capacity gaps, PER-SUS may contribute to fewer treatment delays and potential reductions in avoidable cancer mortality, reinforcing the value of sustained program cycles and strengthened site readiness and licensing pathways.