For more than a century, radiotherapy has remained one of the most important weapons in the fight against cancer. Alongside surgery and chemotherapy, it has become a fundamental component of modern cancer treatment, helping doctors destroy malignant cells, shrink tumours and control the spread of disease.
Yet, despite its established role in oncology, access to radiotherapy remains deeply unequal across the world.
The technology traces its clinical origins to the late 19th century, following the discovery of X-rays and the pioneering efforts to use radiation for medical treatment. Since then, radiotherapy has evolved from relatively crude radiation techniques into a highly sophisticated form of cancer care capable of targeting tumours with increasing precision.
But advances in technology have not translated into equal access.
According to Mitra Ghalibafian, head of the radio-oncology department at Mahak Hospital, low- and middle-income countries continue to face a major shortfall in radiotherapy infrastructure and equipment.
Historically, developing countries have accounted for roughly 85 per cent of the world's population but possessed only about 35 per cent of global radiotherapy facilities.
The imbalance illustrates a wider challenge in global health: the countries with the largest populations and growing cancer burdens often have the fewest resources available to provide advanced cancer treatment.
A treatment many cancer patients need
Radiotherapy is not a treatment reserved for a small proportion of cancer patients.
Experts estimate that approximately half of all people diagnosed with cancer will require radiotherapy at some point during their treatment. Depending on the type and stage of cancer, as well as the overall treatment strategy, estimates can rise to between 50 and 60 per cent.
Radiation can be used with different objectives. In some cases, it is intended to destroy cancer cells and eliminate a tumour. In others, it may be used to shrink a tumour before surgery, eliminate remaining cancer cells after surgery or control the disease when a cure is no longer possible.
Its role can therefore extend throughout the cancer journey, making access to functioning radiotherapy services an important determinant of treatment outcomes.
For patients in countries where machines are scarce, treatment delays can become a major obstacle.
A shortage of facilities may mean patients have to travel long distances, wait for treatment slots or seek care outside their communities. The financial burden can be particularly severe for families already dealing with the costs of cancer diagnosis, medication, surgery and other forms of treatment.
The challenge is greater for children
Radiotherapy also has an important role in childhood cancer care, although its use in children requires particularly careful planning.
Modern cancer treatment frequently depends on advanced medical imaging to determine where a tumour is located, how extensive it is and how closely it is positioned to vital organs and other tissues.
Imaging can also help doctors monitor how a tumour responds to treatment and determine whether further intervention is required.
Radiotherapy can subsequently be used where medically appropriate to destroy malignant cells and control or eliminate tumours.
However, children present a special challenge because their bodies are still developing.
Growing tissues and organs can be more sensitive to radiation, while children who successfully overcome cancer may live for many decades after treatment. This means that doctors must consider not only the immediate effectiveness of treatment but also its potential long-term consequences.
The objective is therefore to deliver a sufficiently high radiation dose to the tumour while protecting surrounding healthy tissues as much as possible.
Precision is increasingly important
This concern has helped drive the development and adoption of more precise radiation-treatment techniques.
Modern paediatric radiation oncology increasingly relies on technologies and treatment-planning methods designed to concentrate radiation on the tumour while limiting unnecessary exposure to nearby organs.
The importance of precision is particularly pronounced in children because damage to developing organs and tissues can potentially produce effects years or even decades after treatment.
Consequently, the goal of contemporary radiotherapy is no longer simply to deliver radiation to a tumour. It is to deliver the right dose, to the right location, while protecting the patient's healthy tissues as much as possible.
A global cancer-care gap
The unequal distribution of radiotherapy facilities reflects a broader disparity in access to cancer care.
While high-income countries have increasingly invested in advanced radiation equipment, specialised personnel and sophisticated treatment-planning systems, many low- and middle-income countries continue to struggle with the basic infrastructure needed to provide radiotherapy services.
The problem extends beyond purchasing machines.
Effective radiotherapy requires trained radiation oncologists, medical physicists, radiographers, engineers and other specialised professionals. Facilities also need reliable electricity, equipment maintenance, quality assurance systems and continuous technical support.
Without these components, even the acquisition of expensive radiotherapy equipment may not guarantee reliable access to treatment.
For millions of cancer patients, the issue is therefore not whether radiotherapy exists as a treatment, but whether it is available when and where they need it.
Technology must be matched with access
The history of radiotherapy demonstrates how far cancer medicine has advanced since the discovery of X-rays more than a century ago.
Today, radiation can be planned and delivered with a degree of precision that would have been unimaginable to the earliest practitioners. Imaging can guide treatment decisions, while sophisticated technologies can help clinicians protect healthy organs and tissues.
But the continuing global shortage of radiotherapy infrastructure highlights an uncomfortable reality: medical innovation alone cannot close the cancer-care gap.
As cancer incidence increases in many developing countries, expanding access to radiotherapy will remain critical.
For patients, particularly children, the availability of modern radiation treatment can make the difference between delayed care and timely treatment, between uncontrolled disease and effective tumour control, and ultimately between losing a life and gaining additional years.
The challenge for global health systems is to ensure that the benefits of more than a century of radiotherapy innovation are not limited to those who happen to live in countries with the resources to provide them.