Limitations of Radiotherapy

Limitations

1. High cost

Sophisticated equipment is required for radiotherapy in order to perform cancer treatments with a high accuracy and effectiveness. The equipment includes an accelerator, a simulator, a bean direction shell, a treatment planning computer and a specialized treatment room (Greene, 2014). The cost for these equipment is high, ranging from $60,000 to 350,000, in regard to the type of radiotherapy. For RapidArc, it costs around $60,000; The costs for Novalis and Gammaknife are $80,000 and $140,000 respectively. While that for Cyberknife and Tomotherapy are $200,000 and $350,000 correspondingly (Hong Kong Anti-Cancer Society, 2016). In addition, the costs for salaries of the medical professionals such as radiotherapists and physicists should also be taken into consideration. The operating and maintenance costs of the machines and equipment should not be overlooked as well (Greene, 2014).

The expensive costs of equipment would probably transfer to patients, causing a relatively high treatment cost (Liu, Wu, Day, Muo, Sung, Kao & Liang, 2015). The treatment cost ranging from $80,000 to $350,000, depending on the type of radiotherapy (Hong Kong Cancer Fund, 2016). While Novalis costs the least and Tomotherapy would be the most expensive among the types. Some of the patients may not be able to afford the costs for radiotherapy. Thus, treatment costs may become the major concern and obstacle for patients to undergo radiotherapy as cancer treatment.

1. Limited effectiveness when used alone

There is probably limitation when treating cancers alone with radiotherapy. The effectiveness and efficiency may not be satisfied when using radiotherapy alone to treat cancers. According to the research study done in 2014, the median survival rate of only using radiotherapy (mean = 5 months) is lower than that of the combination of radiotherapy and resection (mean = 11 months) by about 6 months (Mukherjee, Sarmiento, Nosova, Boakye, Lad, Black, Nuno & Patil, 2014). It is usually used with chemotherapy (Dawson & Sharpe, 2006). Patients may need to perform multiple therapies or treatments to treat cancers, which possible induce more occurrence of side effects, harming the well-being of patients’ health.

1. Limited effectiveness against metastasized cancers

Radiotherapy works as cancer-killing radiation is delivered at tumor sites. Unlike chemotherapy, the radiation for radiotherapy does not travel throughout the body to destroy cancer cells (Dawson & Sharpe, 2006). It is effective to treat tumors that grow locally, however, there may be difficulties for killing cancer cells that undergone metastasis. In order words, radiotherapy cannot effectively kill cancer cells that have spread in the body, which chemotherapy does, as the radiation is not able to spread in patients’ body to kill cancer cells (National Centre Institute,2017).

1. Long course of treatment

The duration for the whole radiotherapy treatment is relatively long. Each course would require over 30 times of treatments, which takes more than 2 months. While the time for each treatment would require a few hours (Hong Kong Anti-Cancer Society, 2016). Patients probably need to go to the hospital or clinic for treatment frequently, for example 5 days per week. This may affect patients’ daily routine to certain extend (Cheung, 2006). As radiotherapy required patients to access to hospitals frequently, it would be a concern and a limitation for patients when selecting the treatment for cancers.

1. Occurrence of side effects

The last limitation of radiotherapy is the presence of different side effects. The side effects can probably be divided into those cover most cancers and those which are site-specific that are only present in certain specific cancers. Fatigue, certain skin problems, loss of hairs, loss of appetite and certain problems associated with ears are the examples of the former. At the same time, the latter including the oral effects and higher risk of ischemic heart disease.

One of the most common type of side effects is fatigue caused by the extra energy needed in replacing the destroyed or killed normal tissues near the cancer cells. Branch, Hubenak, Kronowitz, Zhang (2014) stated that radiotherapy kills those cells since the metabolic stress is increased and DNA lesions are created. For the skin problems, they can be divided into two aspects: mild case and serious case. Dull erythema and skin tightening are the common symptoms of the mild case but for the serious one, there are some open wounds, which lead to severe pain, caused by moist desquamation and may even cause necrosis. (Sott, 2014) The skin that suffer from those problems are the area that receive radiotherapy directly and the possibility of having those problems are very high, nearly 90 percent of patients receiving the radiotherapy will suffer from the mild or serious case of the skin problems. For the loss of hairs in different parts of the body, the hairs in the areas receiving the radiotherapy, which are similar with that of the skin problems, will loss during the treatment, they may be grown again but will be sparser than before. Moreover, the radiotherapy for lung cancer, esophagus cancer, nasopharyngeal cancer and cancer of spinal cord may cause the loss of appetite which means the patients may want to vomit and do not want to eat. At the same time, many different types of cancers involve the radiation of the ears such as head, neck, nasopharyngeal and brain cancers. This causes the short-term effects like otitis media and otitis externa. But the long-term effects are more serious such as tinnitus, chronic otitis med, weakening the hearing and even deaf.

Other than those common side effects, different cancers have specific side effects. Darby, Cutter, Peto, Hall, Nisbet, Gigante, Bennet, 2013 indicated that breast cancer will enhance the risk of ischemic heart disease since the radiotherapy of breast cancer includes the procedure that patients’ hearts are exposed to ionizing radiation and the increase in the risk persists for around 20 years. Moreover, the oral effects caused by the radiotherapy of head and neck cancer is also one of the examples. The instant effects include dysphagia, mucositis and dysgeusia while xerostomia, rampant caries and trismus are the examples of the long-term results. In particular, mucositis has the symptoms of hemorrhage, oral erythema, ulcer and pain of the mouth which are caused by the injury of the mucosal lining in the oral cavity. For the long-term effects, xerostomia means that the patients get their mouth dry easily while trismus means the spasm of the jaw muscles, and hence the mouth remains tightly closed (Famine Relief, 2015).