Page 315 Guide to Pain Management in Low-Resource Settings

Chapter 40
Cytoreductive Radiation Th erapy

Lutz Moser

What is the current status What is the signifi cance of
of radiotherapy services radiotherapy in pain?
in low- and middle-income Th e effi cacy of radiotherapy applies mostly to cancer-re-
countries? lated pain. Palliative care improves the quality of life of

patients by providing pain and symptom relief from di-
External-beam radiotherapy can be delivered by linear
agnosis to the end of life (according to the World Health
accelerators or cobalt teletherapy units. Cobalt units are
Organization). Th e principal aim is to alleviate the pa-
more robust and less prone to external infl uences like
tient’s symptoms.
unstable electricity supply. Even though radiotherapy
Pain control in patients with cancer represents a sig-
is one of the most cost-eff ective forms of cancer treat-
nifi cant aspect of radiation therapy practice worldwide.
ment, there is an undersupply of radiotherapy facilities
Radiation therapy is one of the most eff ective, and often
especially in Africa and Asia. Th is problem is due to the
the only, therapeutic option to relieve pain caused by
high initial capital investment in equipment and spe-
nerve compression or infi ltration by malignant tumor
cially designed buildings and in technical maintenance,
or pain from liver and bone metastases, and it provides
equipment replacement, and permanent access to en-
successful palliation of dysphagia caused by esophageal
gineering support. Th erefore, radiotherapy facilities are
carcinoma and of pain due to pancreatic cancer.
restricted to metropolitan centers such as the capital
cities of these countries.
Many countries in Africa do not have radiother- What is the effi cacy of radiotherapy
apy facilities at all. The availability of radiotherapy in pain due to bone metastasis?
services differs in the other countries from 1 machine
per 126,000 people (Egypt) to 1 machine per 70 mil- In about 50–80% of patients, symptoms from bone me-
lion people (Ethiopia). West Africa has the poorest tastases manifest as skeletal or neuropathic pain, path-
supply of radiotherapy equipment, with 1 unit per 24 ological fractures, hypercalcemia, nerve root damage,
million people. In Asia the distribution ranges from and spinal cord compression. Th e most common symp-
no facility in some states, to 1 machine per 11 mil- tom of skeletal metastases is pain, present in the major-
lion people (Bangladesh), to 1 machine per 807,000 ity of patients with metastatic bone lesions. Typically,
people (Malaysia). the pain is slowly progressive over days to weeks and

Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 303
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
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