Cancer significantly contributes to the cause of morbidity and mortality in Zambia 71% of people diagnosed with cancer in Zambia die from the disease; however, access to radiotherapy (RT) services is lacking. More than 50% of cancer patients will require radiotherapy for curative or palliative intent. The country first established RT services in 2006. Prior to that only a few Zambians accessed this specialised treatment abroad, mainly due to the high costs. After a successful run of service for over a decade, in 2022 the country suffered total disruption of RT services due to obsolete equipment that has been earmarked for decommissioning. The country is now in the process of re-establishing the RT services to make them sustainable. This article aims at reviewing how the RT services (RT equipment and personnel) have been managed, the opportunities that exist (demand for RT services, availability of training institutions, support from the government and cooperating partners) and lastly the challenges (equipment shortages and operation, lack of medical physicists and biomedical engineers, financial constraints, procurement and maintenance delays). The insights offered by this work will elicit a data based decision making approach to meticulous RT service provision.