JSCO2016: International Session 9 International Cooperation in Radiation Medicine

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The 54th Annual Meeting of Japan Society of Clinical Oncology (JSCO2016)

"Renovation of Cancer Medicine in the Mature Society"



International Session 1: Lung Cancer
International Session 2: Colorectal Cancer
International Session 3: Gastric Cancer
International Session 4: Urological Cancer (Prostate and Renal Cancer)
International Session 5: Supportive Care for Adverse Events
International Session 6: Gynecological Cancer (Uterine Body Cancer and Ovarian Cancer)
International Session 7: Central Nervous System Tumor
International Session 8: New Development of Particle Beam Therapy for Cancer
International Session 9: International Cooperation in Radiation Medicine
International Session 10: Recent Advances In Cancer Immunotherapy
International Session 11: Breast Cancer
International Session 12: Pharmacology of Antitumor Agents: New Drug Application (NDA)
International Session 13: Malignant Lymphoma
International Session 14: Palliative Care
International Session 15: Radiation Therapy
International Session 16: Head and Neck Cancer
International Session 17: Skin Cancer (Malignant Melanoma)
International Session 18: Hepato-Biliary and Pancreas Cancers
International Session 19: Leukemia
International Session 20: Ethics for Clinical Research
International Session 21: Esophageal Cancer
International Session 22: Bone and Soft Tissue Tumor
FACO/JSCO Joint Symposium

Abstract Archives (in Japanese)


International Session 9: International Cooperation in Radiation Medicine


Role of the IAEA in developing radiotherapy programmes
Eduardo H. Zubizarreta (Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Austria)
The IAEA main delivery mechanism is the Technical Cooperation (TC) Programme. Between 1983 and 2013, the TC Fund invested $289.6 million in cancer and radiation therapy projects worldwide. The TC projects follow a planning cycle that comprises submission of project concepts by Member States, subsequent project design, and finally program approval by the Board of Governors of the IAEA and assignment of resources for their implementation. 25 new national radiation therapy projects and new 20 regional projects are implemented in the 2016 to 2017 cycle, to make a total of 123 active projects in cancer care.
A typical IAEA radiotherapy (RT) project to establish a new facility normally includes human resource capacity building, expert advice, and the provision of equipment. For the human resource component, the project always includes the training of a full team, including radiation oncologists, medical physicists, and radiation therapists. Projects that involve the delivery of expensive RT equipment are very carefully designed and include a preparatory procurement plan that takes into account the existing regulatory safety aspects, numbers of staff, and their training needs. With regard to equipment, the Agency often relies on cost-sharing agreements with governments. In countries where the IAEA has assisted with the establishment of a first radiation therapy centre, it has been found to have had a multiplying effect by promoting further expansion, acquisition of new equipment, and training of staff, culminating in the establishment of additional radiation therapy centres. On several occasions, the involvement of the IAEA in a radiation therapy project facilitated input by donors willing to support this form of cancer therapy.


Current status of radiotherapy in Asia: The challenge in diversity
Miriam Joy Calaguas (South East Asian Radiation Oncology Group (SEAROG))
Improving accessibility to radiotherapy is one complex issue in a region as heterogeneous as Asia. As the incidence of cancer increases due to the advancement in both screening and diagnosis, the aging population and the persistence of carcinogenic risk factors like tobacco and obesity, also increases. The challenge of providing adequate and quality radiotherapy needs concrete and strategic planning in the Asian region.

The Federation of Asian Organizations for Radiation Oncology (FARO) was founded in 2014 as a non-profit scientific organization of 11 countries in Asia. It aims to foster the role of radiation oncology in improving the basic level of radiotherapy for the benefit of the patients in the Asian region. In the latest statistics from FARO (2015), approximately 1.6 million cancer patients per year are treated with radiotherapy in Asia. Currently, there are about 7,984 radiation facilities and an estimate of 200 cancer patients per year for each radiotherapy facility. There are 23,822 radiation oncologists, having a ratio of 1 radiation oncologist treating 97 patients per year.

During radiotherapy, both tumor and normal cells in the treatment field are exposed to radiation. Therefore, the evolution of radiation techniques from 2D to 3DCRT, to IMRT, IGRT, and the other technological advancements, has the primary aim of delivering high doses of radiation to the targeted tumor while minimizing doses to the organs at risks.

Different local and regional radiation oncology societies such as JASTRO, SEAROG, Tri-lateral, FARO, etc, together with other international organizations like IAEA, ASTRO, ESTRO, are establishing linkages in order to improve the current state of radiotherapy in Asia through education and training, development of practice guidelines, research, and quality assurance programs. International cooperation and networking is important in conducting these activities primarily for the best interest of our patients.


Multi-center prospective trials on uterine cervical cancer: Radiotherapy activities in the Forum for Nuclear Cooperation in Asia (FNCA)
Tatsuya Ohno (Heavy Ion Medical Center, Gunma University)
The Forum for Nuclear Cooperation in Asia (FNCA) is a Japanese government-led framework for international cooperation with neighboring Asian countries toward the peaceful use of nuclear technology. The FNCA Radiation Oncology Project started its activities since 1993 with an aim to establish optimal treatments and to improve treatment results for cancers that are common in Asia. This project has been conducting multiinstitutional clinical trials on radiotherapy (RT) for locally advanced uterine cervical cancer, locally advanced nasopharyngeal cancer, and breast cancer. To bring out the example for cervical cancers, 4 clinical trials have been conducted (RT alone, accelerated hyperfractionated RT, concurrent chemoradiotherapy (CCRT), CCRT + paraaortic RT).
In the third trial on CCRT for cervical cancer, 10 institutions from 8 Asian developed and developing countries participated. Between April 2003 and March 2006, 120 patients (60 with bulky Stage IIB and 60 with Stage IIIB) were treated with CCRT. Radiotherapy consisted of pelvic external beam radiotherapy and either high-dose-rate or low-dose-rate intracavitary brachytherapy. Five cycles of weekly cisplatin (40 mg/m2) were administered during the course of radiotherapy. Median follow-up was 63.7 months, and the follow-up rate at 5 years was 98%. The 5-year LC and OS for all patients were 76.8% and 55.1%, respectively The 5-year grade 3 or worse late toxicities in the rectum and bladder were 7.9% and 0%, respectively. The long-term results have suggested that CCRT is safe and effective for patients with locally advanced cervical cancer in the participated Asian centers.
Currently, FNCA cervical cancer protocol has become one of the standard protocols among participated countries. In this symposium, we would like to present our rationale, outcomes of clinical trials, and socio-economic impacts through the more than 20 years activities.


Japan's contribution in the IAEA radiation oncology projects in Asian region: Projects of Regional Cooperative Agreement (RCA)
Tomoaki Tamaki (Department of Radiation Oncology, Fukushima Medical University School of Medicine)
The International Atomic Energy Agency (IAEA) has its objective "to accelerate and enlarge the contribution of atomic energy to peace, health and prosperity throughout the world." With such mandate, the IAEA has promoted the safe and effective practice of radiotherapy worldwide and especially in developing countries. In the activities of the IAEA in Asia, one of the main partners has been the Regional Cooperative Agreement for Research, Development and Training Related to Nuclear Science and Technology for Asia and the Pacific (RCA) which is an intergovernmental agreement established in 1972. The membership has increased from its original 10 Member States to the present number of 22 Member States in the Asia-Pacific Region.
IAEA/RCA has implemented more than 30 regional projects in the Asia and Pacific region in the fields of radiation oncology, nuclear medicine and medical physics since 1980's, and 8 radiation oncology projects have been implemented since 2000. These projects have responded to the rapidly growing needs of human resource development while accommodating the advancement of the radiotherapy technologies at the time. The themes of these radiation oncology projects were brachytherapy for cervical cancer, 3D image-based radiotherapy, 3D image-guided brachytherapy, stereotactic body radiation therapy, and intensity modulated radiotherapy. Japan has taken the role of Project Lead Country in 7 projects.
The IAEA/RCA radiation oncology projects not only provided the first-hand learning and training opportunities for radiation oncology professionals in the region but also strengthened the mechanism of technical cooperation and academic exchange among the Asian countries. These activities have resulted in the establishment of the Federation of Asian Organizations for Radiation Oncology (FARO). It is expected that the future activities of the IAEA/RCA will be enhanced with further cooperation with national radiation oncology societies in Asia and with FARO.


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