December 14 to 17, 2004
Narai Hotel, Bangkok, Thailand

Background:
Following the agreement at the 5th Forum for Nuclear Cooperation in Asia (FNCA) Coordinators Meeting in March 2004 and the agreement at the 5th FNCA Meeting in December 2004, the FNCA 2004 Workshop on Radiation Oncology was held from December 14 to 17, 2004, in Bangkok, Thailand. The meeting was jointly organized by the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan, the Thai Society of Therapeutic Radiology and Oncology (THASTRO) and the Siriraj Hospital, Faculty of Medicine, Mahidol University, in cooperation with the Japan Atomic Industrial Forum, Inc. (JAIF). Representatives from eight FNCA countries, namely China, Indonesia, Japan, Republic of Korea, Malaysia, the Philippines, Thailand and Viet Nam, participated in the workshop.

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Opening ceremony
Dr. Yaowalak Chansilpa, Siriraj Hospital, acted as the moderator. The welcome remarks were delivered by Dr. Suthisak Suthipongchai, Head of Department of Radiology, Siriraj Hospital. This was followed by remarks from, Dr. Yongyut Kongthanarat, President of THASTRO, Ms. Miwako Shimizu, MEXT, Mr. Patom Yamkate, Office of Atoms for Peace (OAP) and finally by Dr. Hirohiko Tsujii, National Institute of Radiological Sciences (NIRS).

Dr. Yongyut Kongthanarat then gave a Special Lecture on the present status of radiation therapy in Thailand and emphasized the shortage of radiation oncologists. The agenda was adopted, and chairpersons nominated.

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Session1:
Accelerated Hyperfractionation Radiotherapy for uterine cervix cancer (CERVIX-II)
The follow-up data up to December 2004, of 103 eligible patients in the CERVIX-II study was presented. The overall 4-year survival and local control rates were 77 % and 84%, respectively. Acute and late morbidities were acceptable. The follow-up of these patients for at least two more years was encouraged to conclude the protocol.

Session2: Chemo-radiotherapy for Uterine Cervix Cancer
The status of the phase II study was presented by each country. A summary of 35 patients from all countries was also presented. The number of patients enrolled is still small compared to the planned accrual of 100 patients and continued recruitment was encouraged. Issues discussed include:
i) Correct hydration schedule in order to minimize acute chemo-toxicity.
ii) Agreement to include data of eligible patients from Phase I study.
iii) The need for evaluation of paraaortic lymphnodes by CT scan, which is not included in FIGO staging, should be considered for future studies.

Session3: Chemo-radiotherapy for Nasopharyngeal Cancer
Clinical trials of combined chemotherapy and radiotherapy were reviewed. The results of the pilot study of concurrent chemo-radiotherapy for nasopharyngeal cancer (NPC) were presented by each country. Pooled data of the pilot study showed that the protocol is well tolerated and could be used for the next phase.
Several proposals for new clinical trials were presented and discussed. Equipment status for diagnosis and treatment of NPC was reviewed based on the feasibility survey.

Session4: New clinical trial of Chemo-radiotherapy for NPC
Treatment planning for NPC using CT simulator and the optimal radiation fields were presented. Further literature review on trials of chemo-radiotherapy for NPC and adjuvant chemotherapy for lung cancer were also presented.
Two protocols for NPC were agreed upon.
1. Phase II trial on N2-N3 disease (NPC-I)
2. Phase III trial for N0-1 stage III-IVB disease (NPC-II)
The estimated target accrual for the Phase II trial is 25 patients. The Phase III trial will start after evaluation of the Phase II trial and the number of patients required will be calculated later.

Session5: QA/QC of Radiation Dosimetry
The description of the measurement technique of joint fieldwork for physical Quality Assurance / Quality Control (QA/QC) of brachytherapy and procedure manual were presented. The results of the measurements conducted at the hospitals visited in 5 countries, the Philippines, Thailand, and Viet Nam in 2003, and Japan and Korea in 2004, were acceptable. The importance of these mutual visits for dosimetry QA/QC was reemphasized. Similar QA/QC activities in the remaining countries, Malaysia, Indonesia, and China, are tentatively scheduled for September - October 2005. Two institutions per country will be surveyed and medical physicists from Japan and some of the member countries will be participating in these visits.

Session 6: Future plans and other relevant activities
Future plans were discussed and approved.
These include: The NPC-I protocol is scheduled to start by March 2005. Rapid accrual is necessary for the results to be evaluated by the next workshop; A Phase III trial for uterine cervix cancers following CERVIX-III to be discussed in next workshop; the possible evaluation of tumor markers in NPC; the possible involvement of otorhinolaryngologists and medical oncologists for future trials.
The meeting requested for a new program for the medical physicists’ group in order to expand the QA/QC activity to external beam therapy.
The meeting suggested Korea as the venue for the next workshop pending agreement of the Korean Government.

Open Lecture
The Open Lectures were held as part of the workshop. There were 34 local participants including medical doctors, medical physicists and researchers. The session was opened with remarks from Dr. H. Tsujii. Four lectures were given by FNCA participants. Dr. Yongyut Kongthanarat gave his Closing Remarks at the end of the session.

Session 7: Evaluation of FNCA Radiation Oncology project
The overall activities of this project were evaluated. The report was amended and adopted.

Session 8: Drafting the Workshop Minutes
The draft minutes were discussed, amended and adopted.

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Closing ceremony Participants expressed appreciation to MEXT, THASTRO, Siriraj Hospital, local staff organizing the meeting, and JAIF. The participants also expressed their gratitude for the continuing support from the Government of Japan for this project. Closing Remarks were given by Dr. H. Tsujii, who expressed his appreciation to the host institute and participants as well as his expectations for the future projects.

 

Tuesday, December 14 to Friday, December 17
Bangkok, Thailand

Organized by:
　　　　　    Siriraj Hospital, Faculty of Medicine, Mahidol University
　　　　　    The Thai Society of Therapeutic Radiology and Oncology (THASTRO)
　　　　　    Ministry of Education, Culture, Sports, Science, and Technology (MEXT)
In cooperation with:
　　　　　    Japan Atomic Industrial Forum, Inc.

Date:	December 14-17, 2004
Venue:	Narai Hotel Siriraj Hospital, Faculty of Medicine, Mahidol University
Stay:	Narai Hotel Address: 222 Silom Road, Bangkok 10500, Thailand Phone: +66-2-237-0100, FAX: +66-2-236-7161