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Minutes of the FNCA 2004 Mini-Workshop on Radiation Oncology for NPC |
July 22- 24, 2004
National Institute of Radiological Sciences (NIRS), Chiba, Japan
Background
(1) Based on the proposal at the Forum for Nuclear Cooperation in Asia (FNCA) Workshop on Radiation Oncology held in December 2003, and approved at the FNCA Coordinators Meeting held in March 2004, the FNCA 2004 Mini-Workshop on Radiation Oncology for Nasopharyngeal Cancer (NPC) was held from 22 to 24 July 2004, at the National Institute of Radiological Sciences (NIRS) in Chiba, Japan. The meeting was jointly organized by the Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT) and NIRS, in cooperation with the Japan Atomic Industrial Forum, Inc. (JAIF). Representatives from 8 FNCA countries, China, Indonesia, Japan, Republic of Korea, Malaysia, the Philippines, Thailand and Viet Nam, participated in the workshop.
The objectives of the workshop are to discuss the standardization of radiation therapy techniques of NPC and on grading of radiation toxicity among participating countries of the joint clinical study for NPC.
Opening ceremony
(2) Dr. Hideo Tatsuzaki, NIRS, acted as the moderator. The opening remarks were delivered by Dr. Yasuhito Sasaki, President of NIRS, followed by welcome remarks by Ms. Miwako Shimizu, MEXT, and finally by Dr. Hirohiko Tsujii, NIRS.
Session 1: Medical Care for NPC
(3) Dr. H. Tatsuzaki, Japan, presented the results of the survey carried out in the participating institutions of the Member States. Fundamental issues include reimbursement of treatment cost by health insurance systems; total cost of therapy including radiotherapy, chemotherapy, imaging and consultation costs; availability and utilization of various modes of imaging in the staging and follow-up of patients; and standard treatment of NPC. The participants made clarifications on the data given and the data is to be confirmed before the FNCA workshop in December 2004. The possibility of releasing the data was discussed.
Session2: Diagnosis for NPC
(4) Dr. Inoue, Japan, Rep. of Korea, presented on the recommended target volume and planning strategy by the Japanese College of Radiology (JCR) and various American institutions. Discussion was centered on the best patient position and field arrangement in the treatment of NPC. Central to the discussion was the tolerance dose of various structures especially optic nerve and chiasm, pituitary gland and temporal lobe. The reported data indicates that the tolerance of the optic nerve / chiasm is 50 - 65 Gy (Emami et al 1991). However the participants felt that the incidence of blindness among NPC survivors was rare in their respective practices. A review of the treatment plans and radiation doses to the optic nerve / chiasm on these survivors was recommended.
Dr. Cho gave a short lecture on the utility of a Positron Emission Tomography (PET) in tumour staging and a review of data from his institution on the use of PET/CT scan in NPC.
It was agreed that, for staging of NPC, CT scan is essential but MRI is optional. PET may be a useful modality, but is not available in all participating countries and therefore will not be used for staging.
Session3: Radiotherapy for NPC
(5) Dr. M.J.C. Calaguas, The Philippines, Dr. D.H.Quoc Thinh, Viet Nam, Dr. T. Kullathorn, Thailand, Dr. J. Zhou, China, Dr. R. Susworo, Indonesia, and Dr. F.B. Ismail, Malaysia,
presented on the routine planning technique for his / her institutions. This includes planning target volume, treatment fields, dose prescription and critical structures. Dr. Calaguas also gave a short presentation on a paper on NPC treatment taken from ASTRO 2003.
The field margins and shaping blocks especially around the oral cavity and optic nerve were discussed in depth. A dose of 40 - 50 Gy to the optic nerve was deemed acceptable, but this structure should be excluded from the treatment fields thereafter if possible.
Drs. Cho and Inoue will make a proposal for the radiation fields based on CT planning at the next meeting. A narrative definition of fields setup for T1-2 and T3-4 cases will be prepared by Japanese members and circulated before the next meeting in December.
Considering the characteristic of a multi-institutional trial which is to have a uniform protocol, the meeting decided that brachytherapy and Intensity Modulated Radiation Therapy (IMRT) should not be used for this trial
Session4: Acute Toxicity Criteria

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(6) At the beginning of the session, Dr. Tsujii, Japan, gave a short presentation on the NIRS data on optic neuropathy and a short literature review.
Dr. T. Ohno, Japan, presented on the standard radiation toxicity criteria based on CTCAE version 3 and RTOG/EORTC. There was extensive discussion on the slides on clinical cases presented especially with borderline cases. The CTCAE would be used
for this study. |
Session5: Chemotherapy for NPC
(7) Dr. Kullathorn, Thailand, gave a review of clinical trials on the use of chemotherapy in NPC especially in the adjuvant setting. This was followed on by Dr. Kobayashi, Japan, who emphasized on the benefit of concurrent chemo-radiotherapy and on the need to improve distant metastases control. He also gave a short review on other drugs for NPC including newer agents and possible directions for future trials.
Session 6: Drafting the Workshop Minutes
(8) The draft minutes was discussed, amended and adopted.
Closing ceremony
(9) Participants expressed appreciation to MEXT, NIRS, 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 organizing committee members and participants.
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FNCA 2004 Mini-Workshop on Radiation Oncology for NPC (Draft)
Organized by: National Institute of Radiological Sciences (NIRS) Ministry of Education, Culture, Sports, Science and Technology (MEXT)
In cooperation with: Japan Atomic Industrial Forum, Inc.
Date: Friday, July 23 to Saturday, July 24, 2004
Venue: NIRS in Inage-Ku, Chiba-City, Japan
Stay at Hotel Sungarden Chiba 1-11-1, Chuo, Chuo-Ku, Chiba-City, Chiba, Japan
TEL: +81-43-224-1131 FAX:+81-43-224-1156
Thursday, July 22
Arrive at Tokyo International Airport
19:00 - 21:00 |
Welcome dinner (at Hotel Sungarden)
Chair: Tatsuzaki, H., Japan
Welcome Remarks: Dr. Yasuhito Sasaki, President, NIRS
Welcome Remarks: Ms. Miwako Shimizu, Special Staff,
Atomic Energy Division,
Research and Development Bureau, MEXT
Welcome Remarks: Dr. Hirohiko Tsujii, Supervisory Director,
Research Center for Charged Particle Therapy, NIRS |
Friday, July 23
09:00 - 10:00 |
Session 1: Medical Care for NPC
Chair: Cho, C.K., Korea
1) Presentation on the Results of Questionnaires
Tatsuzaki, H., Japan
2) Discussion |
10:00 - 10:15 |
< Coffee Break > |
10:15 - 12:00 |
Session 2: Diagnosis for NPC
Chair: Kato, S., Japan
1) Presentation on Imaging and Staging
Inoue, T., Japan
Cho, C.K., Korea
2) Discussion
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12:00 - 13:00 |
< Lunch > |
13:00 - 18:00 |
Session 3: Radiotherapy for NPC
Co- Chairs: Fuad, B.I., Malaysia & R. Susworo, Indonesia
1) Presentation of Target Volume and Treatment Planning
Calaguas, M.J.C., The Philippines
D.H.Quoc, Thinh, Viet Nam
Kullathorn T., Thailand |
15:00 - 15:15 |
< Coffee Break >
Co- Chairs: D.H.Quoc, Thinh, Viet Nam & Kullathorn T., Thailand
Zhou J., China
R. Susworo, Indonesia
Fuad, B.I., Malaysia |
17:00 - 17:15 |
< Break > 2) Discussion |
Saturday, July 24
09:00 - 11:00 |
Session 4: Acute Toxicity Criteria
Chair: Nakano, T., Japan
1) Presentation on Acute Toxicity
Ohno, T., Japan |
10:00 - 10:15 |
< Coffee Break >
2) Discussion |
11:00 - 14:00 |
Session 5: Chemotherapy for NPC
Chair: Suto, H., Japan
1) Presentation on Administer Cisplatin
Kobayashi, K., Japan
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12:00 - 13:00 |
< Lunch >
2) Presentation of Adjuvant Regimen
Kullathorn T., Thailand
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14:00 - 15:00 |
Session 6: Drafting the Workshop Minutes
Co-Chairs: Tatsuzaki, H., Japan
Calaguas, M.J.C., The Philippines
Fuad, B.I., Malaysia |
15:00 - |
Closing Remarks
Hirohiko Tsujii, Japan |
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Participants List of FNCA 2004 Mini-Workshop on Radiation Oncology for NPC
Country |
Name |
Title |
Organization |
China |
Dr. Zhou Juying |
Head, Department of Radiotherapy |
The First Affiliated Hospital of Soochow University |
Indonesia |
Prof. Dr. R. Susworo |
Radiologist / Radiation Oncologist, Department of Radiolody |
Faculty of Medicine University of Indonesia Jakarta Indonesia,
Dr.Cipto Mangunkusumo Hospital |
Japan |
Dr. Hirohiko Tsujii |
Director, Research Center for Charged Particle Therapy |
National Institute of Radiological Sciences |
Japan |
Dr. Takehiro Inoue |
Associate Professor |
Osaka University Graduate School of Medicine |
Japan |
Prof. Takashi Nakano |
Professor |
Gunma University Graduate School of Medicine |
Japan |
Dr. Kunihiko Kobayashi |
Associate Professor |
Saitama Medical School |
Japan |
Dr. Shingo Kato |
Clinical Diagnosis Section, Hospital, Research Center for
Charged Particle Therapy |
National Institute of Radiological Sciences |
Japan |
Dr. Hideo Tatsuzaki |
Head, International Co-operation Section |
National Institute of Radiological Sciences |
Japan |
Dr. Tatsuya Ohno |
Senior Doctor, Hospital, Research Center for Charged Particle
Therapy |
National Institute of Radiological Sciences |
Japan |
Dr. Hisao Suto |
Head, Department of Radiology |
Matsudo City Hospital |
Japan |
Ms. Miwako Shimizu |
Special Staff |
Atomic Energy Division Research & Development Bureau, MEXT |
Japan |
Ms. Masako Kimura |
Senior Officer, International Co-operation Section |
National Institute of Radiological Sciences |
Japan |
Mr. Yoshikazu Shinji |
Senior Officer, International Co-operation Section |
National Institute of Radiological Sciences |
Japan |
Mr. Tadao Seguchi |
Director, Asia Cooperation Center |
Japan Atomic Industrial Forum, inc. |
Japan |
Mr. Hideo Nakasugi |
General Manager, Asia Cooperation Center |
Japan Atomic Industrial Forum, inc. |
Japan |
Ms. Keiko Hanamitsu |
Depty Manager, Asia Cooperation Center |
Japan Atomic Industrial Forum, inc. |
Japan |
Mr. Tomoyuki Teranaka |
Project Manager, Asia Cooperation Center |
Japan Atomic Industrial Forum, inc. |
Korea |
Dr. Chul-Koo Cho |
Head, Department of Radiation Oncology |
Korea Cancer Center Hospital |
Malaysia |
Dr. Fuad Ismail |
Doctor, Department of Radiotherapy & Oncology |
Hospital University Kebangsaan Malaysia |
The Phillippines |
Dr. Miriam Joy C. Calaguas |
Chairman, Department of Radiation Oncology |
St. Luke's Medical Center |
Thailand |
Dr. Kullathorn Thephamongkhol |
Radiation Oncology division, Radiology department, |
Siriraj Hospital, Mahidol University |
Vietnam |
Dr. Dang Huy Quoc Thinh |
Chief, Department of Radiotherapy No. 2 |
Ho Chi Minh City Oncology Hospital |
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