FNCA - Forum for Nuclear Cooperation in Asia

Background:
　The Forum for Nuclear Cooperation in Asia (FNCA) FY2005 Workshop on Radiation Oncology was held from January 23 to 27, 2006, at the Korea Institute of Radiological & Medical Sciences (KIRAMS), Seoul, Korea, following the agreement of the 6th FNCA Meeting in December 2005, and the 5th FNCA Coordinators Meeting in March 2005. The meeting was organized by KIRAMS and co-hosted by the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan, in cooperation with the Atomic Energy Division, Atomic Energy Bureau, Ministry of Science & Technology (MOST) of Korea, and the Japan Atomic Industrial Forum, Inc. (JAIF). Representatives from 8 FNCA countries, China, Indonesia, Japan, Republic of Korea, Malaysia, the Philippines, Thailand and Vietnam, participated in the workshop.

Opening ceremony
　In the opening ceremony, welcome remarks were given by Dr. Soo-Yong Lee, President of KIRAMS, Mr. Tooru Nakahara, Director of Atomic Energy Division, MEXT, and Dr. Hirohiko Tsujii, Project Leader of Japan.

　A special lecture on the present status of radiation therapy in Korea was given by Prof. Seung-Jae Huh, Secretary General of Korean Society of Radiation Oncology. The agenda was adopted and chairpersons were nominated.

Session1:
Follow- up status of patients treated with AHF for Cervix Cancer
　Presentation of the results of the Cervix-II study was given by Dr. T. Ohno. Total of 121 patients were enrolled in the study from January 1999 - November, 2002. Over all 5 year survival and local control rates for all the 103 eligible patients enrolled in the present protocol were 73% and 88%, respectively. Treatment failure was 8% in pelvic region, 21% in distant metastasis and 2% in the both sites. Late GI toxicities of mild degree were increased compared with CERVIX I but this treatment was well tolerated.

Session2: Chemo-radiotherapy for Uterine Cervix Cancer (CERVIX-III)
　Each country presented the phase II study and the summary was presented by Dr.S. Kato. One hundred and eight patients have been enrolled in the study consisting of the following: 18 China, 5 Indonesia, 25 Japan, 10 Korea, 9 Malaysia, 12 Philippines, 19 Thailand, and 10 Vietnam. Seventy eight per cent of patients received 4 or more cycles of chemotherapy and average was 4.3. Sites of distant metastasis were as follows: PAN, SCLN, mediastinal nodes, bone and liver. The incidence and severity of acute toxicity were within acceptable level.

　The number of enrolled patients has already reached the planned accrual of 100 patients. Follow-up is important and the participants are encouraged to continue enrollment till March 2006.

Session3: New Clinical Trial for Cervical Cancer (CERVIX-IV)
　A direction of further clinical study for cervical cancers was proposed by Dr. S. Kato and discussed. In order to prevent paraaortic lymph nodes metastasis as noted in CERVIX III trial, the new proposal was made comparing pelvic CCRT (concurrent chemoradiotherapy) + prophylactic paraaortic lymph node RT vs. pelvic CCRT + adjuvant chemotherapy. The meeting decided to conduct two single arm pilot studies before entering into further trials. Details of the two studies were discussed. Each participating country is expected to conduct the pilot studies for one year and report their results in the next meeting.

　A new protocol for further prospective randomized study will be proposed and discussed in the next meeting based on the experience of the above mentioned studies.

Session4: Phase2 Study of Chemo-radiotherapy for NPC (NPC-I)
　Summary of clinical data of Phase II trial on N2-N3 nasopharyngeal cancer (NPC-I) was presented by Dr. T. Ohno. A total of 16 patients were entered into the study: 3 Indonesia, 5 Korea, 4 Philippines, and 4 Thailand. Among 10 patients who were evaluated at 6 month, only 1 patient finished 2 cycles of adjuvant chemotherapy.
The meeting decided to extend the registration period for another year.

Session5: New Clinical Trial for NPC (NPC-II)
　A draft protocol for phase II study of chemoradiotherapy for locally advanced diseases, T3-4 N0-1 NPC, was presented by Dr. T. Inoue. Two options were given. The first one was randomized trial with or without adjuvant chemotherapy, the second one was concurrent chemoradiotherapy without adjuvant chemotherapy. Most of the participants chose the second option(NPC II). It was clarified that the differences of NPC II from NPC I are the nodal status of the subjects and no adjuvant chemotherapy; NPC I is for N2-N3 and NPC II is for NO-N1. It was agreed that the group would start the new trial NPC-II, after distribution of the revised protocol.

Session 6: QA/QC of Radiation Dosimetry
　The results of the joint fieldwork for physical Quality Assurance / Quality Control (QA/QC) of brachytherapy were presented by Dr. Y. Nakamura. The results of the measurements conducted at the hospitals visited to 7 countries since 2003-2005 were acceptable. A QA/QC activity in a remaining country, China, is tentatively scheduled in September or October, 2006.

　A new QA/QC project for tele-therapy using postal dose survey was proposed by Dr. H. Mizuno. A glass dosimeter, which has a 1-2 % standard deviation in measurement, is proposed as a suitable technology for this project. Participants from each country will discuss the feasibility with their physicists and check importation requirements to receive the glass dosimeter and solid phantom with the concerned authorities. The survey will be initiated in 2006 and can be completed in 1-2 years.

Session 7: Future plans, other activities
　Previous surveys and possible surveys as by-products from FNCA oncology network were presented by Dr. H. Tatsuzaki. Proposed topics for further survey were cancer therapy statistics and cost analysis. The participants in the meeting agreed to provide data on the cancer registry statistics first. The range of data can be extended to whole country but data from the hospitals joined FNCA trials and some other representing hospitals should be collected with priority. Dr. Tatsuzaki will prepare the survey form and send it to all the countries.

　Evaluation result by Dr. S. Machi, FNCA Coordinator of Japan, was distributed. In the review, evaluation and planning of projects, by the FNCA Coordinators Meeting, the Radiation Oncology Project was rated high and was approved for its continuation.

　Each country expressed their comments on the evaluation. The participants expressed the importance of outcomes of the trials, the importance of QA/QC activities, value of data from "East" and the importance of publication and propagation among other things.

　Future plans were discussed and approved.

　The meeting suggested Viet Nam as the venue for the next workshop subject to an agreement of the Government of Viet Nam and accepted the tentative schedule as early December 2006.

　In this meeting, it was decided to present this result in an international forum and publish it in an international journal. Presentations of the result at local societies were encouraged, but not for publication.

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

Closing ceremony
　Participants expressed appreciation to MEXT, KIRAMS, MOST, JAIF and local staff for organizing the meeting. The participants further 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 project.

Technical tour
　Participants conducted a Technical Tour to the Korean Cancer Center Hospital (KCCH), which is a division of KIRAMS.

Open Lectures
　The Open Lectures were held at KIRAMS as a part of the workshop. There were local participants including medical doctors, medical physicists and researchers. The session was opened with remarks from Dr. H. Tsujii. Five lectures were given by FNCA participants. Dr. C.K. Cho gave his Closing Remarks at the end of the session.

(1) The Forum for Nuclear Cooperation in Asia (FNCA) FY2005 Workshop on Radiation Oncology was held from January 23 to 27, 2006, at the Korea Institute of Radiological & Medical Sciences (KIRAMS), Seoul, Korea, following the agreement of the 6th FNCA Meeting in December 2005, and the 5th FNCA Coordinators Meeting in March 2005. The meeting was organized by KIRAMS and co-hosted by the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan, in cooperation with the Atomic Energy Division, Atomic Energy Bureau, Ministry of Science & Technology (MOST) of Korea, and the Japan Atomic Industrial Forum, Inc. (JAIF). Representatives from 8 FNCA countries, China, Indonesia, Japan, Republic of Korea, Malaysia, the Philippines, Thailand and Vietnam, participated in the workshop (See Attachment 1, list of participants).

Opening ceremony
(2) In the opening ceremony, welcome remarks were given by Dr. Soo-Yong Lee, President of KIRAMS, Mr. Tooru Nakahara, Director of Atomic Energy Division, MEXT, and Dr. Hirohiko Tsujii, Project Leader of Japan.

(3) A special lecture on the present status of radiation therapy in Korea was given by Prof. Seung-Jae Huh, Secretary General of Korean Society of Radiation Oncology. The agenda was adopted and chairpersons were nominated. (See Attachment 2)

Session1:
Follow- up status of patients treated with AHF for Cervix Cancer
(4) Presentation of the results of the Cervix-II study was given by Dr. T. Ohno. Total of 121 patients were enrolled in the study from January 1999 - November, 2002. Over all 5 year survival and local control rates for all the 103 eligible patients enrolled in the present protocol were 73% and 88%, respectively. Treatment failure was 8% in pelvic region, 21% in distant metastasis and 2% in the both sites. Late GI toxicities of mild degree were increased compared with CERVIX I but this treatment was well tolerated.

Session2: Chemo-radiotherapy for Uterine Cervix Cancer (CERVIX-III)
(5) Each country presented the phase II study and the summary was presented by Dr.S. Kato. One hundred and eight patients have been enrolled in the study consisting of the following: 18 China, 5 Indonesia, 25 Japan, 10 Korea, 9 Malaysia, 12 Philippines, 19 Thailand, and 10 Vietnam. Seventy eight per cent of patients received 4 or more cycles of chemotherapy and average was 4.3. Sites of distant metastasis were as follows: PAN, SCLN, mediastinal nodes, bone and liver. The incidence and severity of acute toxicity were within acceptable level.

(6) The number of enrolled patients has already reached the planned accrual of 100 patients. Follow-up is important and the participants are encouraged to continue enrollment till March 2006.

Session3: New Clinical Trial for Cervical Cancer (CERVIX-IV)
(7) A direction of further clinical study for cervical cancers was proposed by Dr. S. Kato and discussed. In order to prevent paraaortic lymph nodes metastasis as noted in CERVIX III trial, the new proposal was made comparing pelvic CCRT (concurrent chemoradiotherapy) + prophylactic paraaortic lymph node RT vs. pelvic CCRT + adjuvant chemotherapy. The meeting decided to conduct two single arm pilot studies before entering into further trials. Details of the two studies were discussed (see attachment 3). Each participating country is expected to conduct the pilot studies for one year and report their results in the next meeting.

(8) A new protocol for further prospective randomized study will be proposed and discussed in the next meeting based on the experience of the above mentioned studies.

Session4: Phase2 Study of Chemo-radiotherapy for NPC (NPC-I)
(9) Summary of clinical data of Phase II trial on N2-N3 nasopharyngeal cancer (NPC-I) was presented by Dr. T. Ohno. A total of 16 patients were entered into the study: 3 Indonesia, 5 Korea, 4 Philippines, and 4 Thailand. Among 10 patients who were evaluated at 6 month, only 1 patient finished 2 cycles of adjuvant chemotherapy.
The meeting decided to extend the registration period for another year.

Session5: New Clinical Trial for NPC (NPC-II)
(10) A draft protocol for phase II study of chemoradiotherapy for locally advanced diseases, T3-4 N0-1 NPC, was presented by Dr. T. Inoue. Two options were given. The first one was randomized trial with or without adjuvant chemotherapy, the second one was concurrent chemoradiotherapy without adjuvant chemotherapy. Most of the participants chose the second option(NPC II). It was clarified that the differences of NPC II from NPC I are the nodal status of the subjects and no adjuvant chemotherapy; NPC I is for N2-N3 and NPC II is for NO-N1. It was agreed that the group would start the new trial NPC-II, after distribution of the revised protocol.

Session 6: QA/QC of Radiation Dosimetry
(11) The results of the joint fieldwork for physical Quality Assurance / Quality Control (QA/QC) of brachytherapy were presented by Dr. Y. Nakamura. The results of the measurements conducted at the hospitals visited to 7 countries since 2003-2005 were acceptable. A QA/QC activity in a remaining country, China, is tentatively scheduled in September or October, 2006.

(12) A new QA/QC project for tele-therapy using postal dose survey was proposed by Dr. H. Mizuno. A glass dosimeter, which has a 1-2 % standard deviation in measurement, is proposed as a suitable technology for this project. Participants from each country will discuss the feasibility with their physicists and check importation requirements to receive the glass dosimeter and solid phantom with the concerned authorities. The survey will be initiated in 2006 and can be completed in 1-2 years.

Session 7: Future plans, other activities
(13) Previous surveys and possible surveys as by-products from FNCA oncology network were presented by Dr. H. Tatsuzaki. Proposed topics for further survey were cancer therapy statistics and cost analysis. The participants in the meeting agreed to provide data on the cancer registry statistics first. The range of data can be extended to whole country but data from the hospitals joined FNCA trials and some other representing hospitals should be collected with priority. Dr. Tatsuzaki will prepare the survey form and send it to all the countries.

(14) Evaluation result by Dr. S. Machi, FNCA Coordinator of Japan, was distributed. In the review, evaluation and planning of projects, by the FNCA Coordinators Meeting, the Radiation Oncology Project was rated high and was approved for its continuation.

(15) Each country expressed their comments on the evaluation. The participants expressed the importance of outcomes of the trials, the importance of QA/QC activities, value of data from "East" and the importance of publication and propagation among other things.

(16) Future plans were discussed and approved. (See Attachment 4)

(17) The meeting suggested Viet Nam as the venue for the next workshop subject to an agreement of the Government of Viet Nam and accepted the tentative schedule as early December 2006.

(18) In this meeting, it was decided to present this result in an international forum and publish it in an international journal. Presentations of the result at local societies were encouraged, but not for publication.

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

Closing ceremony
(20) Participants expressed appreciation to MEXT, KIRAMS, MOST, JAIF and local staff for organizing the meeting. The participants further 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 project.

Technical tour
(21) Participants conducted a Technical Tour to the Korean Cancer Center Hospital (KCCH), which is a division of KIRAMS.

Open Lectures
(22) The Open Lectures were held at KIRAMS as a part of the workshop. There were local participants including medical doctors, medical physicists and researchers. The session was opened with remarks from Dr. H. Tsujii. Five lectures were given by FNCA participants. (See Attachment 2) Dr. C.K. Cho gave his Closing Remarks at the end of the session.

Attachment:
- Attachment 1: Participants List
- Attachment 2: Program of the Workshop
- Attachment 3: New Cervix trials
- Attachment 4: future plan

The FNCA FY2005 Workshop on Radiation Oncology

Minutes of the FNCA FY2005 Workshop on Radiation Oncology

Program of the FNCA FY2006 Workshop on Radiation Oncology

Participants List of FNCA FY 2005 Workshop on Radiation Oncology