FNCA FY2011 Workshop on Radiation Oncology Project
January, 10 - 13, 2012
Suzhou and Shanghai, China
(1) Following the agreement of Forum for Nuclear Cooperation in Asia (FNCA) /the 3rd Meeting of Study Panel on the Approaches toward Infrastructure Development for Nuclear Power, the FNCA FY2011 Workshop on Radiation Oncology was held from January10th to 13th, 2012, in Suzhou and Shanghai, China. The meeting was co-organized by China Atomic Energy Authority (CAEA), Soochow University (SUDA), China and the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan. Representatives from 10 FNCA Member States, namely Bangladesh, China, Indonesia, Japan, Korea, Malaysia, Mongolia, the Philippines, Thailand and Vietnam and 3 Regional Cooperation Agreement (RCA) Member States - India, Pakistan and Sri Lanka as observers from the International Atomic Energy Agency (IAEA) participated in the meeting.
(2) Prof. CAO Jianping, Director of School of Radiation Medicine and Protection, Medical College, Soochow University moderated the session. First, Prof. Ge Jianyi, the Vice Director of Soochow University, Director of the First Affiliated Hospital of Soochow University, opened the workshop officially with his opening address on behalf of Soochow University. He explained the objectives of the meeting are to focus on the clinical standardization of radio- and chemo-therapy of cervix cancer and nasopharyngeal cancer in Asia. The organizer, Soochow University, will make every effort to make this workshop success.
It was followed by Opening Remark of Ms. Ren Meizhen, Deputy Secretary General, China Atomic Energy Authority (CAEA). She emphasized that FNCA is a very important multilateral platform for member states to cooperate in the nuclear field, and has played an important role in pushing forward the nuclear cooperation in this regard. Following them, Dr. Hirohiko TSUJII, Former Executive Director of National Institute of Radiological Sciences (NIRS) delivered his remarks.
(3) Prof. Jiang Guo-liang, Former Director of Fudan University Shanghai Cancer Center, Proton and Heavy Ion Center, gave a Special Lecture on "Radiation Therapy for Hepatocellular Carcinoma: the Experience from Fudan University Shanghai Cancer Center". He introduced the establishment of radiotherapy technology, the clinical data, and the prediction of radiation induced liver disease (RILD) in Shanghai Cancer Center.
(4) The 4 new members, namely, Dr. Gombodorj Navchaa from Mongolia, Prof. Dr. Shyam Kishore SHRIVASTAVA from India, Ms. Naseem Akhtar from Pakistan and Dr. Yasantha Ariyaratne from Sri Lanka introduced themselves.
(5) The agenda was adopted, and chairpersons and reporters were elected. (See Program)
Session 1: Phase II Study of Chemoradiotherapy for Locally Advanced Cervical Cancer (CERVIX-III)
(6) Dr. Masaru Wakatsuki, medical doctor of Research Center Hospital for Particle Therapy, National Institute of Radiological Sciences (NIRS) Japan introduced the protocol of Cervix III. The summary of the follow-up data was also presented by him. One hundred twenty cases were registered in this protocol, half of them were stage IIB and another half were stage IIIB. The follow-up rate at the end of 2011 was 98% (117/120 cases). For late adverse effect above grade 3, only 8% of rectal complication has been observed. The 5-year local control of entire group is 76.8%, stage IIB and stage IIIB were 89.6% and 64.6%, respectively. The 5-year overall survival of entire group, stage IIB and stage IIIB were 55.1%, 63.3% and 46.6%, respectively.
(7) At an open discussion followed by the session, there were some comments and questions related to staging and follow-up examination, chemotherapy, ICBT, prognostic factors and patient's follow-up system. We encourage all members to examine their patients with abdominal CT before and after the treatment.
Session 2: Current Topics and Future Prospects of Chemoradiotherapy for Locally Advanced Cervical Cancer
(8) First, Dr. Masaru Wakatsuki introduced the practice of NIRS on cervical cancer. He presented on the long term and follow up results. In addition, he spoke about the occurrence of second malignancy after treatment of cervical cancer in a small proportion of patients.
Prof. Dr. Tatsuya Ohno, Professor / Medical Director, Heavy Ion Medical Center, Gunma University introduced the Current Prospects of Chemoradiotherapy for Locally Advanced Cervical Cancer. He spoke about image-based brachytherapy using CT/MRI. He also spoke on hybrid brachytherapy, a combination of intracavitary and interstitial implant.
Following them, Prof. Dr. Shingo Kato, Professor of Department of Radiation Oncology, International Medical Center, Saitama Medical University explained about Future Prospects about the therapy. He suggested two proposals: CCRT followed by adjuvant chemotherapy and on prospective study on pelvic IMRT.
(9) An open discussion on these proposals followed.
Session 3: Phase II Study of Concurrent Chemotherapy and Extended-Field Radiotherapy for Locally Advanced Cervical Cancer (CERVIX-IV)
(10) Prof. Dr. Shingo Kato introduced the protocol CERVIX- IV .The recent clinical data of Phase II Study of Concurrent Chemotherapy and Extended-Field Radiotherapy for Locally Advanced Cervical Cancer (CERVIX-IV) was presented by representatives of each participating country with the following number of patients: Bangladesh (19), China (4), Indonesia (6), Japan (16), Korea (7 ), Malaysia (1), Philippines (4), Thailand (4) and Vietnam (3).
Dr. Kumiko Karasawa, Head of Treatment Team3, Research Center Hospital for Charged Particle Therapy NIRS presented the summary of the clinical data. Of the total (67) patients registered from all the participating countries, (63) patients are considered evaluable.
(11) An open discussion on the clinical data of Cervix-IV followed. There is an indication of superior two year progression free survival in Cervix IV as compared to Cervix III in node positive cases. However, there is a need for longer follow up and to recruit more patients for this study.
Session 4: QA/QC of External Beam Therapy
(12) Report on a summary of intercomparison measurements using validated glass dosimeters done at 10 centers were presented by Dr. Shigekazu FUKUDA, Head of Heavy Particle Faculty Section, Dept. of Accelerator and Medical Physics, Research Center for Charged Particle Therapy, NIRS. This fiscal year, measurements were done in Institute of Nuclear Medicine and Oncology (INMOL) of Pakistan Atomic Energy Commission (PAEC) on 2 photon beams (6 & 15MV) using glass dosimeter and the ionization chamber. The results were within 1%.
Suggestion for future plan is to audit in wedge QA and chart checks in addition to standard QA.
Next, Dr. Kum Bae Kim, Medical Physicist and Senior Researcher, Korea Institute of Radiological & Medical Sciences (KIRAMS), made a presentation on the Status of radiation oncology in Korea. This was followed by QA/QC needs, methods and results on IMRT, IGRT, treatment systems, gated treatment and brachytherapy QA.
Session 5: Phase II Study of Chemoradiotherapy for NPC (any T, N2-3) NPC-I
(13) Prof. Dr. Tatsuya OHNO presented the summary of the protocol and follow-up data. The median follow-up time is 43 months for the surviving 86/121 patients. The 5 year local regional control and overall survival rate were 79% and 52% respectively. There were no significant differences on overall survival between N2 andN3, T1-2 and T3-4, and +/- bone scan. Compared with our historical data, the current FNCA protocol showed improved survival.
(14) An open discussion on the summary of the protocol and follow-up data of NPC (any T, N2-3) (NPC-I) followed.
Session 6: Phase II Study of Chemoradiotherapy for NPC (T3-4, N0-1) (NPC-II)
(15) Dr. Kumiko KARASAWA introduced the protocol NPC-II. The recent clinical data of Phase II Study of Chemoradiotherapy for NPC (T3-4N0-1) (NPC-II) was presented by representatives of each participating country. The following numbers were reported: Bangladesh (0), China (0), Indonesia (13), Japan (0), Korea (0), Malaysia (6), Philippines (0), Thailand (1), and Vietnam (50). Prof. Dr. Tatsuya OHNO presented the summary of the clinical data of (70) cases.
(16) An open discussion on the clinical data of NPC (T3-4, N0-1) (NPC-II) followed. As the recruitment for this protocol is slow, many countries expressed their views on including patients who are treated with 3DCRT and IMRT. It was agreed that these patients can be included.
Session7: Phase I/II Study of Concurrent Chemoradiotherapy (CCRT) for NPC (NPC-III)
(17) Dr. Kumiko Karasawa introduced the protocol NPC-III. The recent clinical data of Phase II Study of CCRT for NPC (NPC-III) was presented by representatives of each participating country. The following numbers were reported: Bangladesh (1), China (2), Indonesia (4), Japan (0), Korea (0), Malaysia (6), Philippines (5), Thailand (0) and Vietnam (10). Dr. Karasawa presented the summary of the clinical data and the evaluation of the FNCA NPC-III study results. There have been 22 patients enrolled in this study. The interruption of radiotherapy was 27% and the compliance of induction/CCRT (2 or 3 cycles) was 100%. Compliance of CCRT (4 or more cycles) was 60%. Toxicities of induction/ CCRT were acceptable in majority of countries.
(18) Open discussion on the clinical data of Phase I/II study of CCRT for NPC-III followed. A discussion was made about the toxicities of CCRT of the protocol. It was emphasized that the time interval between the induction chemotherapy and CCRT is to be kept to 3-4 weeks. As more countries are using IMRT for treating NPC, Dr. Karasawa requested that IMRT be allowed in the protocol. There is a need up to 120 patients enroll for these study.
Session 8: Country Report from New Member Countries and Collaboration of FNCA and IAEA/RCA
(19) Report on Status of oncology in Mongolia was presented by Dr. Gombodorj Navchaa, Vice-Director in Charge of Clinic, National Cancer Center of Mongolia. The Current Status of Radiation Oncology in Pakistan was presented by Ms. Naseem Akhtar, Principal Scientist, Institute of Nuclear Medicine and Oncology (INMOL), Pakistan Atomic Energy Commission (PAEC), Pakistan. The Current Status of Radiation Oncology in Sri Lanka was presented by Dr. Yasantha ARIYARATNE, Consultant Clinical Oncologist, National Cancer Institute, Maharagama, Sri Lanka. Finally, the report on Concomitant Chemo-Radiotherapy for Stage-III Carcinoma Cervix; A Phase-III Randomized Study (Presentation of Preliminary Data of On-going Study) was reported by Prof. Dr. Shyam Kishore SHRIVASTAVA, Professor/ Head, Department of Radiation Oncology, Tata Memorial Hospital, India.
Session 9: Future Plan, Other Activities
(20) Regarding Next Workshop, Schedule of the Next Workshop and Other activities, the following items were discussed and agreed.
||We agreed that the next workshop will be held in Thailand, tentatively on 14-18 January, 2013.
||Dr. Tsujii reminded the members that the protocol studies can be presented in local meetings and to contact FNCA office in Japan on intended journal publications.
||Discussion on authorship on publications was made and the role of the first and corresponding authors was clarified. It is better to nominate the first author. It was proposed that it is better to publish data with new information.
||A proposal on randomized trial was suggested as part of the future plan.
||Comments from new members were sought and discussed. It was highlighted by the members that under Dr Tsujii's leadership that such a highly successful outcome from protocol studies has resulted from multi-centers in multiple countries which are hardly seen in any other organization.
||All participants of this workshop appreciated the financial support provided by Japan and member countries. However, in order to sustain the success of this important project, it is preferable that all the member countries including Japan, strengthen their financial support.
(21) Regarding Other Activities of the project, the following items were suggested;
||Breast cancer was discussed as being the commonest.
||Dr. Tsujii suggested that each country to present data on breast cancer at the next FNCA workshop.
||A discussion on hepatocellular carcinoma and bone metastasis was made.
(22) The IAEA/RCA observers: FNCA appreciates the contribution of IAEA in nominating and sponsoring observers from India, Pakistan and Sri Lanka to attend this meeting and contributing valuable opinions and suggestions to strengthen the activities of FNCA. These countries have expressed their willingness to participate actively in the FNCA protocol studies. It is envisaged that IAEA will continue to cooperate in these research activities.
Session 10: Drafting the Workshop Minutes
(23) The draft minutes presented by reporters were discussed, amended. The minutes were unanimously adopted by the workshop participants.
(24) Dr. Hirohiko TSUJII closed the workshop officially with his closing remark, in which he expressed his appreciation to China as well as all the participants for their contribution and his expectations for the future of the project.
Session 11: Open Lecture
(25) Open lecture to the public was held at Soochow University as a part of the workshop. In Opening Ceremony, On behalf of Prof. Jiang Xinghong, Director of Medical College of Soochow University, Prof.CAO Jianping made welcome remarks.
(26) As the first lecture, Prof. Dr. Shingo KATO spoke on Introduction of FNCA Radiation Oncology Project.
(27) On the theme of Current Status of Radiation Oncology in China, Dr. Zhou Ju-ying, the First Affiliated Hospital of Soochow University, gave a lecture.
(28) On the theme of Chemoradiotherapy for Esophageal Cancer, Prof. Dr. Shogo YAMADA, President, Screening Center of the Diseases, Morinomiyako Occupational Health Association gave a lecture.
(29) Dr. Miriam Joy C. Calaguas, Chairman, Department of Radiation Oncology St. Luke's Medical Center, Philippines gave a lecture on Radiotherapy for Head and Neck Cancers in the Philippines.
(30) Dr. C.R. Beena DEVI, Senior Consultant Clinical Oncologist, Department of Radiotherapy, Oncology and Palliative care, Sarawak General Hospital gave a lecture on Using Groningen Frailty Index (GFI) as an assessment tool in Geriatric Oncology.
(31) For the last lecture, Prof. Dr. Takashi Nakano, Professor, Gunma University Graduate School of Medicine spoke on Carbon Ion Radiotherapy in Japan, on the theme of Radiation therapy in Asia.
(32) Dr. Hirohiko TSUJII concluded the Open Lecture with his closing remarks.
Session 12 Technical Visit at Suzhou First People's Hospital
(33) The participants conducted a Technical Visit to the First Affiliated Hospital of Soochow University. The overview of the hospital and Radiation Oncology Department were introduced and they observed Radiation Oncology Department.
Session 13 Shanghai Cancer Center Fudan University
(34) The participants conducted a Technical Visit to Shanghai Cancer Center Fudan University. After the introduction of the hospital and the Department of Radiation Oncology, the hospital tour was conducted. Participants visited the Department of Radiation Oncology, Breast Cancer Center, Department of Pathology and Laboratory of Research.