Report of
FNCA FY2022 Workshop on Radiation Oncology

Outline of Workshop

The FNCA FY2022 Workshop on Radiation Oncology was held from 29^th September to 2^nd October 2022, in Ulaanbaatar, Mongolia. The meeting was co-organized by the National Cancer Center of Mongolia (NCCM), the Nuclear Energy Commission of Mongolia (NEC) and the Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT). Representatives from 11 FNCA member countries, namely Bangladesh, China, Indonesia, Japan, Kazakhstan, Korea, Malaysia, Mongolia, Philippines, Thailand and Vietnam participated in the workshop.
September 29^th, the first day of the workshop was held in a hybrid manner.
This project carries out some international joint clinical studies in order to establish treatment protocols for uterine cervix cancer, nasopharyngeal cancer and breast cancer, which affect large number of people in FNCA member countries, and finally to improve the technique of radiation oncology in the Asian region.

Opening Session
Dr. Uranchimeg Tsegmed, Chief Operating Officer/Radiation Oncologist of Department of Radiation Oncology, National Cancer Centre of Mongolia (NCCM) moderated the session. Dr. Erdenekhuu Nansalmaa, General Director of NCCM welcomed the participants with his address. Ms. Munkhtuya Baasanjav, Head of Foreign Affairs Division of Nuclear Energy Commission (NEC) gave participants a welcome address. Dr. Navchaa Gombodorj, Director of Division of Referral and Primary Healthcare Services, Department of Medical Service Coordination, Ministry of Health deliver a welcome address. Dr. TAMADA Masao, FNCA Advisor of Japan gave his opening remarks. Prof. KATO Shingo, the Project Leader of Radiation Oncology Project gave his remarks.

Prospective Observational Study of 3D-Image guided brachy therapy for Locally Advanced Cervical Cancer (CERVIX-V)
This is a new protocol for cervical cancers following Cervix-IV. The patient enrollment started in 2017.

Japan reported the summary of the clinical data as follows.

The number of target cases enrolled is 100 cases. From May 2017 to September 2022, 89 patients were enrolled in CERVIX-V. Out of these, 81 patients were eligible. Case enrollment from member countries is Bangladesh (2), China (10), Indonesia (9), Japan (12), Kazakhstan (6), Korea (0), Mongolia (4), Malaysia (11), the Philippines (8), Thailand (27) and Vietnam (0). The deadline for patient enrollment is November 2023.
As per the preliminary analysis of CERVIX-V, 73 patients whose follow-up periods exceeded 6 months were analyzed. The remaining eight patients had a follow-up period of shorter than 6 months. All patients were treated with 3D-IGBT. Among them, 26 patients were treated with the interstitial technique. Compared to the reference doses, 93% of cases satisfied those doses.
Regarding toxicities, grade 3 acute hematological toxicity was observed in 18 (25%) patients, and grade 3 acute non-hematological toxicity was observed in 2 (3%) patients. No grade 4 or severe acute toxicity was observed. No grade 3 or severe late toxicity was observed to date.
With a median follow-up time of 27 months, the 2-year, locoregional control (LC), progression-free survival (PFS), and overall survival (OS) were 91%, 75%, and 87%, respectively. Locoregional recurrence occurred in 12 cases; 5 were in regional lymph node recurrence, and 7 cases were local recurrence.

Discussion on CERVIX-V followed.

 -Prof. KATO Shingo (Japan) made comments regarding the pattern of local failure.
 -Dr. AFM Kamal Uddin (Bangladesh) made comments and suggested adding a new cancer center (Labaid Cancer Hospital and Super Specialty Center) from Bangladesh. The protocol of CERVIX-V has already been approved by the IRB of that mentioned hospital.
 -Dr. OKONOGI Noriyuki (Japan) explained that the follow-up frequency and modalities should be according to the institutional protocol, but more frequent follow-up would be ideal.

Phase II Study of Neoadjuvant Chemotherapy with Concurrent Chemoradiotherapy (CCRT) for Nasopharyngeal Carcinoma (NPC-III)
A total 120 patients have been registered in this protocol.
The number of patients by county is Bangladesh (1), China (9), Indonesia (12), Japan (0), Kazakhstan (0), Korea (0), Malaysia (31), Mongolia (0), Philippines (7) Thailand (0) and Vietnam (60).

Japan reported the summary of the clinical data as follows.

The primary endpoint of this clinical trial is set to 3-year OS. Patient enrollment was completed in 2019. Total number of patients enrolled in NPC-III is 120. All enrolled cases have now reached primary endpoint evaluation period. Comparing NPC-III with NPC-I, it showed worse local control but comparable OS. Some data is missing for final analysis.

Discussion on the clinical data of NPC-III followed.

 -Prof. OHNO Tatsuya (Japan) asked the reasons behind the higher local failure rate compared to NPC-I trial. While multiple reasons may contribute to this, it was agreed that in-depth investigation required be done when all of the data has been submitted and ready for analysis.
 -Prof. OHNO also asked how to collect data that are yet to be submitted and how to confirm data that are still in question. Online video conferencing was suggested as an effective and efficient method for this.

Phase II Study of Hypofractionated Radiotherapy for Breast Cancer (Postmastectomy Radiation Therapy (PMRT) & (Whole Breast Irradiation (WBI) /BREAST-I)
In this session, protocols PMRT and WBI /BREAST-I were reviewed and the summaries of the 2 clinical studies were presented by Japan.

PMRT/BREAST-I
From February 2013 to October 2019, 222 cases were registered. The number of patients registered from Bangladesh ( 84 ), China ( 13 ), Indonesia ( 0 ), Japan ( 15 ), Kazakhstan ( 20 ), Korea ( 0 ), Malaysia ( 0 ), Mongolia ( 26 ), Philippines ( 18 ), Thailand ( 0 ) and Vietnam ( 46 ).
All but one completed the protocol treatment and was analyzed. The acute adverse effects of skin G1 (62%), G2 (10%), G3 (5%); subcutaneous tissue G1 (16%), G2 (2%); lung G1 (6%); heart G1 (9%). The Follow up period is 1 to 114 months with a median of 64 months. The late adverse effects of skin G1 (42%), G2 (1%); subcutaneous tissue G1 (16%), G2 (2%); breast G1 (5%); lung G1 (6%); heart G1 (2%). There were 6 loco-regional recurrence, 30 distant metastases, 17 breast cancer deaths and 9 intercurrent deaths. The five-year loco-regional control, progression free survival and overall survival rates are 96.3%, 78.0% and 90.1%, respectively

WBI/BREAST-I
From February 2013 to October 2018, 227 cases were registered. The registered numbers were Bangladesh ( 31 ), China ( 6 ), Indonesia ( 16 ), Japan ( 134 ), Kazakhstan ( 14 ), Korea ( 9 ), Malaysia ( 0 ), Mongolia ( 3 ), Philippines ( 0 ), Thailand ( 14 ) and Vietnam ( 0 ).
All patients with 228 tumors completed the protocol treatment and was analyzed. The acute adverse effects of skin G1 (80%), G2 (11%), G3 (2%); subcutaneous tissue G1 (11%); lung G1 (1%). The Follow up period is 6 to 113 months with a median of 65 months. The late adverse effects of skin G1 (21%), G2 (1%); subcutaneous tissue G1 (10%); breast G1 (9%); lung G1 (2%).The cosmetic outcome were excellent (147), good (75) , fair (3) and poor (3) in patients with more than 3 years follow-up.
One loco-regional recurrence, 6 distant metastases, 3 breast cancer death and 9 intercurrent death have been observed. The 5-year LC, PFS survival and OS are 99.6%, 95.1% and 96.0%, respectively.

New Clinical Trials
In 2019's WS, palliative radiotherapies for bone metastasis and brain metastasis were proposed and discussed as new clinical trials. In 2020, surveys were conducted among the project members in order to draft protocols. The results of the surveys were introduced in the 2020's WS.

-Palliative Radiotherapy for Bone Metastasis
Dr. MAKISHIMA Hirokazu (Japan) proposed an outline of 2 survey studies regarding palliative radiotherapy for bone metastasis.

The aim of the 2 surveys is to understand the current practice of RT for painful bone metastasis and the reason behind it. First survey will be targeting FNCA member facilities, attempting to understand the actual current practice within these facilities, by asking criteria for each well-known dose/fractionation and confirming the percentage used based on actual treatment records. Second survey will be targeting radiotherapy facilities within FNCA member countries in attempt to understand the basic mindset of radiation oncologists within these countries, by asking preferred dose/fractionation and the reasoning behind it based on a model clinical case.

Prof. OHNO suggested the need of confirming the reasons why 8 Gy/1 Fr regimen will not be used with short life expectancy cases.

-Palliative Radiotherapy for Brain Metastasis
Dr. Kullathorn Thephamongkhol (Thailand) proposed a clinical study on a prediction model for added value of whole brain radiotherapy in multiple brain metastasis from non-small cell lung cancer.

He explained the background of the study, study design, eligibility criteria, various predictors, endpoint, sample size, and statistical analysis. Data availability, especially availability of biomarker status, required sample size, and other prediction models used in the FNCA institutions were discussed.

Finally, this study was accepted as the next FNCA study (Brain-I). Based on the discussion, Dr. Thephamongkhol will write the full protocol. This retrospective study will be initiated next year after getting approval from the institutional review board (IRB). National Institutes for Quantum Science and Technology (QST) will work as the data center of the study.

Quality Assurance (QA)/Quality Control (QC) for Brachy Therapy (BT)
This activity aims to put in place reliable dosimetry in the institutes among the member countries for effective joint clinical studies. The audits in QA/QC of dosimetry measurement and radiation calibration have been conducted, which is for the reliable radiotherapy.
Along with the initiation of CERVIX-V, this QA/QC activity also focuses on the 3D-IGBT.

The end-to-end test of 3D-IGBT was scheduled during the workshop (at NCCM) but due to technical issues regarding CT simulator, this was not possible and was postponed to the next available opportunity.

The alternative QC test was done by medical physicists from Japan, Mongolia, Korea and Indonesia, Malaysia and Thailand.
The QC test comprised of source strength, applicator offset and source position confirmation, which turned out to be meeting required tolerances.

QA/QC for External Beam Radiation Therapy (EBRT)
Besides the dose audit for brachytherapy, another dose audits for external beam therapy were conducted at the NCCM. They were the external dosimetry audit using ionizing chamber and the intercomparison of the reference dose using radiophotoluminescent glass dosimeter (RGD).
This audit resulted in the difference between the described dose and measured dose were -1.2% and 0.29% for 6MV and 10MV beams, respectively, which were within the required tolerances. It was also mentioned that the RGD dosimetry audit results would be reported in one month after reading the integrated dose of RGD in Japan.

Open Lecture
Open Lecture was held at the NCCM, as a part of the workshop on the 2nd day. There were 9 lectures on the themes of 1) Overview and Introduction of FNCA, 2) Policies implemented by the MOH, Mongolia (MOH) aimed at the development of Oncology and Radiation Oncology, 3) Chemoradiotherapy for cervical cancer ,4) Radiotherapy for breast cancer, 5) Radiotherapy for hepatocellular carcinoma, 6) Development of LINAC-based new technologies in Mongolia, 7) 3D-IGBT for locally advanced cervical cancer in Mongolia, 8) Palliative Radiotherapy and 9) Particle Beam Therapy.

Technical Visit to Department of Radiation Oncology of NCCM
The WS participants visited the Department of Radiation Oncology (DRO) of NCCM.

Hands on Training on 3D-IGBT
Hands on training regarding 3D-IGBT was conducted at NCCM. The training was led by Dr. MURATA Kazutoshi (Japan) with several radiation oncologists and medical physicists from Japan, Thailand and Mongolia. Dr. MURATA gave a lecture to NCCM staffs and FNCA members regarding 3D-IGBT, and a hands-on training with 2 demonstrative cases was conducted followed by an applicator insertion training using a phantom.

Future Plans
The participants reviewed the WS sessions for the last 4 days and discussed the future-plan of the project.
 -Final report on NPC-III will be done when all data has been submitted to the data center and confirmed. Dr. MAKISHIMA Hirokazu will be leading the report which is to be submitted to a peer-reviewed international scientific journal.
 -IAEA collaboration with IAEA/RCA RAS 6/098 was encouraged.
 -It was agreed that the next workshop is to be held in Japan at Saitama Medical University and QST.

Drafting WS Minutes
The draft of the minutes was submitted by rapporteurs, discussed and amended. The draft of the minutes will be circulated after the workshop and finalized.
Prof. KATO Shingo summarized the WS. He also expressed his appreciation to Mongolia and the WS participants.
The workshop was closed with his closing remarks.

Minutes of
FNCA FY2022 Workshop on Radiation Oncology Project

(1) Following the agreement at the 22nd Forum for Nuclear Cooperation in Asia (FNCA) Coordinators Meeting, the FNCA FY2022 Workshop on Radiation Oncology was held from 29th September to 2nd October 2022, in Ulaanbaatar, Mongolia. The meeting was co-organized by the National Cancer Center of Mongolia (NCCM), the Nuclear Energy Commission of Mongolia (NEC) and the Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT). Representatives from 11 FNCA member countries, namely Bangladesh, China, Indonesia, Japan, Kazakhstan, Korea, Malaysia, Mongolia, Philippines, Thailand and Vietnam participated in the workshop.

Opening Ceremony
(2) Dr. Uranchimeg Tsegmed, Chief Operating Officer/Radiation Oncologist of Department of Radiation Oncology, National Cancer Centre of Mongolia (NCCM) moderated the session.

Dr. Erdenekhuu Nansalmaa, General Director of NCCM welcomed the participants with his address.

Ms. Munkhtuya Baasanjav, Head of Foreign Affairs Division of Nuclear Energy Commission (NEC) gave participants a welcome address.

Dr. Navchaa Gombodorj, Director of Division of Referral and Primary Healthcare Services, Department of Medical Service Coordination, Ministry of Health deliver a welcome address.

Dr. TAMADA Masao, FNCA Advisor of Japan gave his opening remarks.

(3) Introduction of individual participants followed.

(4) The agenda was adopted and chairpersons and rapporteurs were selected.

Session 1: Prospective Observational Study of 3D-Image Guided Brachytherapy for Locally Advanced Cervical Cancer (CERVIX-V)
(5) Dr. OKONOGI Noriyuki, a chief physician, Clinical Research Group of Pelvic tumor, Department of Charged Particle Therapy Research, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), presented the summary of analyzed clinical data of CERVIX-V.

The number of target cases enrolled is 100 cases. From May 2017 to September 2022, 89 patients were enrolled in CERVIX-V. Out of these, 81 patients were eligible. Case enrollment from member countries is Bangladesh (2), China (10), Indonesia (9), Japan (12), Kazakhstan (6), Korea (0), Mongolia (4), Malaysia (11), the Philippines (8), Thailand (27) and Vietnam (0). The deadline for patient enrollment is November 2023.
As per the preliminary analysis of CERVIX-V, 73 patients whose follow-up periods exceeded 6 months were analyzed. The remaining eight patients had a follow-up period of shorter than 6 months. All patients were treated with 3D-IGBT. Among them, 26 patients were treated with the interstitial technique. Compared to the reference doses, 93% of cases satisfied those doses.
Regarding toxicities, grade 3 acute hematological toxicity was observed in 18 (25%) patients, and grade 3 acute non-hematological toxicity was observed in 2 (3%) patients. No grade 4 or severe acute toxicity was observed. No grade 3 or severe late toxicity was observed to date.
With a median follow-up time of 27 months, the 2-year, locoregional control (LC), progression-free survival (PFS), and overall survival (OS) were 91%, 75%, and 87%, respectively. Locoregional recurrence occurred in 12 cases; 5 were in regional lymph node recurrence, and 7 cases were local recurrence.

An open discussion on CERVIX-V followed.

 -Prof. KATO Shingo made comments on the progression of the CERVIX-V study. He also made comments regarding the pattern of local failure.
 -Dr. AFM Kamal Uddin (Department of Radiation Oncology, National Institute of Ear, Nose & Throat (ENT)) made comments and suggested adding a new cancer center (Labaid Cancer Hospital and Super Specialty Center) from Bangladesh. The protocol of CERVIX-V has already been approved by the IRB of that mentioned hospital.
 -A discussion was done about the follow-up of the CERVIX-V patients regarding the frequency of clinical follow-up and imaging modalities during follow-up. Dr. OKONOGI answered that the follow-up frequency and modalities should be according to the institutional protocol, but more frequent follow-up would be ideal.

Session 2: Phase II Study of Neoadjuvant Chemotherapy with Concurrent Chemoradiotherapy (CCRT) for Nasopharyngeal Carcinoma (NPC-III)
(6) Dr. MAKISHIMA Hirokazu, Professor (Assistant), Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba presented the summary of analyzed clinical data of NPC-III.

120 patients have been registered in this protocol. The number of patients by county is Bangladesh (1), China (9), Indonesia (12), Japan (0), Kazakhstan (0), Korea (0), Malaysia (31), Mongolia (0), Philippines (7) Thailand (0) and Vietnam (60).

The primary endpoint of this clinical trial is set to 3-year OS.
Patient enrollment was completed in 2019. Total number of patients enrolled in NPC-III is 120. All enrolled cases have now reached primary endpoint evaluation period. Comparing NPC-III with NPC-I, it showed worse local control but comparable OS. Some data is missing for final analysis.

An open discussion on the clinical data of NPC-III followed.

 -Prof. OHNO Tatsuya (Professor and Chairperson Department of Radiation Oncology, Gunma University Graduate School of Medicine) asked the reasons behind the higher local failure rate compared to NPC-I trial. While multiple reasons may contribute to this, it was agreed that in-depth investigation required be done when all of the data has been submitted and ready for analysis.
 -Prof. OHNO also asked how to collect data that are yet to be submitted and how to confirm data that are still in question. Online video conferencing was suggested as an effective and efficient method for this.

Session 3-4: Phase II Study of Hypofractionated Radiotherapy for Breast Cancer (Postmastectomy Radiation Therapy (PMRT) & (Whole Breast Irradiation (WBI) /BREAST-I)
(7) Prof. KARASAWA Kumiko, Professor and Chair, Division of Radiation Oncology, Department of Radiology, School of Medicine, Tokyo Women's Medical University presented the summary of analyzed clinical data of PMRT / BREAST-I. The summary is as follows.

From February 2013 to October 2019, 222 cases were registered. The number of patients registered from Bangladesh ( 84 ), China ( 13 ), Indonesia ( 0 ), Japan ( 15 ), Kazakhstan ( 20 ), Korea ( 0 ), Malaysia ( 0 ), Mongolia ( 26 ), Philippines ( 18 ), Thailand ( 0 ) and Vietnam ( 46 ). All but one completed the protocol treatment and was analyzed. The acute adverse effects of skin G1 (62%), G2 (10%), G3 (5%); subcutaneous tissue G1 (16%), G2 (2%); lung G1 (6%); heart G1 (9%). The Follow up period is 1 to 114 months with a median of 64 months. The late adverse effects of skin G1 (42%), G2 (1%); subcutaneous tissue G1 (16%), G2 (2%); breast G1 (5%); lung G1 (6%); heart G1 (2%). There were 6 loco-regional recurrence, 30 distant metastases, 17 breast cancer deaths and 9 intercurrent deaths. The five-year loco-regional control, progression free survival and overall survival rates are 96.3%, 78.0% and 90.1%, respectively.

(8) Next, Prof. KARASAWA presented the summary of the analyzed clinical data of WBI / BREAST-I followed. The summary is as follows.

From February 2013 to October 2018, 227 cases were registered. The registered numbers were Bangladesh ( 31 ), China ( 6 ), Indonesia ( 16 ), Japan ( 134 ), Kazakhstan ( 14 ), Korea ( 9 ), Malaysia ( 0 ), Mongolia ( 3 ), Philippines ( 0 ), Thailand ( 14 ) and Vietnam ( 0 ). All patients with 228 tumors completed the protocol treatment and was analyzed. The acute adverse effects of skin G1 (80%), G2 (11%), G3 (2%); subcutaneous tissue G1 (11%); lung G1 (1%). The Follow up period is 6 to 113 months with a median of 65 months. The late adverse effects of skin G1 (21%), G2 (1%); subcutaneous tissue G1 (10%); breast G1 (9%); lung G1 (2%).The cosmetic outcome were excellent (147), good (75) , fair (3) and poor (3) in patients with more than 3 years follow-up.
One loco-regional recurrence, 6 distant metastases, 3 breast cancer death and 9 intercurrent death have been observed. The 5-year LC, PFS survival and OS are 99.6%, 95.1% and 96.0%, respectively.

Session 5: New Clinical Trials
 -Palliative Radiotherapy for Bone Metastasis
(9) Dr. MAKISHIMA Hirokazu proposed an outline of 2 survey studies regarding palliative radiotherapy for bone metastasis.

The aim of the 2 surveys is to understand the current practice of RT for painful bone metastasis and the reason behind it. First survey will be targeting FNCA member facilities, attempting to understand the actual current practice within these facilities, by asking criteria for each well-known dose/fractionation and confirming the percentage used based on actual treatment records. Second survey will be targeting radiotherapy facilities within FNCA member countries in attempt to understand the basic mindset of radiation oncologists within these countries, by asking preferred dose/fractionation and the reasoning behind it based on a model clinical case.

An open discussion on the concept followed.
 -Prof. OHNO suggested the need of confirming the reasons why 8 Gy/1 Fr regimen will not be used with short life expectancy cases.

All the members agreed on the proposal and the detailed questionnaire will be sent to all members by Dr. MAKISHIMA.

 -Palliative Radiotherapy for Brain Metastasis
(10) Dr. Kullathorn Thephamongkhol, Lecturer, Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University proposed a clinical study on a prediction model for added value of whole brain radiotherapy in multiple brain metastasis from non-small cell lung cancer.
He explained the background of the study, study design, eligibility criteria, various predictors, endpoint, sample size, and statistical analysis. Data availability, especially availability of biomarker status, required sample size, and other prediction models used in the FNCA institutions were discussed. Finally, this study was accepted as the next FNCA study (Brain-I). Based on the discussion, Dr. Kullathorn Thephamongkhol will write the full protocol. This retrospective study will be initiated next year after getting approval from the institutional review board (IRB). National Institutes for Quantum Science and Technology (QST) will work as the data center of the study.

Session 6-1: QA/QC for Brachytherapy
(11) A dose audit for 3D-IGBT was conducted at the NCCM by the following members; Mr. Bambang Haris Suhartono, Dr. KIM Kum Bae, Mr. Muzzamer Bin Mohammad Zahid, Mr. Pitchayut Nakkrasae, Dr. FUKUDA, Shigekazu, Mr. NAKAJI Taku, Dr. MIZUNO Hideyuki, Mrs. Enkhtsetseg Vanchinbazar and medical physicists from NCCM. Dose audit comprised of source strength, applicator offset and source position confirmation. While end-to-end test of 3D-IGBT was scheduled, due to technical issues regarding CT simulator, this was not possible and was postponed to the next available opportunity.

Session 6-2: Open Lecture
(12) The Open Lecture was held at the NCCM in parallel with the dose audit.

(13) Dr. Uranchimeg Tsegmed moderated the session and Dr. Minjmaa Minjgee, Head of Department of Radiation Oncology of NCCM welcomed the audience with her opening remarks.

(14) Dr. TAMADA Masao gave a lecture about the FNCA. He introduced its overview and spoke about the on-going 7 projects' activities and achievements.

(15) Dr. Navchaa Gombodorj, Ministry of Health of Mongolia (MOH) delivered a speech on Policies implemented by the Ministry of Health aimed at the development of Oncology and Radiation Oncology.

(16) Prof. KATO Shingo delivered a lecture on Chemoradiotherapy for cervical cancer

(17) Prof. KARASAWA Kumiko delivered a lecture on Radiotherapy for breast cancer.

(18) Dr. JANG Wonil, Chief, Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences (KIRAMS) gave a lecture on Radiotherapy for hepatocellular carcinoma.

(19) Dr. Uranchimeg Tsegmed spoke on Development of LINAC-based new technologies in Mongolia.

(20) Dr. Erdenetuya Yadamsuren, Radiation Oncologist of Department of Radiation Oncology, NCCM introduced the 3D-IGBT for locally advanced cervical cancer in Mongolia.

(21) Dr. Kullathorn Thephamongkhol spoke on Palliative Radiotherapy.

(22) Dr. WAKATSUKI Masaru, Director of Department of Radiation Medicine, QST Hospital, Quantum Life and Medical Science Directorate, QST delivered a lecture on particle beam therapy.

(23) Lastly, Prof. KATO Shingo made comments on the lectures and gave the audience the closing remarks.

Session 7: Technical Visit to Department of Radiation Oncology (DRO) of NCCM
(24) Overview of NCCM was introduced to the WS participants by Dr. Uranchimeg Tsegmed. Overview of the Department of Radiation Oncology (DRO) of NCCM was introduced by Dr Minjmaa Minjgee. WS Participants visited the sites of radiation oncology of NCCM.

Session 8: Report on Dose Audit (QA/QC for Brachytherapy)
(25) Mr. NAKAJI Taku, Technical Staff of Radiation Quality Control Section, QST Hospital, Quantum Medical Science Directorate, QST reported on the dose audit for brachytherapy conducted in NCCM Hospital on the previous day. QC test for applicator offset and source strength have been checked meeting required tolerances. However, end to end test for 3D-IGBT was not possible for NCCM hospital in this time due to technical issues.
Discussion on QA/QC for brachytherapy followed.

Dr MIZUNO proposed to have on-site audits by the end of March 2023.

Session 9-1: Hands on Training regarding 3D-IGBT
(26) Hands on training regarding 3D-IGBT was conducted at NCCM. The training was led by Dr. MURATA Kazutoshi (Chief Physician, Radiation Oncology Section, Department of Diagnostic Radiology and Radiation Oncology, QST Hospital, Quantum Life and Medical Science Directorate, QST) with several radiation oncologists and medical physicists from Japan, Thailand and Mongolia.
Dr. MURATA gave a lecture to NCCM staffs and FNCA members regarding 3D-IGBT, and a hands-on training with 2 demonstrative cases was conducted followed by an applicator insertion training using a phantom.

Session 9-2: QA/QC for External Beam Therapy
(27) The dose audits for External Beam Therapy were conducted at the NCCM in parallel with the hands-on training. They were the external dosimetry audit using ionizing chamber and the intercomparison of the reference dose using radiophotoluminescent glass dosimeter (RGD).
These audits were by medical physicists from Japan, Mongolia, Korea and Indonesia.

Session 10: Report on Dose Audit (External Beam Therapy)
(28) Dr. FUKUDA Shigekazu, Section Manager of Radiation Quality Control Section, QST Hospital, Quantum Medical Science Directorate, QST reported on the dose audits conducted on the previous day. The external dosimetry audit resulted in the difference between the described dose and measured dose were -1.2% and 0.29% for 6MV and 10MV beams, respectively, which were within the required tolerances. It was also mentioned that the RGD dosimetry audit results would be reported in one month after reading the integrated dose of RGD in Japan.

Session 11: Future plans
(29) The participants reviewed the WS sessions for the last 4 days and discussed the future-plan of the project.
 -Final report on NPC-III will be done when all data has been submitted to the data center and confirmed. Dr. MAKISHIMA Hirokazu will be leading the report which is to be submitted to a peer-reviewed international scientific journal.
 -IAEA collaboration with IAEA/RCA RAS 6/098 was encouraged.
 -It was agreed that the next workshop is to be held in Japan at Saitama Medical University and QST.

Session 12: Drafting Workshop Minutes
(30) The WS participants reviewed workshop discussion.
The draft of the minutes was submitted by rapporteurs, discussed and amended. The draft of the minutes will be circulated after the workshop and finalized.

(31) Prof. KATO Shingo summarized the WS. He also expressed his appreciation to Mongolia and the WS participants.
The workshop was closed with his closing remarks.

Program of
FNCA FY2022 Workshop on Radiation Oncology

Day 1 Thu, 29th September 2022
Place: Kempinski Hotel Khan Palace in Ulaanbaatar Hotel & ZOOM

Day 2 Fri, 30th September 2022
Place: National Cancer Center of Mongolia (NCCM)

Day 3 Sat, 1st October 2022
Place: National Cancer Center of Mongolia (NCCM)

Day 4 Sun, 2nd October 2022
Place: "TERELJ"

Day 5 Mon, 3rd October 2022

Leave from Ulaanbaatar