Background:

The FNCA FY2006 Workshop on Radiation Oncology was held from January 9 to 13, 2007, in Hanoi & Ho Chi Minh City , Viet Nam . The meeting was organized by the National Cancer Institute of Viet Nam (K Hospital) and co-hosted by the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan , in cooperation with the Japan Atomic Industrial Forum, Inc. (JAIF). Representatives from 8 FNCA countries, namely China , Indonesia , Japan , Republic of Korea , Malaysia , the Philippines , Thailand and Vietnam , participated in the workshop. A representative from Bangladesh participated as an observer.

Opening ceremony in Hanoi

The welcome remarks were delivered by Dr. Nguyen Ba Duc, K Hospital, Dr. Bui Van Tuan, Vietnam Atomic Energy Commission (VAEC) and Dr. Tran Thi Giang Huong, International Cooperation Department, Ministry of Health, Viet Nam . Finally, on behalf of participating countries, Dr. Hirohiko Tsujii, National Institute of Radiological Sciences (NIRS), Japan , expressed his appreciation to Viet Nam for hosting the workshop. He also explained the FNCA framework and welcomed participation of Bangladesh as an observer.Dr. Nguyen Ba Duc gave a Special Lecture on the present status of radiation therapy in Viet Nam and the future plans. Dr. Hirohiko Tsujii explained the history of this FNCA project, and the objectives of this meeting. The agenda was adopted.

Session1: Phase 2 Study of Chemo-radiotherapy for Uterine Cervix Cancer (Cervix-III)

The status was presented as follows:

The number of registered Cervix-III patients: China 18, Indonesia 5, Japan 32, Korea 10, Malaysia 14, the Philippines 12, Thailand 19 and Viet Nam 10. With the median follow up of 18.6 months, the data showed: 87.6% 2y local control, 68.5% 2y progression free survival rate, and 76.5% 2y over-all survival rate.

Session2: Prophylactic PALN RT / Adjuvant Chemotherapy for Uterine Cervix Cancer

Based on several presented data, the role of prophylactic PALN RT was discussed.

Session3: New Clinical Trial for Locally Advanced Cervical Cancer

After a thorough discussion on the PALN RT and adjuvant chemotherapy, Concurrent CRT to extended field (RT to pelvis and PALN) was finally chosen.

Session4: Phase 2 Study of Chemoradiotherapy for NPC (TxN2-3) (NPC-I)

The status was presented as follows:

The number of patients: China 3, Indonesia 3, Malaysia 15, the Philippines 3, Thailand 5. Korea and Viet Nam presented 5 and 135 non protocol cases without adjuvant chemotherapy, respectively.

Accumulated data of the Phase 2 Study, NPC-I were presented as follows:

The number of registered patients was 28. Eighty three % completed at least 4 cycles of concurrent chemotherapy (CTX), while 36% of the patients could not complete adjuvant chemotherapy. Compared with published studies, the incidence of severe nausea/vomiting and leucopenia was low, although that of severe mucositis was similar.

Session5: Session 5: Phase 2 Study of Chemoradiotherapy for NPC (T3-4N0-1) (NPC-II)

Accumulated data of NPC-II (protocol without adjuvant CTX) were presented as follows:

The number of registered patients was 31. Eighty six % of the patients completed at least 4 cycle of CTX. The rate of severe nausea/vomiting and leucopenia is considered low.

Future plan of NPC study was discussed. Both NPC-I and II studies are still open for recruitment of patients.

Session6: QA/QC of Radiation Dosimetry

Dr. Tang Tieng Swee, Malaysia , reported status of medical physics in Malaysia . Dr. Hideyuki Mizuno , Japan , explained Quality Assurance / Quality Control (QA/QC) for teletherapy and audit system in general. Dr. Yuzuru Nakamura, Japan , reported the completed field survey for brachytherapy, which had been conducted from FY2002 to FY2006 in 16 hospitals in 8 countries. The measurement of Ir-HDR machines" activities showed the deviation within +/- 3%. The accuracy of dose at point A calculated by RTPs showed the deviation within +/- 4%. The results were considered satisfactory. Dr. Mizuno, Japan , explained future plan for postal teletherapy audit. The audit is being performed with postal service of glass dosimeters and tough water phantoms. He tried the system in November 2006 in China , and the dose deviation was within +/-2%.

Session 7: Technical Visit at the 108 Army Central Hospital and National Cancer Institute

The participants conducted a Technical Visit to the 108 Army Central Hospital and observed its Cyber Knife system. They subsequently visited the National Cancer Institute and observed the radiation oncology department.

Session 8: Open Lecture in Hanoi

The first open lecture was held at the National Cancer Institute (K hospital) as a part of the workshop. There were around 45 participants including medical doctors, medical physicists and researchers. Finally, a Special Lecture on the Future Plan of Radiation Therapy in Viet Nam was given by Dr. Vuong Huu Tan, Vietnam Atomic Energy Commission (VAEC).

Session 9: Technical Visit to Ho Chi Minh City Oncology Hospital

The participants conducted a Technical Visit to the Ho Chi Minh City Oncology Hospital and saw the radiation oncology department.

Opening Session in Ho Chi Minh City (HCMC)

The welcome remarks were delivered by Dr. Pham Xuan Dung, Deputy Director, Ho Chi Minh City Oncology Hospital , followed by remarks of Dr. Hirohiko Tsujii, National Institute of Radiological Sciences (NIRS).

Session 10: Open Lecture in HCMC

The second open lecture was held as part of the workshop. There were around 80 participants including surgical oncologists, medical oncologists, radiation oncologists, medical physicists and students.

Session 11: Future plan, other activities

Future plans were discussed and approved.

These include: The schedule of NPC-I and NPC-II protocol were modified and extended to accrue more patients. The new QA/QC activity for external beam therapy will continue and finish in 2007. The meeting suggested the Philippines as the venue for the next workshop subject to an agreement of the Government of the Philippines and accepted it"s tentative schedule as January 21-27, 2008.

Session 12: Drafting the Workshop Minutes

The draft minutes presented by rapporteurs were discussed, amended and adopted.

Closing ceremony

Participants expressed appreciation to MEXT, K Hospital, Ho Chi Minh City Oncology Hospital , local staff organizing the meeting, and JAIF. The participants especially expressed their gratitude for the continuing support from the Government of Japan for this project. Closing Remarks were given by Dr. Tsujii, who expressed his appreciation to the host institute and participants as well as his expectations for the future of the project.

Message from Project Leader

"FNCA FY2006 Workshop on Radiation Oncology", the workshop on the medical use of radiation was held in Hanoi and Ho Chi Minh City , Viet Nam . This workshop has been already held for 14 times, but it was the first time we held in Viet Nam since we started.

The main topic of this Workshop was to design a new treatment protocol for locally advanced cervical cancer. In this new protocol (Cervix-IV), treatments with concurrent chemotherapy and extended-field radiotherapy have been proposed for locally advanced uterine cervical cancer. After an extensive discussion, we agreed to start the new clinical study using this protocol from April 2007.

For locally advanced nasopharyngeal carcinoma, two clinical studies: NPC-I and NPC-II are now on going. We will continue to enroll patients for each clinical study to a total of 100 cases. At the end of FY 2008, we will evaluate the effect of the treatments.

The Open Lectures were held in Hanoi and Ho Chi Minh City . The topics of the lectures were introduction of current status on radiation therapy in Viet Nam , chemo-radiotherapy for uterine cancer and nasopharyngeal carcinoma, and high-tech radiotherapy including IMRT and Cyber Knife. More than 50 participants attended the lecture in Ho Chi Minh City . The Open Lectures provided information on the current radiation oncology to local people.

There are wide differences in radiotherapy among Asian countries because of various technical, cultural, and socio-economic differences. The optimal treatment methods in Asian courtiers should meet requirements that they are not only effective but technically and socio-economically feasible with acceptable toxicities.

In past years, combinations of chemotherapy and radiation therapy were financially difficult to use, but nowadays it is available for several countries. However our purpose is to develop chemo-therapy, not to design for new anticancer drugs. Once an effective radiotherapy is established in Asian countries, it could be also feasible in any other places in the world.

It is of note that when this project was launched, the most important topic was to just conduct a clinical study among Asian countries, but in recent years we are able to carry out clinical studies which would improve overall survival. We have made a progress in this medical field.

Dr. Hirohiko Tsujii Director, Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Japan

 (Source: RCA)