Rapid developments in radiation therapy over the past 8 years have highlighted the necessity to address global disparities in access to radiation therapy services. The IAEA-ICARO conferences represent a step towards decreasing this gap and supporting global efforts by providing collective recommendations on some of the most important needs when addressing these global disparities. The following are the conclusions of the ICARO-2 conference:
The need for defined sustainability frameworks is essential in order to support the cancer healthcare needs in LMI-countries if the global cancer challenge is to be overcome;
The DIRAC database highlights disparities across geographical regions and economic levels, indicating deficit of radiotherapy equipment needed for cancer treatment in LMI-countries. It is necessary to keep the DIRAC database updated and at a high level of quality to ensure it can be used for various radiotherapy data analyses;
Transitioning to new technologies and treatment modalities requires input from decision makers and the radiation therapy team before final decisions are made. Before implementation, ROs, MPs and RTTs need to be educated and trained in the new technology;
New technologies or treatment modalities can only be implemented with financial support.
To fully understand the cost vs. effectiveness, more validated evidence on both costs and outcome need to be collected. It is important to utilize the potential of innovative reimbursement strategies for the early adoption of innovative radiotherapy and to stimulate evidence generation;
Active support / support from international organizations and the IAEA for the training of the entire radiotherapy team remains very important. These efforts will undoubtedly lead to the improved treatment of cancer patients with radiation therapy.in LMI countries;
LMI countries need more financial support in order to fight cancer more effectively. Global investment in RT can prolong life, as well as improve the productivity and wellbeing of these nations;
Deliver the highest quality and value of care to cancer patients with the available resources is mandatory regardless of the equipment available or technique implemented.
The awareness of late cardiac toxicities in the RT of breast cancer has led to many techniques reducing the dose and volume of the heart in the radiation field. In RT for cervical cancer, recent developments in 3D image-guided brachytherapy, including the establishment of clinical target concept, prescription dose, and dose-volume constraints for organs-at-risk (OARs), has led to the improvement of clinical results. The large number of trials on the treatment of localized prostate cancer clearly showed the importance of the different strategies and the role of RT in treating this disease. Current evidence from the GORTEC 99-02 continues to support conventional once daily fractionation as the standard of care in chemo-radiotherapy for locally advanced Head & Neck cancer;
Clinical trials remain the gold standard to show changes in outcomes using these new
More clinical trials using radiotherapy combined with systemic therapy, including immunotherapy need to be designed/conducted in order to investigate its efficacy and possible toxicity;
Advances in brachytherapy delivery, while not as fast as for external beam radiation therapy, continue and it will require careful planning as they are implemented in LMI countries;
Important mechanisms for improving quality in RT are: Regular audits (i.e. QUATRO), error reduction and reduction of treatment times by using automation; development of QA programmes, training and accreditation, and good communication between all personnel;
Advances in imaging technologies will lead to improved treatment delivery (better definition of the location of the tumour) and the development of new techniques in radiation oncology;
Introduction of new technologies present challenges that need to be verified prior to treating patients. In this context it is very important to conduct audits to detect discrepancies. The use of end-to-end QA phantoms will help detect errors, improve dose delivery accuracy and will provide confidence;
Using Failure Modes and Effects Analysis (FMEA) in combination with incident learning (IL) will provide an improved overview of risks within the different aspects of the treatment of patients with radiotherapy;
A known dosimetry issue has been addressed with the new CoP that will improve the accuracy in the delivery of radiation therapy for small fields. The recommendations from this study were that more than one detector should be used for these small field measurements and that the CoP should be followed explicitly. It was also shown that detector selection is crucial;
Both ICRU reports provide important guidelines for further improvement of the treatment of cervical cancer with brachytherapy, and the use of SRT in the treatment of brain tumours;
There are many common factors that contribute to accessibility barriers such as: lack of personnel/facilities, lack of training/education, lack of government commitment and lack of funding;
Sparing normal tissues and reducing side effects, without compromising the effectiveness of the treatment remains an important task for the radiotherapy community. Personalized treatment, use of MRI-guided RT as well as particle therapy are candidates for the future to reach this goal;
At the end of the debate it was agreed that intensity-modulated radiotherapy (IMRT), if approached cautiously, could be the standard of care if the right resources and funding are available;
Sessions on Training & Education are very important to improve the knowledge and skills of the attendees.
APPENDIX. I. ICARO-2 STATISTICAL REPORT
Organizer: IAEA
Co-operating organizations: European Society for Therapeutic Radiology and Oncology (ESTRO)
International Cancer Expert Corps (ICEC)
American Association of Physicists in Medicine (AAPM)
International Organization for Medical Physics (IOMP)
Japanese Society for Radiation Oncology (JASTRO)
American Brachytherapy Society (ABS)
Federation of Asian Organizations for Radiation Oncology (FARO)
International Agency for Research on Cancer (IARC)
International Society of Radiographers and Radiological Technologists (ISRRT)
Medical Physicists without borders (MPWB)
South East Asian Radiation Oncology Group (SEAROG)
International Union Against Cancer (UICC)
International Commission on Radiation Units and Measurements (ICRU)
African Radiation Oncology Group (AFROG)
American Society for Therapeutic Radiology and Oncology (ASTRO)
Asociación Latinoamericana de Terapia Radiante Oncológica (ALATRO)
Asociación Latinoamericana de Física Médica (ALFIM)
European Federation of Organisations for Medical Physics (EFOMP)
Federation of African Medical Physics Organisations (FAMPO)
Location: Vienna International Centre
M-Building (BR-B/M1, M2, M3)
Date: 20-23 June 2017
Total No. of participants &
observers:
445 (out of 540 pre-registered)
No. of participants: 391 No. of participants from Member 308
No. of observers/exhibitors: 54
No. of Sessions: 49
No. of oral presentations: 169 (3 opening statements, 163 oral presentations, 3 closing statements)
No. of teaching lectures 6
No. of demo sessions 2
No. of e-contouring workshops 4 No. of lunchtime symposia 8
No. of e-posters 181
Scientific Secretaries: E. Zubizarreta, A. Meghzifene/H. Delis (NAHU) Scientific Support: A. Polo, G. Loreti (NAHU)
Admin. Support: R. Gomez Zaragoza (NAHU)
Conference Coordinator: M. Khaelss (MTCD) Exhibition Coordinator: V. Jordanovska (MTCD) E-Poster Coordinator: O. Belyakov (NAHU)
TC Coordinator: S. Walleczek (TCPC)
Proceedings: Summary report to be published on Human Health Campus web site
Participants: 391
From Organizations: 83
AAPM (American Association of Physicists in Medicine) 5
ABS (American Brachytherapy Society) 1
AFROG (African Radiation Oncology Group) 1
ALFIM (Asociación Latinoamericana de Física Médica) 4
ASTRO (American Society for Therapeutic Radiology and Oncology) 2 EFOMP (European Federation of Organisations for Medical Physics) 3 ESTRO (European Society for Therapeutic Radiology and Oncology) 14 FARO (Federation of Asian Organizations for Radiation Oncology) 1
IAEA (International Atomic Energy Agency) 18
IARC (International Agency for Research on Cancer) 1
ICEC (International Cancer Expert Corps) 5
ICRU (International Commission on Radiation Units and Measurements) 2 ICTP (The Abdus Salam International Centre for Theoretical Physics) 16
IOMP (International Organization for Medical Physics) 5
MPWB (Medical Physics for World Benefit) 1
SEAROG (South East Asian Radiation Oncology Group) 1
UICC (International Union Against Cancer) 1
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CONTRIBUTORS TO DRAFTING AND REVIEW
Abdel-Wahab, M. International Atomic Energy Agency, Austria Belyakov, O. International Atomic Energy Agency, Austria Cordero-Mendez, L. International Atomic Energy Agency, Austria Fidarova, E. International Atomic Energy Agency, Austria
Followill, D. American Association of Physicists in Medicine (AAPM) Grover, S. American Brachytherapy Society (ABS)
Hopkins, K.I. International Atomic Energy Agency, Austria
Huq, M.S. University of Pittsburgh Medical Center , United States of America Izewska, J. International Atomic Energy Agency, Austria
Kochbati, L. Institut National de Cancer Salah Azaiz, Tunisia Loreti, G. International Atomic Energy Agency, Austria Meghzifene, A. International Atomic Energy Agency, Austria Polo Rubio, J.A. International Atomic Energy Agency, Austria Prasad, R.R. International Atomic Energy Agency, Austria Rosenblatt, E. International Atomic Energy Agency, Austria
Scalliet, P. European Society for Therapeutic Radiology and Oncology (ESTRO) Stojkovski, I. Radiotherapy and Oncology University Clinic, Vodnjanska, Macedonia Tamaki, T. Fukushima Medical University, Department of Radiation Oncology, Japan Van Der Merwe, D. Charlotte Maxeke Johannesburg Academic Hospital, South Africa Wondergem, J. International Atomic Energy Agency, Austria
Zubizarreta, E. International Atomic Energy Agency, Austria
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No. 26Advances in Radiation Oncology (ICARO-2)
Topical Overview and Conclusions of an International Conference
INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA
20-02704E