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Accurately Targeting Women’s Cancers in Mongolia, with IAEA Support

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The National Cancer Centre of Mongolia in Ulan Bator. Surgeons there perform 450 liver surgeries a year. (Photo: H. Griffin/The Guardian)

Mongolia has a high burden of non-communicable diseases, and cancer – after cardiovascular disease – is the second leading cause of mortality in the country, according to the United Nations Interagency Task Force on the Prevention and Control of Noncommunicable Diseases.

“Cancer accounts for more than a quarter of all deaths,” explains Uranchimeg Tsegmid, Head of Non-Surgical Oncology at the National Cancer Centre (NCC), a busy hospital in Ulaanbaatar, which receives thousands of patients from across Mongolia seeking diagnosis and treatment. In 2020 alone, health officials in Mongolia reported more than 5,700 new cases of cancer, of which nearly 2,700 were diagnosed in women.

For women in Mongolia, the International Agency for Research on Cancer reports that cervical and breast cancers are among the four most common cancers, the other two being liver and stomach cancers. In 2020, the country reported 334 new cervical cancer cases and lost 1,943 women to the cancer, in total.

Since 20141/, a series of complementary IAEA technical cooperation (TC) projects, have been implemented to help expand the scope and scale of the National Cancer Centre’s services and to enhance their accuracy and quality. Now, with the commissioning of a new treatment planning system (TPS) in 2021 and the introduction of advanced cancer treatment modalities in the last two years, hopes are high that cervical, breast and other common women’s cancers will be diagnosed at earlier stages and treated with greater effectiveness, ultimately improving patient outcomes.

As part of an ongoing TC project, radiation oncologists, medical physicists and radiation technicians operating modern linear accelerators installed in the Radiation Oncology Department of the National Cancer Center of Mongolia have been trained at Giessen-Marburg University Hospital in Germany, Hiroshima University Hospital in Japan, and at the Korea Institute of Radiological & Medical Sciences (KIRAMS) in Seoul.

As a result, in 2018 CT-based 3D brachytherapy was officially introduced to provide effective radiation treatment to cervical cancer sites, with minimal side effects for normal, healthy organs and tissue. Since then, over 200 cervical cancer patients in the country have been able to receive brachytherapy per year.

The IAEA provided expert guidance and training to facilitate the introduction of 3D conformal radiotherapy (3DCRT), an advanced treatment method that allows clinicians to shape radiation beams to match the shape of the tumour. “The first 3DCRT procedure was delivered in June 2019,” said Dr Tsegmid, “and currently, more than 98 per cent of all patients can undergo and benefit from 3DCRT.”

An NCC staff member oversees the application of 3D image-guided brachytherapy, which has helped to improve the quality of cancer treatment provided by the Centre. (Photo: A. Mijatovic/123RF.com)

Improved outcomes for cancer patients

The growing cancer care capacities of the National Cancer Centre are expected to improve the outcomes not only for patients with breast and cervical tumours, but for all cancer patients. “When we speak about women’s cancer, traditionally we mean cervix and breast cancers. But in case of Mongolia, another cancer site predominates among women—liver cancer,” said Dr Kamal Akbarov, a Radiation Oncologist in the IAEA’s Division of Human Health.

Liver cancer is the most common cancer in Mongolia, and it has the highest incidence and mortality rates in women, as well as in the general population. The number of new liver cancer cases in 2020 was almost three times higher than cervical cancer, and almost double the total number of breast and cervical cancers.

The application of sophisticated, high-precision radiotherapy techniques—such as stereotactic body radiation therapy (SBRT), which uses sophisticated image-guidance to pinpoint the exact location of cancers—can provide improved treatment results while minimizing the probability of side effects.

“The aim in the last four years was to meet the increasing demands for newer, more effective treatment modalities,” said Akbarov. “It was essential to upgrade radiotherapy capacities through the installation of advanced equipment, to strengthen the knowledge and skills of staff through advanced training in radiotherapy, to develop clinical guidelines in radiotherapy and to implement both quality assurance and quality control programmes.”

Two ongoing IAEA projects2/ are now helping to plan and prepare for the introduction of other image-guided therapies including SBRT, Intensity-modulated Radiation Therapy (IMRT) and Stereotactic Radiosurgery (SRS). “For cervical cancer, in particular, these techniques will help us to increase the dose to tumours, and reduce them elsewhere, thereby improving the quality of life of our patients,” said Dr Tsegmid.

The IAEA through its Programme of Action for Cancer Therapy (PACT) and in cooperation with KIRAMS, is preparing to launch a series of fellowships to help train medical physicists, radiation oncologists and radiation therapy technologists in teams of three, to help enhance their ability to work collaboratively, safely and effectively.

These activities, and many more which support development priorities in the region, can be found in Compendium document, “Journeys to Success: A Collection of Success Stories from IAEA Technical Cooperation in Asia and the Pacific.” The publication chronicles achievements and the substantial contribution of the IAEA’s technical cooperation programme, as described by IAEA partners and experts from the region, and can be found here.

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1/ MON6017, ‘Improving Cancer Treatment Through Introducing Advanced Technologies in Radiotherapy and Radionuclide Therapy’

2/ MON6021, ‘Improving the Quality of Radiotherapy Services for Common Cancers through the Implementation of Linear Accelerator Based Stereotactic Body Radiation Therapy’

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