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Advanced Radiotherapy Techniques in Focus Next Week

A medical physicist and radiation therapist work together to ensure treatment is given correctly. (Photo: D. Calma/IAEA)

The IAEA is organizing the second International Conference on Advances in Radiation Oncology (ICARO2) next week to review the current developments in clinical applications in the fields of radiation oncology, radiation biology and medical physics and to address the challenge of cancer management in its Member States.

Thanks to increasing use of advanced radiation treatment technologies across the world, such as intensity modulated radiation therapy (IMRT), image guided radiation therapy (IGRT) and stereotactic body radiation therapy (SBRT),  cancer patients can receive more targeted curative doses of radiation therapy with minimal damage to their normal tissues and organs. These technologies have improved the quality of radiation treatment, by enabling precise positioning of the patients, and targeting of tumours minimising doses to normal healthy tissues.

“Ideally all patients could benefit from these techniques, as these treatments are less harmful for critical organs,” said Alfredo Polo, radiation oncologist at IAEA’s Division of Human Health. “However, the implementation of these technologies requires a stepwise approach to ensure that all the elements of the process, including clinical protocols, technology, human resources and quality management systems are in place and converge in an organized way.”

The IAEA helps its Member States in the implementation of advanced radiation therapy technologies. Below are two examples of this support.

New technology implementation in Estonia 

Image guided radiation therapy (IGRT) was first implemented in Estonia in 2006 and intensity modulated radiation therapy (IMRT) in 2009. Today, 30 per cent of all radiotherapy patients receive this type of treatment, and the implementation of additional technologies is growing. “With the installation of the new linear accelerator at the end of 2016, we were able to start offering stereotactic body radiation therapy (SBRT) to our patients and three patients have already been treated since April 2017,” said Eduard Gershkevitsh, Head of Medical Physics Service at the Radiotherapy Centre at the North Estonia Medical Centre.

The IAEA assisted in the selection of the equipment, then supported implementation and training for all categories of staff. “We can now provide the radical radiotherapy to some patients for whom it was not possible before, knowing exactly what was irradiated and responding to the anatomy changes,” Gershkevitsh said.

Using IMRT in Indonesia 

In Indonesia, the transition towards IMRT began in 2007.  “Being the first institution in Indonesia to implement this technique, this transition involved more than just equipment procurement,” said Professor Soehartati Gondhowiardjo, Senior Consultant on Radiation Oncology at Cipto Mangunkusumo General Hospital. “It took several benchmarking visits to other institutions in neighbouring countries and communication with colleagues from institutions already utilizing the technique.”

Over the last 10 years the IAEA has helped medical professionals in Indonesia identify expert centres in the region willing to assist them through the transition process, and in early 2009 they began their first IMRT treatments focusing on head and neck cancers, adapting existing protocols to the local situation.

“IMRT is now provided to approximately 40 per cent of our patients, with head and neck cancers still being the majority, but we have also applied the protocol for prostate cancer and gynaecological cancer, and we are extending this technique to other medical centres,” Gondhowiardjo said.

However, most centres in Indonesia have not begun the move towards IMRT due to resource limitations. Currently, around one third of Indonesian radiotherapy centres are able to provide IMRT, treating 10-15 per cent of all cancer patients.

ICARO2 will take place at the IAEA headquarters in Vienna from 20 – 23 June 2017. Bringing together medical professionals from across the world, conference participants will examine the role of emerging radiotherapy techniques in tackling the health challenges common to many Member States and work towards defining future challenges and directions in the clinical use of radiotherapy.