Rapporteurs: Krystyna Kiel Michael Joiner Geoffrey Ibbott - PowerPoint PPT Presentation

Rapporteurs: Krystyna Kiel Michael Joiner Geoffrey Ibbott

� Radiation Oncology � Radiation Biology � Radiation Physics

� Cancer incidence, stage and treatment varies with region, economic status Developing countries: ◦ � Cervix, Head & Neck, Lung, Breast � More often advanced stage � Treatment more often for palliation, although number of curative cases is increasing Developed countries: ◦ � Lung, Breast, Prostate � Early detection and awareness/prevention programs � Treatment more often for cure

� Barriers in Developing Countries Need for more RT facilities ◦ � Many countries have no RT facilities � Machines/population is very low Perception that radiation is only for palliation ◦ People with means go elsewhere for treatment ◦ � Economic drive to introduce advanced technologies Often a lack of multidisciplinary protocols and tumor ◦ boards, i.e., for pediatric tumors MONEY MONEY ◦

� Issues in Developing Countries Interest in introducing advanced technologies ◦ without sufficient resources or evidence Potential for adopting new technology (e.g., IMRT) ◦ without full appreciation of risks Lack of qualified personnel ◦ Lack of training for advanced technologies ◦

� Experience in 3D treatment planning is essential prior to initiating more-advanced technologies � Certain populations might benefit from adv. tech. � Technology separates physician from patient Too easy to depend on technology ◦ � Many advances in imaging are exciting May help better determine target ◦ � Reduction in field margins should be accompanied by image guidance, compensation for motion Requires studies to prove we can use this capability ◦

� Hyperfractionation and accelerated fractionation are not as promising as expected � Hypofractionation is useful as a resource- sparing approach to cancer treatment Evidence in lung, brain, prostate, breast cancer ◦

� Advanced technologies very demanding of resources � Technologies are under development, not all deficiencies are resolved � New techniques (e.g., IMRT) can produce poor results if QA not adequate � Overwhelming majority of participants recognize continuing role for Cobalt units. � Potential exists for advanced treatment methods with Cobalt

� IMRT: Inadequacy of some planning systems ◦ Studies show inability of planners to achieve goals ◦ Studies show planned distribution often not delivered ◦ Studies required to prove value before widespread use ◦ � Small radiation fields Appropriate calibration equipment often not available ◦ Equipment often can’t deliver reference field size ◦ � New technologies are advancing faster than appropriate QA programs can be developed

� Global shortage of skilled professionals � Will be a long-term demand for trainers and educators � Training must be adapted to working environment and available technology � Insufficient recognition of value of training � Programs should include broad education � Role for networking on national and regional level to support education � IAEA support for education and training was recognized and appreciated

The rapporteurs found the conference enlightening and enjoyable We are grateful for the support of the IAEA for our participation