IAEA's role in the global management of cancer-focus on upgrading radiotherapy services

Figures & data

Table I.  IAEA activities in improving cancer management in developing countries

Target problem	Activities
Inadequate/insufficient care of cancer patients	Strengthening national cancer care programmes through expert advice
	Syllabi for the training of radiotherapy professionals
Shortage in well-trained staff	Provide access to education, and training courses
Under utilization of existing facilities	Distant and on site learning courses
	Collaboration e.g. ESTRO, ASTRO, IARC, INCTR, WHO, PAHO, AFRA
Deficiencies in Quality Assurance programmes	Guidelines for establishment/strengthening of QA programmes
	TLD audits, QUATRO-programme
Poor level of radiotherapy services	Plan and upgrade radiotherapy equipment utilization and interrelated technologies
	Expertise in safety issues and accidental radiation exposure analysis
Establish and develop evidence based treatment guidelines	Clinical research programmes/prospective randomized trials of ‘resource sparing’ protocols for common cancers
	TecDocs/guidelines for standards and state of art practice

TLD: termoluminescent dosimetry

QUATRO: Quality Assurance team for Radiation Oncology involving a programme for comprehensive clinical audit of a radiotherapy centre

Figure 1.  Evolution of the funding of the IAEA Technical Cooperation Programme devoted to supporting Member States in the area of Human Health.

Figure 2.  Estimate of cancer incidence in developing and developed (industrialized) countries. Note that in 1990 the incidence was practically the same in the two groups. In a time frame of 20 years, there will be approximately 260 million new cancer cases and nearly 150 million will be in developing countries [3].

Table II.  Worldwide resources in radiotherapy: teletherapy and brachytherapy in developing and developed countries (North America, Western Europe, Australasia and Japan, with uncompleted data especially from North America/Japan); data from the IAEA/WHO Directory of Radiotherapy Centres (June 2005).

	Developing countries N (%)	Developed countries N (%)	All N (%)
Countries in DIRAC	129 (81%)	30 (19%)	159 (100%)
Teletherapy	3340 (35%)	4883 (65%)	5778 (100%)
Radionuclide (^60Co, ^137Cs)	2112 (69%)	715 (31%)	2827 (100%)
Linear accelerators	1228 (18%)	4168 (82%)	5396 (100%)
Brachytherapy (HDl, LDL)	1187 (34%)	1698 (66%)	2885 (100%)

Table III.  IAEA research activities in cancer field a) recent studies, b) current studies. Publication reference indicated [25–29].

a) Recent studies
Cancer Site	Year	Study Participants	Study type	Results and Impact
Oesophagus	2002	South Africa, India, Poland, United States	High-dose rate brachytherapy	Use of a few treatments with brachytherapy (radioactive sources in the area of the cancer) can effectively relieve the symptoms of oesophageal cancer.[25]
Head and neck	2003	Denmark, India, Pakistan, Sri Lanka, Bulgaria, Malaysia, Turkey	Radiation with and without Mitomycin-C chemotherapy	Mitomycin-C, a chemotherapy agent, did not improve tumour control or survival. There is an increasing trend to use chemotherapy with radiation in many cancers. Indiscriminate use wastes valuable resources and increases toxicity.[26]
Cervix	2005	India, Japan, South Korea, China, Ukraine	Radiation with and without hyperthermia	Hyperthermia did not improve outcome.[27]
Oesophagus	2004	Canada, South Africa, United States	High-dose rate brachytherapy with or without conventional radiation	Brachytherapy treatment was sufficient for palliating advanced oesophagus cancer. If an additional 2 weeks of daily radiation is unnecessary, those resources can be used more effectively for other patients.[28]
Bone metastases	2001	United States, Brazil, Spain, Cameroon, Peru, Pakistan	Different schedules of half-body radiation	A 2-day schedule was as effective as a longer schedule and provided effective pain relief. [29]
b) Current studies (Additionally a new CRP with 2 clinical randomized studies in breast cancer focusing on research sparing radiotherapy and neo-adjuvant treatment has been approved and will be initiated in developing countries 2006).
Cancer Site	Study Participants	CRP Study Title	Research Question
Cervix	India, Brazil, Peru, South Africa, Morocco, United Kingdom	Radiobiological and clinical study on viral-induced cancers response to radiotherapy	1. Whether a shorter brachytherapy schedule is equivalent to a longer schedule after external beam radiation
			2. Whether cisplatin improves control and survival
			3. Whether virally-induced genetic changes predict outcome
Cervix	China, India, Tanzania, South Africa, United Kingdom, United States, Uganda	Doctoral CRP on clinical and experimental studies to improve radiotherapy outcome in AIDS cancer patients	1. Whether cisplatin added to radiation therapy improves control and survival in HIV-infected women.
			2. Is the toxicity of treatment in HIV-infected patients increased?
			3. Are there biological changes in cervix cancers associated with HIV infections?
Head and neck cancer	Algeria, Tunisia, Egypt, Thailand, Indonesia, Pakistan, Morocco, Netherlands	Resource sparing treatment of head and neck cancer	Whether a brachytherapy boost after neoadjuvant chemotherapy and chemoradiation therapy improves control and survival, without severe toxicity.
Oesophagus	Brazil, Canada, Croatia, India, Iran, South Africa, Sudan, United States	The role of teletherapy supplementary to intraluminal high dose rate brachytherapy in the palliation of advanced oesophageal cancer	Whether brachytherapy treatment is sufficient to control and palliate oesophagus cancer or whether additional external beam radiation is needed.
Head and neck	Chile, Denmark, India, Pakistan, Estonia	Aspects of radiobiology applicable in clinical radiotherapy – increase of the number of fractions per week	Whether 6 treatments per week is better than the standard 5 treatments per week