Applied Radiation Biology and Radiotherapy Section, International Atomic Energy Agency, Vienna, Austria.
Disclosure: The author declares no conflict of interest.
Address for correspondence: Branislav Jeremić, MD, PhD, IAEA, Applied Radiation Biology and Radiotherapy Section, Wagramer Strasse 5, A-1400 Vienna, Austria. E-mail: firstname.lastname@example.org
The Department of Nuclear Sciences and Applications of the International Atomic Energy Agency (IAEA) is committed to contribute to sustainable development in IAEA Member States through the use of nuclear sciences and their applications in several fields, including human health. The Division of Human Health of the Nuclear Sciences and Applications executes its program activities through four sections, applied radiation biology and radiotherapy (ARBR) being one of them.
The main goal of the Division of Human Health is to enhance the capabilities in Member States by addressing growing needs related to the prevention, diagnosis, and treatment of health problems through the application of nuclear techniques. In particular, ARBR mostly deals with the clinical use of radiation for the treatment of cancer. The main objective is to improve the availability and safe use of evidence-based and resource-sparing cancer management strategies in IAEA Member States. This is achieved by helping to establish new treatment centers in countries lacking the basic internationally accepted level of treatment and establishing resource-sparing treatment protocols, including guidelines for the treatment of the most common cancers in the limited-resource setting. Consultant and technical meetings are frequently organized for which experts from different countries were invited to discuss current aspects in the field of radiation oncology and radiobiology of particular importance for member states. These meetings were then used to advise member states of the appropriate implementation specific topics in daily practice. Finally, teaching events and training courses for radiation oncologists and support staff are organized, and more effective treatments for different types of cancer based on radiobiological principles and clinical and laboratory studies are developed.
ARBR recognizes the magnitude of lung cancer problem worldwide and, in particular, specifies of the problem of the developing countries. The lack of national cancer control programs and population-based cancer registries is coupled with lacking adequate oncology (in general) infrastructure, leading frequently to misdiagnosis and underdiagnosis of lung cancer. Lung cancer is usually diagnosed in advanced and incurable stage. Insufficient staffing, lack of accredited training programs and systematic continuous medical education efforts in developing countries bring into a focus the necessity for more activities in the field of lung cancer.
IAEA activities in the field of lung cancer can broadly be divided into four major groups. The first one is a series of Regional Training Courses (RTC). Between 2004 and 2008, a total of five such courses have been organized and executed. The first two RTCs (October 2004, Algeria; June 2005, Japan) were teaching and didactic in nature, composed of a series of lectures focusing on various aspects of diagnosis and treatment of lung cancer. Specific of these courses was that 1 whole day (of the total of 5 days) of the course was devoted to participants presenting their own patterns of practice in the diagnosis and treatment of lung cancer, primarily focusing on radiotherapy characteristics. This novel approach was deemed necessary for future follow-up achievements in the field in these institutions, envisaged to take place regularly (e.g., 3–5 years). Two RTC held in Europe (November 2005, Estonia; January 2006, Turkey) not only maintained the same schedule or structure but also brought a new substance by including more practical or training aspects. One full day was dedicated to “hands-on” treatment planning (different volumes, organs at risk, beams choice, etc.), simulation (using various accessories for patient positioning), and patient setup on treatment machines. A variety of clinical cases, most commonly seen in daily practice, was used. To enable better interaction between teaching staff and participants during the practical sessions, small groups were formed (7–8 per teacher) as to ensure optimal benefit of the teaching process and enable adequate time to each participant to be actively engaged. Finally, 1 day was dedicated to extensive discussions summarizing participants’ short-term demands and needs and to have their suggestions to IAEA or ARBR how to improve activities in lung cancer diagnosis and treatment. It served as well for identification of further subregional differences to be taken into account when planning similar activities in the future. Existing language characteristics (RTC in Estonia was organized with simultaneous translation into Russian) and existing technological capability were taken into account, ultimately adjusting the level of teaching and practical applications to subregional demands and needs. The fifth teaching course was again organized in Africa (Dakar, Senegal, October 2008) being didactic in its performance due to the technological limitations at the site.
Second group of activities consist of a series of consultant meetings organized by the ARBR in Vienna focusing on different topics with internationally recognized experts. Two meetings were held specifically addressing the issue of (1) developing a guidelines for lung cancer in limited resource settings1 (March 2006) and (2) discussing study design for the forthcoming clinical study on optimization of radiotherapy and chemotherapy in palliation of advanced (stages III and IV) NSCLC (June 2007). In addition, four consultants meetings were held on positron emission tomography or computed tomography in treatment planning of lung cancer (July 2006 and October 2007), elective nodal irradiation in lung cancer (September 2006), and stereotactic body radiotherapy for lung and other body cancers (November 2006). Special emphasis was always made on the applicability of evidence-based approaches in limited resource setting of developing countries.
Third group of activities includes production of various documents, such as lung cancer guidelines in limited resource setting,1 patterns of practice in diagnosis and treatment of lung cancer in Eastern Europe,2 elective nodal irradiation in lung cancer,3,4 as well as positron emission tomography or computed tomography in treatment planning,5 and stereotactic radiotherapy in lung and other cancers (Nagata Y, et al., Submitted).6
Finally, based on the importance of lung cancer worldwide and the fact that most of lung cancer cases occurring in the developing countries would fall into locally advanced (stage III) or metastatic (stage IV) NSCLC, ARBR is embarking on a clinical study investigating optimization of palliative approaches in this setting using radiotherapy and chemotherapy. In stage III NSCLC, this study will test RT versus CHT and RT, whereas in stage IV NSCLC, it will test CHT versus RT and CHT. This study was officially opened and started accruing patients in 2008 under the title “Optimization of Treatment of Advanced Nonsmall Cell Lung Cancer Using Radiotherapy and Chemotherapy.”7
In summary, ARBR (http://www-naweb.iaea.org/nahu/arbr/default.shtm) is putting a special effort to timely respond to growing demands and needs of IAEA member states in the field of lung cancer. These activities should be seen as a systematic attempt to bring this topic in the agenda of cancer management in a comprehensive way.
1.Macbeth FR, Abratt RP, Cho KH, Stephens RJ, Jeremic B, International Atomic Energy Agency. Lung cancer management in limited resource settings: guidelines for appropriate good care. Radiother Oncol 2007;82:123–131.
2.Kepka L, Danilova V, Saghatelyan T, et al. Resources and management strategies for the use of radiotherapy in the treatment of lung cancer in Central and Eastern European countries: results of an International Atomic Energy Agency (IAEA) survey. Lung Cancer 2007;56:235–245.
3.Videtic GM, Belderbos JS, Spring Kong FM, Kepka L, Martel MK, Jeremic B. Report from the International Atomic Energy Agency (IAEA) consultants’ meeting on elective nodal irradiation in lung cancer: Small cell lung cancer (SCLC). Int J Radiat Oncol Biol Phys 2008;72:327–334.
4.Belderbos JSA, Kepka L, Spring Kong FM, Martel MK, Videtic GM, Jeremic B. Report from the International Atomic Energy Agency (IAEA) consultants’ meeting on elective nodal irradiation in lung cancer: non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys 2008;72:335–342.
5.Macmanus M, Nestle U, Rosenzweig KE, et al. Use of PET and PET/CT for radiation therapy planning: IAEA expert report 2006–2007. Radiother Oncol 2009;91:85–94.
6.Zimmermann F, Wulf J, Lax I, et al. Stereotactic body radiation therapy (SBRT) for early non-small-cell lung cancer (NSCLC). Front Radiat Ther. In press.
7.Optimization of Treatment of Advanced Nonsmall Cell Lung Cancer Using Radiotherapy and Chemotherapy. Available at: www.ClinicalTrials.gov