Overview of radiotherapy resources in Latin America: a survey by the International Atomic Energy Agency (IAEA).

BACKGROUND AND PURPOSE: An analysis of the resources for radiotherapy in Latin America was done to establish a baseline to help plan future development in the region. PATIENTS AND METHODS: The data from 19 countries were obtained during three International Atomic Energy Agency (IAEA) regional meetings. The survey covered radiotherapy centres, major equipment and personnel. The centres were categorised into four different levels. Data were related to economic and population indices. RESULTS: Four hundred and seventy centres were identified in 18 countries. Centres were divided into 4 levels: half were included in level 1, 25% in level 2 and 18% in level 0 (stand alone teletherapy machines). Human resource represents 933 radiation oncologists, 357 physicists and 2326 radiation therapy technologists. In general, availability of equipment and personnel was related to economic status of the country. CONCLUSIONS: Although there is a shortfall of equipment, the major restriction to patient service is an insufficient number of specialists in 16 of the 18 countries. An upgrade of standards in many centres is required to offer a comprehensive radiation oncology service. The information provided in this paper represents a useful base to plan future development in terms of equipment installation and training programs.     

International Agency for Research on Cancer fellowships programme-over 30 years of experience.

In 1966 the International Agency for Research on Cancer (IARC) initiated a fellowship programme designed for young postdoctoral scientists from any country in the world who wish to receive training in another country in an area relevant to the aetiology and pathogenesis of cancer. Various disciplines are covered such as cellular and molecular biology, pathology, genetics and biochemistry, and particular attention is given to training in cancer epidemiology. A total of 471 fellowships have been awarded during the last 32 years, averaging 15 fellowships per year, and representing approximately one in four of the applications evaluated every year. Thirty-six percent of the total number of fellowships awarded have come from developing countries and eastern Europe. North America and western Europe are the regions preferentially selected by 98% of the fellows for training, with the USA (48%) and the UK (19%) remaining the most frequently selected countries for a host laboratory. Approximately 82-85% of fellows returned to their home countries and around 82% remain active in cancer research. A total of 101 fellowships have been awarded in epidemiology or biostatistics with the majority of IARC fellows in epidemiology originating from developing countries or developed countries in which the teaching of chronic diseases epidemiology is deficient. In addition, the IARC has received considerable input into its activities through its fellowship programme. The IARC fellowship programme is an effective tool in the provision of training in cancer research to young scientists worldwide, selected on the basis of scientific excellence and has made a substantial contribution to the development of cancer research in many countries.     

International Agency for Research on Cancer Workshop on 'Expression array analyses in breast cancer taxonomy'

In May 2006, a workshop on Expression array analyses in breast cancer taxonomy was held at the International Agency for Research on Cancer (IARC). The workshop covered an array of topics from the validity of the currently defined breast tumor subtypes and other expression profile-based signatures to the technical limitations of expression analysis and the types of platforms on which these omics results will eventually reach clinical practice. Overall, the workshop participants believed firmly that tumor taxonomy is likely to yield improved prognostic and predictive markers. Even so, further standardization and validation are required before clinical trials are set in motion.     

The International Agency for Research on Cancer （IARC） evaluation of the carcinogenicity of outdoor air pollution： focus on China

The International Agency for Research on Cancer （IARC） has classified outdoor air pollution and the particulate matter （PM） in outdoor air pollution as carcinogenic to humans, as based on sufficient evidence of carcinogenicity in humans and experimental animals and strong support by mechanistic studies. The data with important contributions to the evaluation are reviewed, highlighting the data with particular relevance to China, and implications of the evaluation with respect to China are discussed. The air pollution levels in Chinese cities are among the highest observed in the world today and frequently exceed health based national and international guidelines. Data from high-quality epidemiologic studies in Asia, Europe, and North America consistently show positive associations between lung cancer and PM exposure and other indicators of air pollution, which persist after adjustment for important lung cancer risk factors, such as tobacco smoking. Epidemiologic data from China are limited but nevertheless indicate an increased risk of lung cancer associated with several air pollutants. Excess cancer risk is also observed in experimental animals exposed to polluted outdoor air or extracted PM. The exposure of several species to outdoor air pollution is associated with markers of genetic damage that have been linked to increased cancer risk in humans. Numerous studies from China, especially genetic biomarker studies in exposed populations, support that the polluted air in China is genotoxic and carcinogenic to humans. The evaluation by IARC indicates both the need for further research into the cancer risks associated with exposure to air pollution in China and the urgent need to act to reduce exposure to the population.     

Twinning partnerships through International Atomic Energy Agency (IAEA) to improve radiotherapy in common paediatric cancers in low- and mid-income countries

Purpose

The article summarises the current use of radiotherapy (RT) in childhood cancer and suggests methods to improve current practice in regions where outcomes of paediatric cancer patients are inferior to those of high-income countries.

Methods and materials

The International Atomic Energy Agency (IAEA) is supporting low- and mid-income countries (LMICs) in upgrading cancer care where nuclear applications, particularly RT, are used. A consensus meeting of experts was invited to advise IAEA on the needs for RT in paediatric cancer patients. The current indications for RT were reviewed, together with regional differences in access, practice and outcome.

Results

Regional variations in the use of evidence-based multidisciplinary care including RT were associated with varying outcomes of paediatric cancer patients. The contribution of modern and investigational technology to these differences is uncertain and should be determined in clinical trials. Adequate resources are required to support children through the acute phase of treatment and to permit early recognition and management of late effects. An IAEA sponsored project for prospective data collection to assess the current and future status of radiation treatment in childhood cancer in LMICs has commenced.

Conclusion

RT remains an essential component of the multidisciplinary management of many paediatric cancers. Excessive variations in outcome are inappropriate and call for action on harmonising training programmes and compliance with evidence-based recommendations. Training projects targeting paediatric cancer care are being implemented and clinical studies comparing new technologies against evidence-based approaches are needed to achieve this goal. The IAEA has an important role in these activities and has commenced prospective data collection in 13 LMICs to monitor trends in treatment techniques and outcomes.     

Report from the International Atomic Energy Agency (IAEA) consultants' meeting on elective nodal irradiation in lung cancer: small-cell lung cancer (SCLC)

Thoracic radiotherapy (RT) is an integral part of the management of small-cell lung cancer (SCLC) because its administration provides a survival benefit in patients with limited-stage disease. However, there are many areas of controversy with respect to the delivery of curative RT, and these include definition of the target to be irradiated. A current area of concern is defining what the RT portal must encompass with respect to the mediastinal lymph nodes; that is, whether one should electively treat all mediastinal nodes, or selectively include those with some clinical risk for harboring disease, or perhaps omit elective nodal irradiation altogether. The purpose of the present report is therefore to address the concepts underlying elective or selective nodal irradiation as it applies to SCLC, looking at clinical, imaging, and RT reports to help define the parameters appropriate to treating individual patients.     

Report from the International Atomic Energy Agency (IAEA) consultants' meeting on elective nodal irradiation in lung cancer: non-small-Cell lung cancer (NSCLC)

Lymphatic spread is an important pathway of progression in non-small-cell lung cancer (NSCLC), along with local spread and distant metastasis. The probability of lymph node (LN) involvement is dependent on the site of the primary tumor, stage, and histology. Elective nodal irradiation (ENI) is the irradiation of clinical and radiological uninvolved LN to account for microscopic tumor invasion in these LNs because we have not been able to determine the extent of LN spread accurately. The clinical value of ENI is uncertain. The impact of ENI is dependent on many (staging-, treatment-, and patient-related) factors. The purpose of this report is to analyze the current status of ENI and to provide comprehensive in-depth analysis and guidance on how to generally approach this issue in NSCLC.     

Advanced non-small-cell lung cancer (NSCLC) treated with folinic acid (F), fluorouracil (FU), vincristine (O), and mitomycin-C (Mi), (F-FOMi).

Thirty-one patients with advanced non-small-cell lung cancer (NSCLC) were treated with a combination of folinic acid, fluorouracil, vincristine, and mitomycin (F-FOMi). Eight partial responses (26%), eight stable disease (26%), and 15 progressive disease (48%) were obtained. Patients with performance status (PS) 0-1 had a significantly better response rate than those with PS 2-3. Overall actuarial survival was 10 months. Toxicity was mild and mainly gastrointestinal with mucositis and diarrhea. F-FOMi seems to be comparable to regimens more widely used in the treatment of NSCLC.