2019 Elekta Travel Award

Dr. Michael Jameson PhD

MR Linac Global Lead Physicist, GenesisCare, Alexandria NSW

Adjunct Senior Lecturer, University of New South Wales


The Elekta Report

This is my report for the 2019 Elekta travel award, granted to attend an Asian conference. The Asia Pacific Special Interest Group (APSIG) committee annually selects the winner for this Award. I chose to attend the ESTRO meets Asia conference, held in Singapore for the second time.

About the Conference 

The webpage for this conference outlines ESTRO’s reasons for starting the Meets Asia conference series

“The distribution of the global population has undergone drastic changes over the last decades. Asia now counts for 59.4% of the world’s population (compared to 9.6% for Europe and 4.8% for North America). Amongst many other things, this also results in an increased regional need for cancer treatment, including radiation oncology.

Compared to Europe however, the differences in both the direct and indirect cancer treatment indicators are immense, requiring a diversified approach to address the resource and perception barriers around radiation oncology. Following requests from important local societies such as SEAROG, JASTRO and CSTRO, ESTRO’s offer of courses and workshops was successfully rolled out across Asia, creating the momentum for taking the collaboration to more expansive phase….” (1)

This reflects a recognition from ESTRO of the growing importance of the Asia region both in terms of global cancer burden but also as source of creative and significant innovation in radiation oncology. 

Motivation

I had previously visited Singapore in 2019 for a holiday. During that time, I presented a lecture at an event organised by the Singapore Institute of Technology. The event coincided with a course that Prof Peter Metcalfe from the University of Wollongong was teaching. The attendees included clinical medical physicists and staff from one of the proton facilities under construction at that time. Topics covered included radiation safety, the physics of radiotherapy, radiobiology, and adaptive radiotherapy. I was interested in attending this conference because the Asian region has countries that span the income spectrum. With countries like Australia, New Zealand, and Japan in the high-income group, Indonesia in the upper-middle, India, and others in lower-middle and Afghanistan and North Korea in the lower-income group. 

Figure 1 World by income map from the world bank (2)

In my opinion, this was the unofficial theme of the conference. There were a variety of presentations and posters with different emphasis on clinical service and innovation. For example, in my session there was a presentation by Dr. Khan from the Government Medical College and Hospital in Nagpur, India. Dr Khan made an impassioned case for low- and middle-income countries in Asia to create indigenous protocols for classifying disease stage and response in locally advanced head and neck cancer. The reason for this is the paucity of radiotherapy centres in India resulting in waiting lists and patients presenting for treatment with advanced disease. Dr Khan says the sheer disease volume makes an Indian T4b and Western T4b tumours very different. 

Figure 2 Slide from Dr Khan’s talk highlighting some of the challenges faced by Radiation Oncology in India
  • Figure 3 Images from Dr Khan’s presentation showing the response (before at top and after below) from one of the trial patients to the hybrid arm (3)

Dr Khan presented a local trial comparing two palliative RT regimes; “Standard” (30 Gy / 10fx) and “Hybrid” (18 Gy / 3 fx followed by 10 Gy / 5fx). It was found that the hybrid regiment offered better control and QoF. 

There was some focus on the use of MRI in radiotherapy with presentations from Europe and Australia. This included A/Prof Lois Holloway and Andrew Wallis from Liverpool Hospital and my own research on the potential for adaptive radiotherapy for brain cancer.

Figure 4 A/Prof Lois Hollow presenting on the use of MRI in Radiotherapy
Figure 5 The author presenting on the potential for MR guided adaptive RT for brain cancer
Figure 6 Andrew Wallis explaining the progression of radiotherapy over the years and the reliance on imaging technology

On the final day, Dr Lu, director of the Shanghai Proton and Heavy Ion centre presented their work. The centre started treating in 2014. Over 2000 patients have now been treated. One of the take-home messages from this presentation was the need for high-quality training and accreditation in Asian countries. In order to successfully commission the centre, Dr Lu had to recruit physicists from the US.

Figure 7 Dr Lu presenting on the Shanghai proton and heavy ion centre

Finally, there was a fantastic presentation by Simon Downes, the Prince of Wales Hospital, reporting on the first ten years of APSIG. This talk was an overview of all the work that APSIG has assisted in Asia over the last 10 years. It was appropriately well received. 

Figure 8 Simon Downes presenting on the work of APSIG

In summary, I would like to thank APSIG, BHT, ACPSEM and Elekta for giving me the chance to attend this conference and learn from our Asian colleagues. It was a privilege to present my research and represent APSIG at the meeting. I think I will have to add ESTRO meets Asia to the annual travel calendar!

References

1.              ESTRO Meets Asia Conference Webpage  [Available from: https://www.estro.org/Congresses/ESTRO-meets-Asia-2019-(1)/ESTRO-meets-Asia-2019.

2.              World by Income from the World Bank  (available from https://datatopics.worldbank.org/world-development-indicators/the-world-by-income-and-region.html.)

3.              Khan D, Kamble K, Diwan A. If Chemoresistance is harbinger of Radioresistence, can hybrid fractionation schedule circumvent it?  ESTRO Meets Asia; Singapore2019.


Michael Jameson PhD