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Radiotherapy in Developing Countries PROCEEDINGS of a SYMPOSIUM, VIENNA, 1 -5 SEPTEMBER 1986 ORGANIZED by IAEA in CO-OPERATION with WHO

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Radiotherapy in Developing Countries PROCEEDINGS of a SYMPOSIUM, VIENNA, 1 -5 SEPTEMBER 1986 ORGANIZED by IAEA in CO-OPERATION with WHO Radiotherapy in Developing Countries PROCEEDINGS OF A SYMPOSIUM, VIENNA, 1 -5 SEPTEMBER 1986 ORGANIZED BY IAEA IN CO-OPERATION WITH WHO INTERNATIONAL ATOMIC ENERGY AGENCY, VIENNA, 1987 RADIOTHERAPY IN DEVELOPING COUNTRIES NUCLEAR SAFETY INFORMATION LIBRARY PLEASE RETURN A2643 PROCEEDINGS SERIES RADIOTHERAPY IN DEVELOPING COUNTRIES PROCEEDINGS OF AN INTERNATIONAL SYMPOSIUM ON RADIOTHERAPY IN DEVELOPING COUNTRIES - PRESENT STATUS AND FUTURE TRENDS ORGANIZED BY THE INTERNATIONAL ATOMIC ENERGY AGENCY IN CO-OPERATION WITH THE WORLD HEALTH ORGANIZATION A N D HELD IN VIENNA, 1-5 SEPTEMBER 1986 INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA, 1987 RADIOTHERAPY IN DEVELOPING COUNTRIES IAEA, VIENNA, 1987 STI/PUB/719 ISBN 92-0-010087-2 © IAEA, 1987 Permission to reproduce or translate the information contained in this publication may be obtained by writing to the International Atomic Energy Agency, Wagramerstrasse 5, P.O. Box 100, A-1400 Vienna, Austria. Printed by the IAEA in Austria March 1987 FOREWORD Cancer is of increasing concern all over the world, but the situation is becoming very serious in developing countries. Timely vaccination, and progress in sanitation and personal hygiene have improved life expectancy in many Third World countries, thus making it more likely that their citizens will eventually contract cancer. The doc­ tor in the developing world has not much to offer against this disease. Because medi­ cal care is not readily available and because means of early diagnosis are inadequate, cancer in these countries is often in an advanced stage when a patient is presented for treatment. Surgeons are scarce in the hospitals of the developing world, and chemotherapy is rather expensive. Radiotherapy might be useful either as a single modality of treat­ ment or in conjunction with surgery and chemotherapy for a significant percentage of patients. According to the World Health Organization (WHO), 40% of the developing countries do not have any radiotherapy services at all, while there is also a severe shortage of drugs used to fight cancer. In most of the countries where radiotherapy is available it functions inadequately because of its isolation from the health care system, the lack of qualified staff and equipment and insufficiency of funds. In countries where there are no radiotherapy facilities or where facilities are used inadequately, a large group of patients are being denied an effective mode of treatment. The Agency is actively involved with this problem because nuclear energy can be used as a means of treatment. WHO, a sister organization, is also vitally interested in the treatment of cancer because by the year 2000 the problem is expected to reach enormous dimensions and something should be done about it now. Many of the Agency activities are performed in close collaboration with WHO, as is this Symposium. By way of concerted co-ordinated research programmes, the Agency is trying to encourage a few of the ideas for improving radiotherapy practice that have direct relevance to the developing countries. One of these programmes is related to the use of adjuvant therapy to enhance the effects of irradiation. When radiotherapy sources are scarce, these potentiating modes of therapy help in conserving resources. Technical assistance is mainly offered in the form of fellowships for training of physicians and physicists from the developing countries in radiotherapy practices. The Agency also undertakes to provide experts wherever needed for on the job training. Unfortunately, the Agency’s resources are limited and support for therapy machines has been possible in a very few cases only. There is also an IAEA/WHO project dealing with the setting up of a network of brachytherapy centres for treatment of early cases of carcinoma of the cervix. This project was carried out in Egypt in 1983 and was highlighted at this Symposium. In addition to the annual training courses designed for this project, the Agency plans two biannual training courses in the region of South-East Asia and the Pacific for radiotherapists and related disciplines. Also directly related to radiotherapy is the IAEA/WHO network of Secondary Standard Dosimetry Laboratories which is concerned with improving the dosimetric accuracy of radiotherapy. This network presently includes some fifty laboratories mainly in the developing world. It is supported by about twelve national primary stan­ dard laboratories and by the International Office of Weights and Measures. The Agency’s dosimetry laboratory near Vienna functions as a co-ordinating laboratory for the network and organizes dose intercomparison measurements among partici­ pating laboratories. The aim of the present Symposium was to gather together specialists from deve­ loped and developing countries to review progress and present their latest findings. It was the first major meeting of its kind organized to take stock of the situation and assess the magnitude of the problem. It is evident that much work needs to be done before the aim of having radiotherapy facilities for treating cancer in each and every central hospital of the developing world is realized. The Symposium might be regarded as a first concrete step towards this goal. EDITORIAL NOTE The Proceedings have been edited by the editorial staff of the IAEA to the extent considered neces­ sary for the reader's assistance. The views expressed remain, however, the responsibility of the named authors or participants. In addition, the views are not necessarily those of the governments of the nominating Member States or o f the nominating organizations. Although great care has been taken to maintain the accuracy of information contained in this pub­ lication, neither the IAEA nor its Member States assume any responsibility for consequences which may arise from its use. The use of particular designations of countries or territories does not imply any judgement by the publisher, the IAEA, as to the legal status of such countries or territories, o f their authorities and institu­ tions or of the delimitation of their boundaries. The mention of names of specific companies or products (whether or not indicated as registered) does not imply any intention to infringe proprietary rights, nor should it be construed as an endorsement or recommendation on the part of the IAEA. The authors are responsible for having obtained the necessary permission for the IAEA to reproduce, translate or use material from sources already protected by copyrights. Material prepared by authors who are in contractual relation with governments is copyrighted by the IAEA, as publisher, only to the extent permitted by the appropriate national regulations. CONTENTS RADIATION THERAPY FOR CARCINOMA OF THE CERVIX Treatment of carcinoma of the cervix in developing countries (IAEA-SM-290/81) ............................ ......... 3 M. Snelling Technical and radiobiological peculiarities in fractionated high dose rate afterloading — A ten year report on the treatment of carcinoma of the cervix (IAEA-SM-290/83) ................................. 13 F.H. Glaser High dose rate afterloading in the treatment of cervix carcinoma with external irradiation and brachy therapy (IAEA-SM-290/13) ........... 27 T. Kuipers Preliminary report on the treatment of carcinoma cervix uteri with a combination of conventional irradiation and mitomycin С as radiosensitizer (IAEA-SM-290/29) ........................... 33 S. Puribhat, C. Chotigavanich, S. Tangkaratt, P. Puntumchinda, S. Sombooncharoen The role of intra-arterial chemotherapy in the management of uterine tumours with a complex modality treatment (IAEA-SM-290/59) ....... 41 J. Stumpf, G. Vadon, G. Németh Introduction of advanced remote afterloading brachytherapy techniques into developing countries, considering high activity sources, maintenance and care of equipment (IAEA-SM-290/23) ...................... 47 U.M.F. Altemark, S.M. Quandt Discussion .............................................. 55 DIFFERENT APPROACHES IN RADIATION THERAPY Radioprotection of the immune system during radiation therapy (IAEA-SM-290/84) ...................................... 61 H. Altmann, H. Tuschl, E. Кип Carcinoma of the oesophagus — Palliation by intracavitary irradiation (IAEA-SM-290/5) ............................... 71 C.G. Rowland, K.M. Pagliero Résultats d’irradiations hemicorporelles chez 92 patientes porteuses de cancer du sein polymétastatique traitées à l’Institut Curie (IAEA-SM-290/47) ...................................... 79 D. Jullien, J.-R. Vilcoq, F. Сатрапа Tratamiento multidisciplinario del tumor de Wilms. Experiencia de trece años (IAEA-SM-290/10) ................................... 87 T. Lanché, R. Borrego, G. Martínez, R. Rivera Radioterapia preoperatoria en el tratamiento del cancer de rectosigmoides (IAEA-SM-290/19) ...................................... 97 C. González-Miranda, L. Badinez, J■ Rajevic The role of radiotherapy in localized non-Hodgkin’s lymphomas (IAEA-SM-290/8) ....................................... 105 M.B. Patricio, R. Cabral, M. Neves, A. de Ponte, M. Vilhena Neoadjuvant chemotherapy and hypofractionated irradiation in the treatment of head and neck cancers (IAEA-SM-290/33) .................... Ill J.-M. Deneufbourg Technical problems associated with radiotherapy for nasopharyngeal carcinoma. Experience at the Department of Radiotherapy, Kenyatta National Hospital, Nairobi, Kenya (IAEA-SM-290/67) .............. 121 J.N. Onyango, A.M. Babu, N. Tole Intracavitary irradiation for nasopharyngeal carcinoma (IAEA-SM-290/39) .....................................
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