1. Observations from the Rapporteurs
Rapporteurs: Krystyna Kiel
Michael Joiner
Geoffrey Ibbott

2. Three Perspectives Radiation Oncology Radiation Biology
Radiation Physics

3. Radiation Oncology: RT is the most cost-effective cancer treatment
Cancer incidence, stage and treatment varies with region, economic status
Developing countries:
Cervix, Head & Neck, Lung, Breast
More often advanced stage
Treatment more often for palliation, although number of curative cases is increasing
Developed countries:
Lung, Breast, Prostate
Early detection and awareness/prevention programs
Treatment more often for cure

4. Radiation Oncology MONEY Barriers in Developing Countries
Need for more RT facilities
Many countries have no RT facilities
Machines/population is very low
Perception that radiation is only for palliation
People with means go elsewhere for treatment
Economic drive to introduce advanced technologies
Often a lack of multidisciplinary protocols and tumor boards, i.e., for pediatric tumors
MONEY

5. Radiation Oncology Issues in Developing Countries
Interest in introducing advanced technologies without sufficient resources or evidence
Potential for adopting new technology (e.g., IMRT) without full appreciation of risks
Lack of qualified personnel
Lack of training for advanced technologies

6. Radiation Oncology: Introducing Advanced Technologies
Experience in 3D treatment planning is essential prior to initiating more-advanced technologies
Certain populations might benefit from adv. tech.
Technology separates physician from patient
Too easy to depend on technology
Many advances in imaging are exciting
May help better determine target
Reduction in field margins should be accompanied by image guidance, compensation for motion
Requires studies to prove we can use this capability

7. Radiation Biology
Hyperfractionation and accelerated fractionation are not as promising as expected
Hypofractionation is useful as a resource- sparing approach to cancer treatment
Evidence in lung, brain, prostate, breast cancer

8. Radiation Physics Advanced technologies very demanding of resources
Technologies are under development, not all deficiencies are resolved
New techniques (e.g., IMRT) can produce poor results if QA not adequate
Overwhelming majority of participants recognize continuing role for Cobalt units.
Potential exists for advanced treatment methods with Cobalt

9. Radiation Physics IMRT: Small radiation fields
Inadequacy of some planning systems
Studies show inability of planners to achieve goals
Studies show planned distribution often not delivered
Studies required to prove value before widespread use
Small radiation fields
Appropriate calibration equipment often not available
Equipment often can’t deliver reference field size
New technologies are advancing faster than appropriate QA programs can be developed

10. Education and Training
Global shortage of skilled professionals
Will be a long-term demand for trainers and educators
Training must be adapted to working environment and available technology
Insufficient recognition of value of training
Programs should include broad education
Role for networking on national and regional level to support education
IAEA support for education and training was recognized and appreciated

11. Final Comments
The rapporteurs found the conference enlightening and enjoyable We are grateful for the support of the IAEA for our participation