Role of Accelerator Technologyto Support Diagnosis and Treatment of

Cancer

Kardinah Instalasi RadiodiagnostikRS.Kanker Dharmais /Pusat Kanker Nasional

Outline

• Cancer Control Program

• Program Action Cancer Therapy-IAEA

• Indonesia Cancer Control Program

• Diagnosis – Treatment

• Medical Radioisotopes

• Targeted Molecular Imaging in Oncology

Differences in treatment outcomes are sometimes huge, with pediatric oncology being the most dramatic example. While in the developed world cure rates following childhood cancer are approximately 75%, these percentages drop to 10-15% or even less in many low-income countries. It has been calculated that almost 100,000 children die from cancer every year who could have been cured had they received appropriate treatment.

Cancer in the Developing World: Can We Avoid the Disaster?Franco Cavalli

Nat Clin Pract Oncol. 2006;3(11):582-583

IAEA PACT July 2008 9

A New Platform• To join forces with other partners• To fight cancer comprehensively• To have an effective, efficient and

well coordinated IAEA cancer programme that is aligned with the work of WHO in this area

• To mobilize new resources

9

International Network for Cancer Treatment and Research

Tata Memorial

CentrePrivateSector

Ministry of Health: Indonesian Cancer Control Program

11Photos left to right: PMDS Albania, Nicaragua, Vietnam

PACT experience in developing countries shows urgent need for:Screening: Cervical and Breast

Radiotherapy to Treat and Cure

Palliative Care for Late Stages

PACT:Priority Interventions

WHO promotes the stepwise implementation of interventions according to the level of

resources

Very Low level of resourcesPalliative care and prevention of the most

prevalent cancer risk factors (e.g. tobacco)

High Level of resources

Awareness of early signs & symptoms of cervical & breast cancers plus adequate

diagnosis and treatmentMost of the Worlds Population

Low Technology breast & cervical cancer screening Treatment of all

curable tumours

Low level of resources

Middle level of resources

Mammography & Pap smear breast & cervical cancer screening

Example:

Regional Cancer CentreNational Cancer Centre

Plan of Regional Cancer Centre Indonesia

IAEA Ministry of Research & Technology

Ministry of Health

DG of Medical Care, Ministry of Health

DG of Disease Control & Environmental Health,

Ministry of Health

National Nuclear Energy Agency

(BATAN)

Dharmais Cancer Hospital, National Cancer Center

National Cancer Control Program• Prevention• Early detection • Diagnosis• Treatment

PACT• Cancer Diagnosis• Cancer Treatment

Level 1Full diagnostic services includes interventional studies eg

myocardial perfusion, captopril renal examinations

Level 2Provides basic outpatient therapeutic treatment

(I-131 for hyperthyroidism) , PET

Level 3Provides therapeutic (I-131 for thyroid

cancer, I-MIBG)

Primary ServiceBasic non-interventional nuclear medicine studies eg bone and

lung scan

Queensland Health Clinical Services Capability Framework Version 2.0 2005

Tumor definition by PET

Vander wel et al. Int J Radiat Oncol Biol Phys. 2005; 61: 649-55.

Staging for therapy

• Staging with PET/CT is superior to either modality alone

Conventional staging

Foto Thoraks

USG abdomen

Bone scanning

PET staging

Cachin, F. et al. J Clin Oncol; 24:3026-3031 2006

Guide therapy by evaluation of metabolic response

Surgery may be avoided or tailored based on tumor characteristics

Divgi et al, Lancet Oncol. 2007; 8 : 304-10.

Response to Hormonal TherapyPre-Rx Post-Rx

FES FDG FDGNewly Dx’d met breast CA

ER+ primary

FES-negative bone mets

University of Washington

Recurrent sternal lesion

ER+ primary

Recurrent Dz strongly FES+

Example 1

Example 2

(Linden, J Clin Onc, 2006)

PET/MR

AJR 192,April 2009

J Clin Oncol. 2008;26:2155–2161

Cancer Imaging. 2010; 10(1): 144–152.

PERMENKESNomor 1249/MENKES/PER/XII/2009

• Pengaturan untuk pelaksanaan pelayanan PET-CT

• Dokter Spesialis Kedokteran Nuklir dan Radiologi

• Technologist

• Perawat

• Radiofarmasis

• Fisika Medik

CA Cancer J Clin 1971;21;334-340

Advancing Nuclear Medicine Through Innovation http://www.nap.edu/catalog/11985.html

Journal of Nuclear Medicine Technology Volume 38, Number 1, 2010 6-17

Indian J Radiol Imaging 2008;18:290-294

Advancing Nuclear Medicine Through Innovation http://www.nap.edu/catalog/11985.html

J.R.Coll.Surg.Edinb., 45, April 2000, 110-19

Incidence

Level facility

QualityContinuityProduction and supplyOther

diagnostic and

treatment options

Diagnosis and Treatment

Gamma Camera

PET

Late Stage

Research Services