Modernization of Radiation Therapy in Cambodia

Dr. Mora Mel, Radiation Oncology Resident at National Cancer Center (currently placement in the Philippines under IAEA fellowship)

Based on IARC’s Globocan 2012 project1, the estimated annual cancer incidence in Cambodia is approximately 14,000 cases. The incidence is predicted to rise rapidly in the future, due to the population and economic growth in the country. Due to the lack of access to comprehensive cancer care, the number of cancer deaths is projected at around 11,000.

In Cambodia, radiation therapy facilities first existed in 1960s, but they were completely destroyed during the Khmer Rouge regime from 1975 to 1979. It was not until 2003 that the Cambodian population had access to radiotherapy again through a collaboration between the Cambodian government, French government and French non-governmental organizations. A cobalt 60 machine, an X-Ray simulator, 2D dosimetry systems and a low dose cesium brachytherapy machine were installed in the Khmer-Soviet Friendship Hospital. However, the facilities broke down in the early 2010s and radiotherapy was absent for a few years again until a single linac was installed. Although hugely important, the capability of the facility is unable to meet the needs of cancer patients in the whole country.

Prof Sokha Eav, a pioneer in oncology after the tragedy in Cambodia, has been actively leading the effort to improve access to cancer care and to radiotherapy. In the early 2000s he initiated and planned a National Cancer Center (NCC) project to provide comprehensive cancer care to the public, including radiation oncology, nuclear medicine, medical oncology, onco-hematology and palliative care. NCC aims to function as a center of excellence in cancer care, education and research in the country.

Professor Koy Vanny (1st from left), Professor Eav Sokha (3rd from left), Professor Chheang Ra (4th from left) fromCalmette Hospital with colleagues from APROSIG and UCSF

Professor Koy Vanny (1st from left), Professor Eav Sokha (3rd from left), Professor Chheang Ra (4th from left) fromCalmette Hospital with colleagues from APROSIG and UCSF

On January 13, 2014 the groundbreaking ceremony for the construction of the NCC, presided by the International Atomic Energy Agency (IAEA) Director General, the Cambodian Minister of Health and the Director General of Calmette Hospital, marked the realization of the project in the compound of Calmette Hospital in the center of Phnom Penh. Two more regional cancer centers, one in the northwest and the other in the northeast of the country, are also part of the nationwide cancer care plan. One of the main key components in the project is to establish and maintain safe, accurate, and modern radiation facilities in the center. Three linear accelerators with capabilities of IMRT, IGRT, and SRS/SBRT, one CT-simulator and one HDR after-loading brachytherapy machine will be installed in the NCC. As of September 2017, one linac, a CT simulator and a HDR brachytherapy machine has been installed and awaiting commissioning. We aim to commence treating patients at the National Cancer Centre in Phnom Penh in 2018.

New Varian Clinac installed at National Cancer Centre, Phnom Penh in August 2017

New Varian Clinac installed at National Cancer Centre, Phnom Penh in August 2017

To assure and maintain the standard of radiotherapy, the NCC has been actively collaborating with the international community such as IAEA, Australia, Belgium, France, New Zealand and the United States. These partners have been involved in building up human resources, advice regarding building construction and machine selection, and technical assistance in machine installation and commissioning.

In 2015, a partnership between the NCC and the Asia Pacific Radiation Oncology Special Interest Group of the Royal Australian and New Zealand College of Radiologists  (APROSIG) was established. The following year, a team from APROSIG including radiation oncologists, a medical physicist and radiation therapy technologist visited the NCC site in Phnom Penh alongside a team from the University of California San Francisco (UCSF), in order to understand the current needs of NCC and provide support in ensuring a safe and sustainable commencement of radiotherapy services. More importantly, the teams were able to assess the future roles they will play to assist the NCC in achieving the goal of safe and precise radiotherapy.

APROSIG were successful in obtaining Australian government funding through the Australian Volunteers International Development (AVID) program to send volunteer Australian radiation staff to Phnom Penh for periods of 12 months. The project was also recently awarded an Australia Awards fellowship to fund 3-week fellowships for 8 Cambodian oncology staff within Australian hospitals in 2018. A radiation therapist trainer, Ms Kate Rogl, is currently in country in Phnom Penh. 2 Australian medical physicist volunteers, Ms Soo Min Heng and Mr Garry Grogan have already travelled to Phnom Penh to help train the local medical physicist, with a third volunteer, Mrs. Nikki Shelton, to arrive later in 2017. The volunteers will be involved in training the local staff to provide safe and precise radiotherapy, deliver a sustainable service and ultimately, become the future trainers. The long-term goals of the collaboration between the NCC and APROSIG include the establishment of local training programs for radiation oncology, medical physics and radiation therapy technology, as well as establish a cancer research unit. The other international partners will also play crucial roles in assisting to achieve the ultimate aim: the Cambodian ‘triangle of cancer centers’ to provide the nationwide optimal care to cancer patients.

National Cancer Centre staff with Australian volunteers, Ms Soo Min Heng and Ms Kate Rogl

National Cancer Centre staff with Australian volunteers, Ms Soo Min Heng and Ms Kate Rogl

If you are interested in contributing towards the Cambodian-APROSIG project, please contact  md.mora.m@gmail.com (Cambodia) or mei.yap@sswahs.nsw.gov.au (Australia). You can also donate to the project at :

https://give.everydayhero.com/au/apsig-4

References

  1. Ferlay J, Soerjomataram I, Dikshit R, et al: Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359-E386, 2015