the current status and advancement of radiation oncology in China

Austral - Asian Journal of Cancer ISSN-0972-2556, Vol. 6, No.2, April 2007

 

In 1998 WHO"S data showed that 45% of malignant tumors can be cured. This includes 22% cured by surgery, 18% by radiotherapy, 5% is by chemotherapy. Radiotherapy has been one of the essential treatment modalities in oncotherapy. Approximately 70% of cancer patients receive radiotherapy during the whole treatment. Radiotherapy cure rate has reached to 37%~53% in oral pharynx carcinoma, lingual root carcinoma, amygdale carcinoma. In other cancers such as antrum highnori carcinoma, antrum ethmoidale carcinoma, early stage carcinoma of tongue, carcinoma of rhino pharynx and cervical cancer the cure rate can reach to 38%~40%. The cure rate can even get to 80% in early stage of esophageal carcinoma. Up to now, even though there have been certain advances with chemicals and biotherapy technique, radiotherapy is still one of the main treatments for malignant tumor 武警总医院肿瘤科黎功

Radiation oncology started in China in 1930s, which limited to only a few hospitals of Shanghai, Beijing, Guangzhou. After 1949, with the great development of medical treatment and health services, radiotherapy also made a great progress. But in comparison with the developed countries, radiation oncology in China still has a great distance to cover including equipment items, personnel, , treatment technique etc.

Until 2001, investigation data from the Chinese Medical Society of Radiation Oncology showed about 800 Chinese hospitals applied radiation to cancer patients. The whole Chinese personnel engaged in radiation oncology is more than ten thousand and whole radiotherapy equipments are more than 2000 units. In the whole nation, the departments of radiation oncology that are able to apply x-knife therapy have approached to 300. More than 40 departments can use Y-knife. The annual irradiated patients is now more than 500 000.

Three-dimensional conformal radiation therapy could be applied in more than 200 departments.

Compared with the 1990s, the number of radiotherapy departments, equipment and the number of staff has increased three times, four times and twice respectively. This speed of development is the fastest in the world. The market for China-made radiotherapy equipments is increasing rapidly. At present, China can produce low-energy medical linear accelerator, ten thousand curie active series cobalt therapeutic machine, simulation machine, after loading machine, low-energy X-ray beam machine, Y-knife as well as radiotherapy treatment planning system. Among the total, ⁶⁰Co therapeutic machine and after loading machines made in our country take up more portion in the domestic market.

Although the number of radiotherapy equipment increased fast, the capacity per capita is still lower than the world average level. WHO suggest that there should be 2~3 tele-radiotherapy treatment facilities per million people. The present number is 3.4 in British, 8.2 in America, in France it is 4. However the possession of accelerators is 0.43 per million population in China, and merely 0.79 when ⁶⁰Co therapeutic machines are included. This means China still is lack of 2000 radiotherapy units. The per capita possession is similar to East-Asian and Middle American countries, but it is better than African, Southeast-Asian countries, India and Eastern Europe. Furthermore, these limited facilities are mostly located in eastern China. The major index in western China such as radiotherapy organization, radiotherapy equipment and radiotherapy applicable level are greatly lower than the country’s average.

The lack of auxiliary equipment is also a present character of China. Radiotherapy equipment (accelerator, cobalt machine, after loading machine) should educe therapeutically effect thoroughly to achieve invariably high-quality medical treatment level, the major equipment still need the assistance of simulation machine, dose meter, radiotherapy treatment planning system and check system etc. At present in China, only the provincial cancer hospital and some big hospitals in large cities possess the above-mentioned conditions. Some radiation oncology departments in middle-small cities irradiated using only one therapeutic machine without simulation and some hospitals only have after loading machine or Y-knife without any auxiliary equipment. However most provincial cancer centers have developed a high-level technique of radiotherapy, such as intensity modulated radiotherapy technique, 3-dimensional conformal radiotherapy, total body radiation technique, asymmetry irradiation technique, stereo tactic radiotherapy, radio surgery and Y-knife. The cobalt machine only is still used in western China. There are also some regions which use Y-knife but neglecting technique development, which is also a special Chinese phenomenon. These disproportion phenomena result in mass deviation of medical treatment.

Radiation oncology is a general medical system, the optimal tumor radiotherapy depends on the cooperation and technique applied by the members of a multidisciplinary team consisting of physicians, radiotherapy technicians, radiotherapy engineers and so on. The role of the radiotherapy engineer in our country is not optimal. Because our technicians still stay in a low-grade educational level, they can not fully participate in planning and administering treatment. Most radiotherapy technicians in radiation oncology departments are transferred from nursing or technologists from other fields.

 Radiation oncologist should not only master clinical knowledge, pharmaceutical sciences, oncology, diagnostic image logy, radio physics, radiobiology but also biochemistry of cancer, computer technique, and information medical knowledge etc. Confronting the radiotherapy technique reform guided by precise radiotherapy, only a few cancer hospitals or college hospitals possess such high quality of personnel. For example, the ratio in most developed countries has achieved 3:1 (doctor: physicist), and the rate reached to 2:1 in Hong Kong, but in China it is only 8:1. Further, most physicists have not received special training. In fact, the ratio is only 16:1 excluding the untrained physicists. Most radiation oncologists are clinically trained as oncologists without specialized radiotherapy knowledge unlike the qualifications of 8 years training in America, Europe and Japan.

We can see from the report of the plenary lecture and exhibition of ASTRO and ESTRO, that tumor radiotherapy is changing from 3D to 4D, which raises higher demands again on the radiation oncologists, but also provides a good opportunity for Chinese to improve the status of radiotherapy technician and catch up with the advanced technology of the world.

In China, the incidence of cancer is rising. According to the estimation of the national cancer treatment and prevention department, newly diagnosed patients are about 2 million while people succumbing to malignant tumor are about 1.4 million every year. According to the statistics of cancer hospitals in Beijing, Shanghai, Guangzhou and Hangzhou, about 65% ~75% cancer patients undergo radiation therapy as part of their whole treatment, while the data is 60% in the United States. It is therefore estimated about 1.3 million persons should be treated with radiation in China every year but currently only 0.283 million patients receive radiation, so it is a long way from guaranteeing 70% of 2 million cancer patients can obtain radiation therapy every year in China.

Radiation oncology comes now with just one hundred years history, but it is developing very fast. In the past decade, traditional and common radiotherapy has changed greatly with the development of computer technology, network technology, medical imaging technology and biotechnology. Tumor targeting is becoming much more reasonable and precise. With the help of PET/CT or functional MR, the biological targeting radiation will be finally realized. The calculating mode of physical dosage is changing gradually to biology-physical dosage mode. With the help of network technology, it is now possible to integrate radiotherapy information. The commercialization of IGRT has helped the integration of radiotherapy come true. In the coming 10 years, ART and BCRT will be on the agenda. Modern radiation oncology tends to be multi-subject integrated and continuing high technology application.

In China, Although radiation oncology is facing a big challenge, it also has a chance to improve the level of radiotherapy. Chinese hospitals should improve the quality of the radiotherapy team, maintain continuous education, support the national production research and manufacturing in radiotherapy auxiliary equipment while introducing advanced equipment and technology. Meanwhile, we should reinforce the research-on-research about modern radiotherapy, promote communication with developed countries, establish nation-wide consistent quality management and manipulation network system as soon as possible. We believe that the whole level of radiotherapy and quality of China will move to a new stage in the future.