In 2002, Colombia approached the IAEA with a request to assist the country in establishing an intensity modulated radiation therapy (IMRT) programme at the National Cancer Institute (INC) in Bogota.
Positioning and immobilization of a patient for IMRT of the head and neck region. (Photo: Martha Cotes-Mestre, National Cancer Institute, Colombia)
The objective of this request was to improve the accuracy of radiotherapy treatments, in particular for head and neck and pelvic cancers, thus improving patient outcomes and reducing toxicities. An initial expert mission to the INC noted that there was not enough expertise in three-dimensional conformal radiotherapy (3-D CRT) at that time to initiate an IMRT programme. IAEA criteria require that centres contemplating an IMRT programme should fill out a self-assessment questionnaire and, in general, must have at least two years of previous experience with 3-D CRT implementation.
Furthermore, it is desirable for centres to have an operational follow-up clinic where treated patients are followed for months and years after treatment in order to record and quantify their treatment outcomes in terms of tumour control and toxicity of therapy. This type of follow-up clinic did not exist at the time.
Dose distribution in a patient treated with IMRT to the neck region. (Photo: Martha Cotes-Mestre, National Cancer Institute, Colombia)
The project was comprised of two phases: 1) between 2003 and 2005, the INC moved from 2-D to 3-D CRT with IAEA support and established a follow- up clinic, and 2) between 2005 and 2007, the INC initiated IMRT treatments. The latter phase required the upgrade of local space and facilities, the purchase and delivery of equipment and software and training of staff, including radiation oncologists, medical physicists and technologists, as well as scientific visits of administrators to other centres already implementing IMRT programmes.
Two internationally recognized experts in medical physics and radiation oncology were present on-site during the first IMRT treatments providing guidance and practical orientation to the local staff. As is normally the case for these projects, the IAEA organized a national local workshop on the topic, providing external lecturers but also local experts. This served the purpose of facilitating dialogue and enabled the establishment of the joint partnership collaboration between centres with long standing experience in IMRT and the newly initiated programme.
As a result of the IAEA projects, the INC, a large public hospital and the main teaching centre for oncology and radiotherapy in Colombia, joined the group of centres that practice this modern treatment modality in the country.