Report of
FNCA FY2025 Workshop on Radiation Oncology

Outline of Workshop

*Official name: the Center of Nuclear Medicine and Oncology of the Abai Regional Health Department. For simplicity, “the Center of Nuclear Medicine and Oncology” is used throughout this page.

The FNCA FY2025Workshop on Radiation Oncology was held in a hybrid format from 13th-16th October 2025, in Semey, Kazakhstan. The meeting was co-organized by the The Center of Nuclear Medicine and Oncology of the Abai Regional Health Department, National Nuclear Center of the Republic of Kazakhstan (NNC) and the Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT).

Representatives from 12 FNCA member countries, namely Bangladesh, China, Indonesia, Japan, Kazakhstan, Korea, Malaysia, Mongolia, Philippines, Singapore, Thailand and Vietnam participated in the workshop (Singapore participated for the first time).

Opening Session
During the Opening Session, Dr. Sergey Berezin, Deputy Director General of the National Nuclear Center of Kazakhstan, served as the moderator. The session began with welcome remarks delivered by Mr. Zhasulan Sabitov, Deputy Director of Strategic Development and Organizational/Economic Affairs of the Abai Regional Health Department; Mr. Sayat Tanatarov, Director of the Nuclear Medicine and Oncology Center under the Abai Regional Health Department; and Prof. Tasbolat Adylkhanov, Chief Consultant in Oncology at the Kazakhstan National Cancer Center.

This was followed by opening remarks from Mr. TAMADA Masao, FNCA Japan Coordinator, and Mr. NAKAJIMA Shogo of the Ministry of Education, Culture, Sports, Science and Technology (MEXT), after which Dr. KATO Shingo, the Japanese Project Leader, also addressed the participants.

The session continued with a series of special lectures.

Dr. Nurgul Zhumakanova, Head of the Radiation Oncology Department at the Nuclear Medicine and Oncology Center in Semey, delivered a lecture titled “Advancing Radiation Therapy in Kazakhstan: Current Status and Future Perspectives.” Dr. Miras Zekebayev, Radiation Oncologist at the Kazakh Institute of Oncology and Radiology, presented on “Radiotherapy Capabilities at Kazakh Institute of Oncology and Radiology.”

Additionally, Dr. Wang Lian Chek Michael, Head of the Division of Radiation Oncology at the National Cancer Centre Singapore, gave an overview of radiotherapy practices at his institution.

<Clinical Studies>
This project has carried out international joint clinical studies aimed at establishing treatment protocols for cancers that are highly prevalent in FNCA member countries, including uterine cervix cancer, nasopharyngeal cancer, and breast cancer. The overarching goal of this project is to improve radiation oncology practice in the Asian region.

Prospective Observational Study of 3D-Image Guided Brachytherapy for Locally Advanced Cervical Cancer (CERVIX-V)
This is a protocol for cervical cancers following Cervix-IV. The patient enrollment started in 2017.

Dr. OKONOGI Noriyuki, Associate Professor, Department of Radiation Oncology, Juntendo University Graduate School of Medicine presented the protocol of CERVIX-V and the clinical outcomes.

Phase II Study of Hypofractionated Radiotherapy for Breast Cancer (Postmastectomy Radiation Therapy (PMRT) & (Whole Breast Irradiation (WBI) /BREAST-I)
Prof. KARASAWA Kumiko, Department Head, Department of Radiation Oncology, Kawakita General Hospital, and Dr. KONO Sawa, Tokyo Women's Medical University, School of Medicine presented the summary and the late adverse effects of WBI / BREAST-I and PMRT/BREAST-I.

Whole Brain Radiotherapy for Multiple Brain Metastasis from Non-Small Cell Lung Cancer (BRAIN-I)
Dr. Kullathorn Thephamongkhol, Associate Professor, Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, presented the protocol of BRAIN-I (Added Survival Benefit of Palliative Whole Brain Radiotherapy in Non-Small Cell Lung Cancer: An External Validation and model updating of a Prediction Model).
The presentation covered the study background, methodology, data submission and verification process, rationale for using case report forms, and key study highlights, as well as the study design and overview of the planned prognostic multivariable modeling study.

New Clinical Study and New Research Study
1) Concurrent chemoradiotherapy using whole pelvic IMRT and 3D-IGBT for locally advanced cervical cancer (CERVIX-VI)
The clinical study CERVIX‑VI, proposed by Prof. OHNO Tatsuya, had its concept and draft protocol reviewed and approved.

2) Ultra-hypofractionated radiotherapy (Ulatra-HF-R) for post-operative Breast Cancer (BREAST-II)
Prof. KARASAWA Kumiko presented the summary of the questionnaire-based survey on post-operative ultra-hypofractionated radiotherapy for breast cancer, followed by discussion.

3) Locally advanced rectal cancer (RECTUM-I)
Dr. Wajana Thaweerat, Lecturer at Siriraj Hospital, Mahidol University, presented the results of the questionnaire-based survey on total neoadjuvant therapy for locally advanced rectal cancer, followed by an open discussion.

Hands-on Training on 3D- Image Guided Brachytherapy (3D-IGBT) for Cervical Cancer
Hands-on Training on 3D- Image Guided Brachytherapy (3D-IGBT) for Cervical Cancer was conducted at the Center of Nuclear Medicine and Oncology of the Abai Regional Health Department.

QA/QC for 3D-IGBT
This activity aims to put in place reliable dosimetry in the institutes among the member countries for effective joint clinical studies. The audits in Quality Assurance (QA)/Quality Control (QC) of dosimetry measurement and radiation calibration have been conducted, which is for the reliable radiotherapy.

As part of the 3D‑IGBT dosimetry survey conducted across participating countries since 2019 under Cervix‑V, Dr. MIZUNO Hideyuki and Dr. NAKAJI Taku, QST hospital reported the results of the on-site audit conducted on the first day at the Center of Nuclear Medicine and Oncology.

Future Plans
On the 3rd day, the participants reviewed the Workshop sessions and discussed the future-plan of the project. It was agreed that the next workshop is to be held in Korea in October 2026.

Drafting Workshop Minutes
The draft minutes were submitted by the rapporteurs, discussed, and amended during the workshop, and the final version was completed after circulation among the participants.
Prof. KATO Shingo delivered the closing remarks and expressed his appreciation to all participants.

Technical Visit
1) The Center of Nuclear Medicine and Oncology of the Abai Regional Health Department.
On the 3rd day, Technical visit was held at the Center of Nuclear Medicine and Oncology of the Abai Regional Health Department.

2) Semipalatinsk Test Site
On the 4th day, the participants traveled to Kurchatov and visited facilities related to the Semipalatinsk Nuclear Test Site, including the exhibition hall, the ground zero area, and Atomic Lake, which was formed by an underground nuclear explosion.

Open Lectures
Open Lectures was held at the Center of Nuclear Medicine and Oncology, as a part of the workshop on the 3rd day. The following 7 lectures were given.

1. Overview and Progress of Forum for Nuclear Cooperation in Asia (FNCA) - Cooperation with Neighboring Asian Countries in the Field of Peaceful Uses of Nuclear Energy.
2. Current Problems and Achievements in Cancer Treatment in Kazakhstan
3. Recent Advances in the Treatment of Locally Advanced Cervical Cancer
4. Physics Aspects and Consideration in Gynecological Cancer Brachytherapy
5. Recent Trends and Advances in Radiotherapy for Breast Cancer
6. Stereotactic Radiotherapy: Indication, Techniques, and Outcomes for Hepatocellular Carcinoma
7. Particle Beam Therapy

Minutes of
FNCA FY2025 Workshop on Radiation Oncology Project

(1) Following the agreement at the 25th Forum for Nuclear Cooperation in Asia (FNCA) Coordinators Meeting, the FNCA FY2025 Workshop on Radiation Oncology was held from 13th to 16th October 2025, in Semey, Kazakhstan. The meeting was co-organized by National Nuclear Center of the Republic of Kazakhstan (NNC), Center of Nuclear Medicine and Oncology of the Abai Regional Health Department and the Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT). Representatives from 12 FNCA member countries, namely Bangladesh, China, Indonesia, Japan, Kazakhstan, Korea, Malaysia, Mongolia, The Philippines, Singapore, Thailand and Vietnam participated in the workshop.

Opening Ceremony
(2) Mr. Sergey Berezin, Deputy Director General of National Nuclear Center of the Republic of Kazakhstan moderated the session.

Dr. Zhasulan Sabitov, Deputy Director of Strategic Development and Organizational and Economic Issues of the Abai Regional Health Department gave a welcome address.

Prof. Sayat Tanatarov, Director of the Center of Nuclear Medicine and Oncology of the Abai Regional Health Department, Kazakhstan gave participants a welcome address.

Prof. Tasbolat Adylkhanov, Chief Consultant in Oncology, National Research Oncology Centre, Kazakhstan delivered his welcome address.

Dr. TAMADA Masao, FNCA coordinator of Japan delivered an opening address.

Mr. NAKAJIMA Shogo, Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT) delivered an opening address.

Prof. KATO Shingo, the Project Leader of the Radiation Oncology Project gave his remark.

(3) Dr. Nurgul Zhumakanova, Head of Radiation Oncology Department,
Center of Nuclear Medicine and Oncology, Semey, Kazakhstan delivered a special lecture on Advancing Radiation Therapy in Kazakhstan: Current Status and Future Perspectives.

(4) Dr. Miras Zekebayev, Radiation Oncologist, Kazakh Institute of Oncology and Radiology gave a special lecture on Radiotherapy Capabilities at Kazakh Institute of Oncology and Radiology.

(5) Introduction of individual participants followed.

(6) The agenda was adopted and chairpersons and rapporteurs were selected.

(7) Dr. Michael Wang, Chair and Senior Consultant, Division of Radiation Oncology, National Cancer Centre Singapore delivered a talk on Radiation Oncology in Singapore.

Session 1: Prospective Observational Study of 3D-Image Guided Brachytherapy for Locally Advanced Cervical Cancer (CERVIX-V)
(8) Dr. OKONOGI Noriyuki, Associate Professor, Department of Radiation Oncology, Juntendo University Graduate School of Medicine presented the protocol of CERVIX-V and the clinical outcomes.

The number of target cases enrolled is 100 cases. From 2017 to October 2023, 108 patients were enrolled in CERVIX-V. Out of these, 99 patients were eligible. Case enrollment from member countries are followings: Bangladesh (2), China (16), Indonesia (9), Japan (13), Kazakhstan (8), Korea (0), Mongolia (4), Malaysia (11), The Philippines (8), Thailand (32) and Vietnam (5).

As per the preliminary analysis of Cervix-V, 99 patients with median follow-up of 44.3 months were analyzed. All patients were treated with 3D-IGBT. Among them, 34 patients were treated with the interstitial/hybrid technique. Compared to the reference doses, 90% of cases satisfied the dose constraints in all items.

Regarding toxicities, grade 3 acute hematological toxicity was observed in 27 (27%) patients, and grade 3 acute non-hematological toxicity was observed in 3 (3%) patients. No grade 4 or severe acute toxicity was observed. No patients developed grade 3 or worse treatment-related late toxicity.

With a median follow-up time of 44.3 months, the 2-year, locoregional control (LC), progression-free survival (PFS), and overall survival (OS) were 92.5%, 77.4%, and 90.6%, respectively. Local recurrence occurred in 11 cases by the last observation date.

The FNCA Cervix-V has shown excellent oncological outcomes and acceptable toxicities. It demonstrates the usefulness of 3D-IGBT for cervical cancer in FNCA cooperative institutions.

(9) An open discussion on CERVIX-V followed.
- Prof. OHNO Tatsuya, Professor and Chairperson, Department of Radiation Oncology, Gunma University Graduate School of Medicine clarified the reason for the long treatment time. The reason given was machine breakdown.
- Discussion on the importance of overall treatment time of not more than 56 days to obtain optimum treatment outcome. It was also suggested to make separate analyses on Stage IIB and IIIB patients.
- Dr. OKONOGI Noriyuki will prepare the paper for journal publication soon.

Session 2: Phase II Study of Hypofractionated Radiotherapy for Breast Cancer (Postmastectomy Radiation Therapy (PMRT) & (Whole Breast Irradiation (WBI) /BREAST-I)
(10) Prof. KARASAWA Kumiko, Department Head, Department of Radiation Oncology, Kawakita General Hospital, and Dr. KONO Sawa, Tokyo Women's Medical University, School of Medicine presented the summary and the late adverse effects of WBI / BREAST-I. The summary is as follows:

From February 2013 to October 2018, 227 cases were registered. The registered numbers were Bangladesh (31), China (6), Indonesia (16), Japan (134), Kazakhstan (14), Korea (9), Malaysia (0), Mongolia (3), The Philippines (0), Thailand (14) and Vietnam (0). All patients with 228 tumors completed the protocol treatment and were analyzed. The late adverse effects of skin G1 (21%), G2 (1%); subcutaneous tissue G1 (10%); breast G1 (9%); lung G1 (2%). The cosmetic outcomes were excellent (148), good (74) , fair (3) and poor (3) in patients with more than 3 years follow-up.

(11) Next, Prof. KARASAWA and Dr. KONO presented the summary and the late adverse effects of PMRT / BREAST-I followed. The summary is as follows:

From February 2013 to October 2019, 222 cases were registered. The number of patients registered from Bangladesh (84), China (13), Indonesia (0), Japan (15), Kazakhstan (20), Korea (0), Malaysia (0), Mongolia (26), The Philippines (18), Thailand (0) and Vietnam (46). The follow up period is 1 to 139 months with a median of 80 months. The late adverse effects of skin G1 (42%), G2 (1%); subcutaneous tissue G1 (16%), G2 (2%); breast G1 (5%); lung G1 (6%); heart G1 (2%). There were 7 loco-regional recurrences, 39 distant metastases, 29 breast cancer deaths and 10 intercurrent deaths. The five-year loco-regional control, progression free survival and overall survival rates are 97%, 84.6% and 90.5%, respectively. Among the cases measured or evaluated, those with a difference of 2 cm or more between the left and right sides or subjective symptoms of mild edema. After follow-up, it was found that 93 patients (41.9%) underwent measurement and evaluation for edema in both upper limbs, accounting for 89.2% of them.

An open discussion on the clinical data of BREAST-I followed.

Session 3: Whole Brain Radiotherapy for Multiple Brain Metastasis from Non-Small Cell Lung Cancer (BRAIN-I)
(12) Dr. Kullathorn Thephamongkhol, Associate Professor, Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University presented the protocol of BRAIN-I (Added Survival Benefit of Palliative Whole Brain Radiotherapy in Non-Small Cell Lung Cancer: An External Validation and model updating of a Prediction Model).

(13) Dr. Kullathorn Thephamongkhol presented the background and methodology; how to send and check the data; the reasons behind case record form and research highlight and call to action. The study design and schema for the prognostic multivariable modeling study were also presented.

(14) The number of target cases enrolled is 800 cases. Current status until 13th October 2025, 847 patients were enrolled in BRAIN-I. Out of these, 506 patients were analyzable. Case enrollment from member countries are as follows: Bangladesh (4), China (50), Indonesia (1), Mongolia (3), Malaysia (15), Japan (12), The Philippines (22), and Thailand (676). 341 patients were under review with missing data.

(15) Dr. Kullathorn Thephamongkhol presented the proposed action plan for the study. Data recovery including revisiting missing data, new cases enrollment and updating data will be until January 2026 with the target of 100-150 new cases. Last date for case enrollment will be on the 31st January 2026. Data cleaning including systematic quality checking and logic error fixing to produce the final dataset would be done from February to March 2026. Data analysis will be conducted from April - May 2026.

(16) An open discussion on the clinical data of BRAIN-I followed.
- Dr. Kamal Uddin, Associate Professor, Department of Radiation Oncology, National Institute of ENT, Bangladesh clarified about the time to determine ECOG status, and has been answered that it will be at the time when we decide to deliver whole brain radiotherapy.

Session 4: New Clinical Study
(17) Prof. OHNO Tatsuya proposed a new clinical study, CERVIX-VI, investigating concurrent chemoradiotherapy using whole pelvic IMRT and 3D-IGBT for locally advanced cervical cancer. The concept and detailed protocol items of this trial were reviewed and confirmed based on the pre-distributed questionnaire. This protocol was formally approved by the FNCA members as part of its activities. It was also proposed that QA/QC items be further reviewed by the medical physicist team. Following necessary revisions, the finalized protocol will be shared with all FNCA members.

(18) Prof. KARASAWA Kumiko presented the summary of results of the questionnaire-based survey for post-operative ultra-hypofractionated radiotherapy for breast cancer. The presentation included a comprehensive overview of facility and interest, eligibility criteria, facility information, radiation method, and general comments. All members shared their views on the proposed protocol and indicated the potential feasibility and willingness of their respective country to participate in the study. All members acknowledged the variability of current practices across countries and emphasized the need for standardization. Radiotherapy details related to boost dose determination, the feasibility of applying simultaneous integrated boost (SIB) technique, and QA/QC procedures were discussed in depth. A secondary questionnaire-based survey was proposed with the aim of consolidating techniques and establishing a consensus protocol among participating countries. The possibility of conducting a dummy run in the future to assess the feasibility of protocol implementation across different countries was raised. The preparation of a secondary questionnaire-based survey will be prepared by Prof. KARASAWA Kumiko.

Session 5: Other Clinical Studies
(19) Dr. Wajana Thaweerat, Lecturer, Faculty of Medicine Siriraj Hospital, Mahidol University presented the results of the questionnaire-based survey for total neoadjuvant therapy for locally advanced rectal cancer. An open discussion followed, during which all members agreed to proceed with a retrospective study. The protocol for the retrospective study will be prepared by Dr. Thaweerat, Wajana and will be presented at the upcoming meeting.

Session 6: Hands-on Training on 3D- Image Guided Brachytherapy (3D-IGBT) for Cervical Cancer
(20) Hands-on Training on 3D- Image Guided Brachytherapy (3D-IGBT) for Cervical Cancer was conducted at the Center of Nuclear Medicine and Oncology of the Abai Regional Health Department.

Prof. Tasbolat Adylkhanov delivered opening remarks, followed by the confirmation of the agenda by Prof. KATO Shingo. Lectures regarding 3D-IGBT were given by Prof. OHNO Tatsuya, Dr. OKONOGI Noriyuki, and Prof. WAKATSUKI Masaru, Deputy Director General, QST Hospital, National Institutes for Quantum Science and Technology (QST). Hands-on training with one demonstrative case was conducted, including contouring session and planning session supervised by Prof. OKONOGI Noriyuki, Mr. Pitchayut Nakkrasae, Chief Medical Physicist and Assistance Instructor, Faculty of Medicine Siriraj Hospital, Mahidol University and other instructors from Japan and Thailand.

Session 7: Open Lectures
(21) Open Lectures were held at the Center of Nuclear Medicine and Oncology of the Abai Regional Health Department.

(22) Prof. Tasbolat Adylkhanov and Dr. Nurgul Zhumakanova moderated the session.

(23) Dr. TAMADA Masao gave a presentation about Overview and Progress of Forum for Nuclear Cooperation in Asia (FNCA) - Cooperation with Neighboring Asian Countries in the Field of Peaceful Uses of Nuclear Energy.

(24) Prof. Tasbolat Adylkhanov delivered a lecture on Current Problems and Achievements in Cancer Treatment in Kazakhstan.

(25) Prof. KATO Shingo gave a lecture on Recent Advances in the Treatment of Locally Advanced Cervical Cancer.

(26) Mr. Pitchayut Nakkrasae delivered a lecture entitled Physics Aspects and Consideration in Gynecological Cancer Brachytherapy.

(27) Prof. KARASAWA Kumiko delivered a lecture on Recent Trends and Advances in Radiotherapy for Breast Cancer.

(28) Dr. JANG Wonil, Chief, Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences (KIRAMS) gave a lecture on Stereotactic Radiotherapy: Indication, Techniques, and Outcomes for Hepatocellular Carcinoma.

(29) Dr. MAKISHIMA Hirokazu, Chief Physician, Head and Neck Thoracic Oncology Section, Department of Diagnostic Radiology and Radiation Oncology, QST Hospital, National Institutes for Quantum Science and Technology delivered a lecture on Particle Beam Therapy.

(30) Prof. KARASAWA Kumiko concluded the Open Lecture with her closing remarks.

Session 8: Technical Visit to Center of Nuclear Medicine and Oncology of the Abai Regional Health Department
(31) Technical visit was held at the Center of Nuclear Medicine and Oncology of the Abai Regional Health Department.

Session 9: QA/QC for 3D-IGBT
(32) Dr. MIZUNO Hideyuki, Section Manager, Quality Control Section, QST Hospital, QST and Dr. NAKAJI Taku, Researcher, Radiation Quality Control Section, QST Hospital, presented the preliminary QA/QC audit reports for 3D IGBT done at the Center of Nuclear Medicine and Oncology, Semey, Kazakhstan. The auditing results of the end-to-end test, applicator offset value, and source strength were demonstrated within the acceptable criteria.

However, several concerns regarding quality assurance were highlighted and the physicists of the center immediately took actions in response to recommendations.

Session 10: Future Plans
(33) Prof. KATO Shingo presented the future plans and next activities.

1. Next workshop will be held in Seoul, South Korea and tentatively scheduled on November 2-5, 2026. There was a proposal to hold the future workshop in the next 2 years in either Vietnam or Singapore.
2. Clinical Studies
   • Cervix-V: The first report . Continue follow-up and evaluate long term outcome (5 years). Report submission for journal publication with Dr. Okonogi as first author.
   • Breast-I: Continue follow-up to evaluate 10-year outcome.
   • Bone-I: Patterns of care survey (every 3 years). The next survey will be distributed on spring 2026.
   • Brain-I: Correct missing data and add new patients (except Thailand) by January 31, 2026. Evaluate the final outcomes and report submission for journal publication with Dr. Kullathorn as first author.
   • Cervix-VI: Finalize the protocol and will be distributed to participating countries. For IRB approval with subsequent start of enrollment of patients next year.
   • Breast-II: Continue discussion and create a 2nd questionnaire on treatment methods next year.
   • Rectum-I: Retrospective study on TNT with short/long course RT. Protocol will be presented and finalized at the next workshop.
3. QA/QC of 3D-IGBTul
   • On-site audits of 3D-IGBT (Country: still under consideration)
4. Other activities
   • Continue collaboration IAEA RCA/RAS 6098 evaluate TecDoc ”Choosing wisely for palliative radiotherapy in Asian countries.”

Session 11: Drafting Workshop Minutes
(34) The WS participants reviewed workshop discussion.

The draft of the minutes was submitted by rapporteurs, discussed and amended. The draft of the minutes will be circulated after the workshop and will be finalized.

(35) Prof. KATO Shingo gave the closing remarks and thanked all the participants.

Session 12: Technical Visit to the Semipalatinsk Test Site and Institute of Radiation Safety and Ecology, NNC.
(36) Technical visit was held at The Semipalatinsk Test Site and Institute of Radiation Safety and Ecology, National Nuclear Center of the Republic of Kazakhstan.

Program of
FNCA FY2025 Workshop on Radiation Oncology

Day 1 Mon, 13th October 2025
Place: Center of Nuclear Medicine and Oncology of the Abai Regional Health Department

Day 2 Tue, 14th October 2025
Place: Center of Nuclear Medicine and Oncology of the Abai Regional Health Department

Day 3 Wed, 15th October 2025
Place: Center of Nuclear Medicine and Oncology of the Abai Regional Health Department

Day 4Thu, 16th October 2025
Place: The Semipalatinsk Test Site and Institute of Radiation Safety and Ecology,
National Nuclear Center of the Republic of Kazakhstan (NNC)