The development of brachytherapy in China gained the world’s attention

By Dr. Niu Lizhi  executive president of Jinan University School of Medicine affiliated Fuda Cancer Hospital

June 28th, 2016, the second day of the 2016 ABS World Congress-American Brachytherapy Society, was the time for Chinese experts to demonstrate the development of brachytherapy in China. The congress has witnessed the speeches of over 10 Chinese medical experts and 20 wall posters. The original research in China has gained the word’s attention. In particular, the scientific literacy and Englishproficiency of Chinese doctors are inspiring. I firmly believe that the development of brachytherapy for cancer holds a bright future in China.

                   CIBS members and chairman of the congress

On the same day, Prof. Zhang Fujun, Prof. Wang Junjie and Prof. Zhang Jianguo from Interventional Brachytherapy Branch, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-cancer Association established official relations with ABS, which has for the first time secured China’s Brachytherapy Society’s place in the world arena. It is fair to say that the day is a milestone in the history of brachytherapy in China.

Expert meetings

ABS World Congress-American Brachytherapy Society and CIBS held their first official meeting in San Francisco on June 28th, 2016. Prof. David Gaffney, incumbent chairman of ABS/WCB, Prof. Steven Frank, former chairman of ABS/WBC, Secretary Ms. Cate Yashar, CFO Firas Mourtada, the executive director Mr. Rick Guggolz met the incumbent chairman Prof. Zhang Fujun, former chairman Prof. Wang Junjie, vice-chairman Prof. Zhang Jianguo, after-loading therapy expert Prof. Cheng Guanghui of Interventional Brachytherapy Branch, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-cancer Association and discussed matters, including cooperation, exchange visits, young doctor training, etc.

Prof. Wang Junjie delivered a speech titled “China Brachytherapy Update-Current Situation & Prospectives”, introducing to the audience the status quo of Brachytherapy in China, 3D Printing Individual Templates Guided Brachytherapy and technology promotion. Prof. Zhang Fujun briefed to the participants the achievements made in the field of brachytherapy in China in the past ten years and more, especially the innovations made in radioactive particle stent and 3D printing.

Experts from other countries spoke highly of the innovation spirit of Chinese doctors shown in developing radioactive particle stent, 3D printing and rapid degradation particle chain and have tentatively reached an accord that a special session on seed implantation therapy will be set up for Chinese experts at the next session of forum to be held in Boston in April 2017. Moreover, several leaderships and experts from foreign Societies will be invited to attend China Academic Conference on Seed Implantation for Cancer or China Congress of Brachytherapy for enhanced communication and understanding to make World Congress of Brachytherapy to be held in China.

Congress summery

June 28th, 2016 was the day for Chinese experts to demonstrate the development of brachytherapy in China. At the congress, 10 delegates from Chinese delegation delivered speeches and 20 wall posters were put up, which have gained the word’s attention. In particular, the scientific literacy and Englishproficiency of Chinese doctors are quite inspiring.

Prof. Niu Lizhi, Jinan University School of Medicine affiliated Fuda Cancer Hospital delivered a speech and had his paper posted

At the congress, several Chinese experts showed to the participants the research on radioactive seeds for solid tumors. Prof. Wang Juan from Hebei General Hospital reported the research on radioactive seeds implantation therapy for retroperitoneal tumor. Prof. Li Yuliang from the Second Hospital of Shandong University reported the research on seed implantation therapy for pancreatic cancer. Prof. Niu Lizhi from Jinan University School of Medicine affiliated Fuda Cancer Hospital reported radioactive seeds implantation therapy for cardiac tumor and pancreatic tumor. In addition, the reports delivered by experts from Tianjin Medical University, Jiangsu Province Hospital, Chinese PLA General Hospital have gained extensive attention from the participants.

In recent years, China has made significant development in the field of radioactive seeds implantation therapy for cancer. The innovative research and superb achievement made by Chinese experts can be shown in the following aspects:

1、Seed chain

An US study shows that when it comes to seed implantation in the prostate cancer, the rate of seed displacement to lung by using particle chain is much lower than that of chainless seed implantation. Moreover, using particle chain has guaranteed the uniform distribution of the seeds and the dosage also, which is the main reason why doctors from the US give preference to particle chain. The degradation of particle chain needs 90 days. In comparison, the degradation of particle chain material, a patent owned by Prof. Zhang Fujun from China only takes 10 days. Medical experts showed great interest in the new material, hoping that Prof. Zhang Fujun could commercialize it in the shortest term.

2、MR

The focus of the current session of conference is that many hospitals in the US have been performing brachytherapy under MR guidance especially for pelvic organ tumors in that MR is the most accurate imaging examination for pelvic organs, such as prostate, uterine neck, rectum and anus. Brachytherapy for tumors in these organs requires precise positioning. MR-guided brachytherapy has just started in China. Prof. Li Chengli from Shandong Medical Imaging Research Institute is an authoritative expert in MR-guided brachytherapy. We believe with his effort, MR-guided brachytherapy will be more and more widely used in China.

3、Brain tumor

An American hospital carried out a research where radioactive seeds are inserted into the surrounding tissue after primary brain tumor resection in order to prevent tumor recurrence. The research showed that radioactive seed implantation in the surrounding tissue after primary tumor resection can reduce the recurrence rate of tumor. Prof. Hu Xiaokun, chairman of Image Technology Branch, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-Cancer Association, has made remarkable achievement in the field of seeds implantation for brain tumor. Regrettably, he didn’t make it to attend the current session of congress. We hope he could attend the next session of congress to show to the world his research achievement.

Indian experts carried out research on radioactive seeds for head and neck tumor

4、Head and neck tumor

Head and neck tumor are the tumors of the highest incidence rate in India. The application of high dose rate Iridium-192 has achieved good curative effect as it is shown in the pictures below. The team of professors represented by Prof. Zhang Jianguo has made the most brilliant achievement in the field of brachytherapy for head and neck tumor. The clinical result and research achievement in brachytherapy for neck and head tumor are leading the world and have gained the attention of the participating experts.

      Indian experts carried out research on radioactive seeds for head and neck tumor

5、Vertebral tumor

Vertebrae are the most common site of metastases. Applying radioactive I-125 seeds implantation on metastatic vertebral tumor after failure of radiotherapy or when radiotherapy is not applicable is the innovation made by Chinese medical experts. Both team of professors represented by Prof. Wang Junjie from Peking University Third Hospital and team of professors represented by Prof. Huang Xuequan shared with the participants their experience and research on radioactive seeds for vertebral tumors, the good therapeutic effect of which has gained the attention of foreign experts.

6、Lung cancer

At the current session of forum, the only research report on brachytherapy for lung cancer was made by the team of professors represented by Prof. Zhang Fujun from Sun Yat-sen University. They reported the significant efficacy of radioactive I-125 seeds implantation for metastatic lung cancer and primary and unresectable lung tumors as well as the significant increase of local control rate and prolongation of survival time. The study was published in Radiology-the top magazine in interventional treatment. 

7、Radioactive seeds stent

The team of professors represented by Prof. Guo Jinhe from Southeast University reported the research results of animal experiment and clinical studies on radioactive seeds stent for tracheal-caused stenosis. The strategy has not only solved the problem of tracheal stenosis but also enabled the radioactive seeds to treat cancer, which has prevented tumor recurrence and effectively prolonged the survival time of cancer patients. The study was published in the well-known magazine Lancet Oncology.

Low-dose-rate seed VS high-dose-rate seed: each has its own strength

In the US, high-dose-rate seeds (including Palladium-103, Iridium-192) are used to treat solid tumors, prostate cancer excluded. High-dose-rate seeds can be taken away within a short period of time after radiating the tumor tissue, which can be classified into temporary seed implantation. In comparison, low-dose-rate seeds have to be implanted in the tumor for a long term, which falls into the category of permanent seed implantation. The advantages of temporary seed implantation are short irradiation time and good short-term effect though it also has its downside. Prof. Wang Juan from Hebei General Hospital noted that the protection of high-dose-rate seed is more difficult than that of the low-dose-rate one, which better suits Chinese condition. The advantage of low-dose-rate is that the total irradiation dosage can be increased. According to research from Japan, good tolerance is noted when prostate cancer patients were given I-125 seeds implantation, the radioactivity of which is up to 200GY. It also shows the safety of low-dose-rate seed implantation.

In a nutshell, both low-dose-rate seed and high-dose-rate seed have their own strength and are suitable for different tumors. We hope that seeds with different dose rates will be available for cancer patients in China.

Dr. Xu said cancer is not only to be killed but also need to be friendly treat.

Xu Kecheng, a doctor and professor in Guangzhou Fuda Cancer Hospital in China,and also a liver cancer survivor, who living with cancer about 11 years untill now, here i talk about him because he is the one kind doctor and worth people to know him.

Now, he is 76 years old,when his mother died from cancer, and after that for a few years, he found he also got a stage 3 liver cancer, someone suggested him accepted the traditional cancer treatment radiation, but he refused and accepted a long-term immunotherapy. The time and result showed that his decision is right, two of his cancer patients who are his friend also have the same cancer, but they accepted the hepatectomy, chemo and radio, finally, they died from the lower immunity function to fight the cancer,they just survived half a year after accepting the surgery.  

Why he is a good doctors? He have been doing the Clinical work over 50 years,he donated all his life to research and found the new cancer treatments,as a cancer patient too he know how painful and negative caused from cancer, so even in a old age he still decided to built a cancer hospital study new cancer treatments to save the cancer patients. He help many patients who from poor family, he always pay seriously attention to patients’ disease and health, how the patient feeling, what kind of pain they are suffering, he always try his best to help patients to go through the hard time before treatments, he said he love to visit the patients at any time, they just like his families like his precious persons.

Let Cancer Patients Survival Is The Absolute Principle

Dr.Xu said：“As a doctor i hope can provide patients the best suitable and “intelligent”treatments,

as a cancer patient and survivor, i hope all our doctors can provide the most right and least pain treatment to patients , as a soldier to challenge and fight cancer, i feel glory. I believe, human will finally to overcome cancer, our cancer patients will recovered or live with cancer in a long time.”

I remember Dr.Xu also mentioned that, cancer is our enemy which not just need to be killed but also need to be friendly treat, because enemies are too many to be killed and destroyed , or they will be opposite of the wish, just like the war, it is impossible to destroy all of enemies but let them completely convinced, they will never invade and attack us. The same ways to the cancer, if we could not kill all of the cancer cells, why not let us live peacefully with the survival cancer. With the years of experience in treating cancer, he got a new idea that they could combined different treatments depend on the patients’ body condition, so the main new treatment “3C+P” is on the use, this new research result have been recognized at home and abroad, the data shows there are 70% of cancer patients’ condition have obvious improvement, they prolong patients’ survival time and improve the quality of their life. The “ 3C+P” treatment main treat the cancer like unresectable, metastases on operation, no response on chemo/radio and recurrent advanced cancer.

Giving patients emotional concern and spiritual encouragement are every doctor’s duty.

Dr.Xu spend over 50 years in research cancer, have innumerable experience in cancer treatment and diagnose diseases, also great achievements and works, he is not only just a doctor, but also author, chief editor, he writing books and papers with number of words over ten million, who has or had a lot of academic titles, but he said let cancer patients survival are the glory and proud of thing for him. Every patients from home and abroad he will always spend over half hour to ask the patients’ body condition, that is vary important to hear clearly patients’ disease situation, feeling and demand, no matter when he will always spend some time to see the patients even in his busy days, he said the encouragement and confidence for patients before/after surgery are good to patients’ emotion and spirit to fight the cancer so that will also benefit doctors to do the surgery. As a doctor, should regard the patients’ life to be No.1 forever that also become a duty for every doctor, random to give patients to do chemo and radio are forbidden, the treatment plan must be discussed by professional and rich cancer-treatment experienced export and doctor to finish with his team, not just only serious requirement of doctors but also the nurse and every worker in fuda hospital.

The Main attending cases from Dr.Xu

Kidney cancer and bone metastases, pancreatic endocrine tumor, pancreatic cancer, retroperitoneal liposarcoma, “ dough figurine” retroperitoneal liposarcoma, non-small-cell lung cancer (NSCLC),  melanoma, esophagus cancer, multiple neuroendocrine tumor, breast cancer, ovarian cancer, neck giant teratoma,  uterine Cancer,  lymphoma, liver cancer and etc.

International social position

1. Chief president of Fuda Cancer Hospital, Jinan University School of Medicine

2. President of International Society of Cryosurgery (ISC)

3. Honorary president of Asian Society of Cryosurgery.

4. Special Adviser of Japan Society of Low Temperature Medicine

International Honors and Awards

1. China Provincial and Municipal Academic Awards for Enzyme and Isoenzyme Diagnosis for Hepatocellular Carcinoma.

2. Guangdong Provincial Academic Award for Cryoablation of Liver Cancer(2013).

3. Japan: JSLTM Gold Medal for Cryoablation of Pancreatic Cancer (2008).

4. Austra: Great Gold Medal for Cancer Cryosurgery(2011)

5. Austra: Excellent Work Award for Book Modern Cryosurgery for Cancer

publications

Guangzhou Doctors Became Famous in Malaysia

Ten years ago, Xiaoxuan (alias), a Malaysian child, was diagnosed with brain cancer. Her parents took her all around to seek medical treatment. As they believed that Chinese doctor should have excellent medical skills since China has a large population, they took the flight to Guangzhou and Xiaoxuan underwent operation at Guangzhou Fuda Cancer Hospital. After two-year treatment, Xiaoxuan's disease was cured and she did not need to come back to Guangzhou for follow-up treatment. In the following ten years, Xiaoxuan and her parents have been making overseas phone calls on special occasions to express their appreciation to doctors at FUDA. On December 7, 2015 when the “Role Model of the Times” award winner and chief president of Fuda Hospital was invited to deliver a lecture in Malaysia, Xiaoxuan's family came along the way to the lecture venue. The child with brain cancer ten years ago has grown up and becomes a graceful young lady. Nineteen-year-old Xiaoxuna bowed her thanks to medical workers of FUDA at the venue to express her appreciation to Guangzhou doctors for saving her life.

Ten years ago, the 9-year-old Malaysian child with brain tumor sought treatment and was cured in Guangzhou.

Ten years ago, Xiaoxuan was seeking treatment in Guangzhou.

In 2004, 8-year-old Malaysian girl Xiaoxuan was diagnosed with brain glioma at a local hospital. As tumor was located at a special site in brain, only two third of tumor was removed at the local hospital in the end of 2005. “Brain glioma has a special character. It has an ill-defined margin like crabs and cannot be completely removed through operation. Patients often die of cerebral failure within months or years due to repeated operation.” After operation, Xiaoxuan's symptoms such as vomiting and headache hadn't been alleviated. Local doctors suggested Xiaoxuan's parents to seek for new treatment.

“At the very first start, we had wanted to go to Singapore for treatment. But later we learned that Guangzhou Fuda Cancer Hospital has a local immunotherapy for tumor bed that can prevent tumor recurrence. As we believed Chinese doctors must have excellent medical skills since China has a large population, we took a flight to Guangzhou with Xiaoxuan.” Xiaoxuan's father recalled.

“There was a 3-4cm large tumor in the third ventricle of cerebrum of Xiaoxuan. The tumor mass blocked the flow of cerebrospinal fluid and caused hydrocephaly. However, another major brain operation is more than what a 9-year-old child could take.” Xu Kecheng, the chief president of Guangzhou Fuda Cancer Hospital told the reporter. After case analysis, Prof. Wu at FUDA decided to give Xiaoxuan the following treatment. Firstly, residual tumor was removed as much as possible during the craniotomy. Then one side of a thin catheter was embedded in the third ventricle of cerebrum and the other side was embedded in abdominal cavity through subcutaneous tunnel of neck and chest to introduce cerebrospinal fluid into abdominal cavity. Then a medicine capsule was embedded in the tumor bed with the open end of the capsule at the basal part of the tumor and the close end under the head skin. After operation, immune preparations are injected into the capsule on a regular basis.

After the operation, Xiaoxuan came to FUDA every other month to receive immune preparation injection. After nearly two years' treatment and follow-up visit, Xiaoxuan's disease was cured and she did not need to come back to Guangzhou any more.

According to medical workers at FUDA, Xiaoxuan was very staunch though she was just a little girl when she underwent treatment. Each time after the injection, she would have fever up to 40℃. She managed to get through with it without crying. As Xiaoxuan's family had been to FUDA for many times, they mingled well with medical workers at FUDA like family members. Xiaoxuan's father said, “To speak of what we have went through is easy, but it was really difficult to have it done. Medical workers at FUDA have done a lot to take care of us.” He recalled, “I remember there was one time in winter that medical workers at FUDA invited us to have hot spring right after we arrived at FUDA”. As he had been going through the customs and going from and to hospital for many times with Xiaoxuan, in addition he was dark-skinned, medical workers cordially called him “Uncle Pirate”.

Ten years later, the recovered patient came along the way to bow her thanks when Guangzhou doctor delivered a lecture in Malaysia.

 Ten years later, Xiaoxuan and her “lifesaver” gathered in Malaysia

Ten years ago, Xiaoxuan's parents took her to Guangzhou for treatment as the last resort. Ten years later, Xiaoxuan's family came along the way to the lecture venue in order to express their thanks to the “lifesaver” when they learned that Xu Kecheng was invited to deliver a lecture in Malaysia.

Xiaoxuan grew taller. She has a pair of big dark and sparkle eyes on her round face. The dimple on both cheeks makes her even more beautiful. It is hard to associate the graceful young girl with the child with brain cancer ten year ago.

“Ah, is it really you, Xiaoxuan?”“Nice meeting you, president Xu. It is me.” Xu Kecheng could not believe that the girl who was standing right in front of him is the girl with brain cancer ten years ago. “She embraced me tightly with tears in her eyes. I could feel a small bulging on her left head skin through her black hair.” Xu Kecheng said the bulging was the medicine capsule embedded by Prof. Wu ten years ago. It was really amazing that such an inexpensive but effective medicine capsule has saved the lives of hundreds of brain cancer patients.

It is learned that now 19-year-old Xioaxuan is a preparatory student of Methodist Pilley Institute, Sibu, Malaysia. “My classmates just couldn't tell that I'm a brain cancer survivor. They just wouldn't believe it when I shared my story with them. I told them it was doctors in Guangzhou who have cured my brain cancer.” She has never forgotten those who have treated her and taken care of her at FUDA. She asked about the recent situations of doctor Wu, her surgeon, Doctor Liu Zhengping, Doctor Wang Feng, the nurse Xiaoxia. She said, “I really appreciate what they have done for me”. She said now her best hope is to have a healthy body. She also hoped she can get the opportunity to go back to Guangzhou and visit medical workers at FUDA again. Xu Kecheng said, “It is my sincere hope that you will apply for Medical School of Jinan University in Guangzhou and become a doctor in the future.”

The 5th International (Guangzhou) Forum on Cancer Treatment (IFCI) （First Part)

The 5th International (Guangzhou) Forum on Cancer Treatment (IFCT) in conjunction with Founding Conference of International Society of Stem Cell Regenerative Medicine, which was held in Guangzhou Fuda Cancer Hospital on July 2^nd , 2016.

It is my first time to attend the Congress which was held in Guangzhou Fuda Cancer Hospital. When i stepped into the hall, there are many experts and medias from different countries to attend the opening ceremony , which make me so excited and amazed about that. 

During the opening ceremony the professor Xu Kecheng did a welcome speech, what most impressive for me is that:

The past two hundred years have witnessed the development of modern cancer treatment. In particular, the recent years and more have seen the deeper understanding of cancer among the public. Moreover, the researches on genetics and protrinology have prompted the development of large number of targeted medicines for cancer. However, there remain huge challenges in the field of cancer treatment. We are still using the conventional technologies to treat most common cancers making few breakthroughs.

The development of imaging technology has prompted the rise of interventional oncology, which marks a remarkable advance in cance treatment. Modern cryoablation which is represented by argon-helium cryosurgery was emerged in the late period of last century. Irreversible Electroporation, came out in recent years, have gained rapid development. Both of the ablation methods have brought hope of life for cancer patients who cannot tolerate surgery or who have unresectable tumors. As an unique therapy, immunotherapy has made itself into new territory for cancer treatment. 

When i heard about that, there was same feeling deep down my heart, i just heard and watch many of cancer patients who benefit from the new cancer treatment, and make them cured or have a long-term survival.

During the meeting, the experts from all over the world to do their keynote speeches and share their new researches of cancer treatments, and what they are talking about is going to a new higher stage of cancer treatment. The subject include:

Section 1: New Thoughts and Strategies on Cancer Treatment.

1. Pancreatic Cancer Research: Gaps and Opportunities.----- Los Angeles, US.

2. Importance of Regulation and Ethics Committee for Cellular Therapy.------ Tokyo, Japan.

3. Testosterone Enhances of the differentiation Efficiency of Insulin-producing Cells from Human Induced Pluripotent Stem Cells.------ Guangzhou, China.

4. Combining ERBB4 with TP53 and RAS Sugnaling Predicts Clinical Outcome in Subtypes of Gastric Cancer.------ Beijing, China.

5.  Sleep Disturbances in Cancer Patients. ------- University of California Los Angeles, USA.

Discussion

Specially Invited Speeches: Voice of Patients

1. Treatment Experience in China. ----- UK

2. New protocol got Cryoablation in Breast Cancer Treatment: what women want and need.------- Oregon, USA

3. Treatment Experience with IRE in Fuda. ------- Philippine

Section 2: Cryoablation Therapy for Cancer

1. The Repetitive Freeze-thaw in Vivo and in Vitro Subculture Method, RFTIVIVSCM to Treat Cancer Patients, and some Evidences from the Mesenchymal Cells Derived from Adipocytes to Support Cancer Therapy.------- Tokyo, Janpan

2. Newly Developed Cryosurgical System Using Thermosiphon: A Fundamental Study and An Animal Experiment.------- Nagoya, Japan

3. A Novel BioCryolmmunological Concept in Science and Medicine: Discovery, Hypothesis & Evolution.------- Vienna, Austria.

4. Survival Analysis of 8000 Cases of Cancer Treated by Percutaneous Cryosurgery.------ Guangzhou China.

5. Application of Catheter Radiofrequency Ablation Combined Stenting in Malignant Bilignant Obstruction------ Guangzhou China.

6. Experience with Skin Cancer Ablation By Intralesional Cryosurgery As well As Executing A live Demonstration. ----- Haifa, Israel

Discussion

Liquid Nitrogen Based Cryoablation. ----- Caesarea, Israel.

Section 3: Irreversible Electroporation Therapy in Cancer Treatment.

1. Ultrasound Guided IRE for Cancer Treatment.------- Taiwai, China

2. Basic Research and Clinical Application of Irreversible Electroporation Ablation in Cancer Treatment.---------- Beijing, China.

3. Experience in Complication of IRE in Cancer Treatment.---------- Guangzhou, China.

4. Interventional Oncology: The Current Status and Future Direction.----------- Leeds, UK.

5. Minimally Invasive Laparoscopic Surgery for Cancer.--------- Kuala Lumpur, Malaysia.

Section 4: Immunotherapy in Cancer Treatment

1. Clinical Application of Stem Cell Transplantation in Pancreatic Surgery.-------- Oxford, UK.

2. Therapeutic Efficacy of Cancer Stem Cell Vaccines in the Adjuvant Setting.------- Michigan, USA.

3. Review to Immune Therapy in Oncology.---------- Beijing, China.

4. Immnotherapy in Lung Cancer in 2016.-------- New York, USA

5. Opinions and Exploration in Multidisciplinary and Personalized Treatment for Cancer.-------- Beijing, China.

6. Clinical Progress of Mesenchymal Stem Cell Therapy in Infertility.--------- Shenzhen, China.

7. Stem Cell Therapy In the Treatment of Cancers.--------- Bangkok, Thailand.

After Listening the content from this international Forum,i know for fighting the various cancer and disease around us, the doctors and experts always try to improve their clinical medical technologies and skills, and try their every effort to save every life from sickness. We can not decide and control the environment we live with, and don’t know when the disease may happen to us, but we need to believe whatever bad disease we meet, the human always can find new breakthrough to overcome the troubles.