What was the help of the "UMIT"Oncological Center of Tomotherapy for five years of work

TopDoc.me wrote many times about the "UMIT" Oncological Center of Tomotherapy (Astana). This innovative center is engaged in effective treatment of oncological diseases in Kazakhstan using tomotherapy machines - a combination of a computed tomography scanner and an irradiator. Tomotherapy today is a real chance for cancer patients to get less painful and more effective treatment. It is especially important to use the tomotherapy method for children and patients with cardiac implants.

Yerzhan Mukataevich Shayakhmetov, the director of the center, tells more about the work of the UMIT Oncological Center.

- Yerzhan Mukataevich, for 5 years now your clinic has been treating cancer with tomotherapy. What significant progress has been achieved over the years?

- From January 1, 2019, our center began to receive the first patients. And since then we have attained significant results, achieved positive growth dynamics not only in the number of treated patients, but also in the development of the center itself.

Over these 5 years, the "UMIT" Oncological Center of Tomotherapy:

• was the first in Kazakhstan and Central Asia to successfully introduce an innovative method of radiation therapy - tomotherapy.
• passed the national accreditation of compliance with medical healthcare institutions of the Republic of Kazakhstan with the result - "highest category".
• in 2021, received an accreditation certificate from the Joint Commission International (JCI) - one of the world's leading standardization systems in the safety and quality in healthcare.
• became a member of the European Society for Radiotherapy and Oncology (ESTRO) - a scientific organization promoting the development of radiation oncology in all its aspects. In May 2023, the center took part in the ESTRO 23 Congress in Vienna, Austria.
• introduced an advanced artificial intelligence technologies into the workflow – the MIM software for working with medical images.
• established its own scientific department to summarize the results obtained over five years and to further develop and support scientific research.
• within the state order, the center received 1,700 patients for tomotherapy treatment.

Our center is the only oncological center in Kazakhstan, which :

• for the first time performed a unique Total Body Irradiation (TBI) procedure, or total bone marrow irradiation in children with leukemia;
• jointly with the National Scientific Medical Center conducts simultaneous surgeries – one-time surgical treatment of two or more pathological conditions that do not have a common etiology (oncology + cardiac surgery, oncology + gynecology, oncology + abdominal surgery);
• the only oncological center in Kazakhstan that conducts radiation therapy for the main tumor and distant metastases by a single plan;
• the only oncological center in Kazakhstan that performs radiation therapy to cancer patients with implanted artificial pacemakers (cardiostimulators, defibrillators);
• the only oncological center in Kazakhstan that develops pediatric radiotherapy: craniospinal irradiation, total lung irradiation, brain irradiation with preservation of the hippocampus, radiation therapy under sedation.

Our plans include entering the world arena and an active development of medical tourism, and for these purposes our center:

• develops its own program "100 steps for the development of medical tourism" to attract foreign cancer patients for tomotherapy treatment;
• participated in international healthcare exhibitions in Azerbaijan, Uzbekistan, Tajikistan, Kyrgyzstan. Actively cooperates with the Association of Medical Tourism of the Akimat of Astana;
• presented a poster at the largest in Central Asia, the 28th Kazakhstan International Healthcare Exhibition - KIHE 2023.

In addition, on June 22, 2023, we, as part of a delegation with the National Scientific Medical Center and the Almaty Multidisciplinary Clinical Hospital, attended the “One Belt, One Road” conference organized by the China Cancer Association at the Xinjiang Medical University. This meeting laid a good foundation for comprehensive cooperation in the field of the latest oncological technologies with the countries participating in the “One Belt, One Road” project.

Also for an integrated approach in oncology treatment our center has:

• in addition to radiation therapy - tomotherapy, there is an outpatient chemotherapy;
• all types of cancer surgery are carried out in partnership with the NSMC;
• the center of oncomammology, digital mammography with tomosynthesis;
• the department of endoscopy (colonoscopy, VEGDS, bronchoscopy);
• laser surgery procedures are performed on the Asclepion MCL-31 erbium laser (Germany);
• professional psychological assistance to cancer patients;
• educational project is supported to inform on all issues related to oncology.

- The procedure of total body irradiation (TBI) for a child - what is the significance of this event for young patients in our country?

- Our “UMIT” Tomotherapy Center has introduced the total bone marrow irradiation procedure for children with chronic leukemia in November 2022. Irradiation in the conditioning regimen is carried out before bone marrow transplantation, in partnership with the National Research Center for Maternal and Child Health. The TBI procedure is considered a major achievement, since not every cancer center, not only in the CIS, but also in the world, can implement this method.

If previously children with leukemia went abroad for bone marrow transplantation, now they can receive this procedure here in Kazakhstan. Before bone marrow transplantation, the child needs to undergo irradiation of bone structures, total bone marrow of the whole body, to destroy all cellular elements, so that later oncohematologists can perform bone marrow transplantation. As a result of using this technique, the survival rate of donor bone marrow is 80%.

It is a significant event not only for our oncology center, but for the entire healthcare system of the Republic of Kazakhstan. We held the first master class together with the invited specialists from the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. And after that, our team has already performed five procedures of total body irradiation. Two more children are now preparing for the procedure.

- What other unique procedures are performed in your center?

- We perform irradiation of almost all forms and nosologies (cancer types) in oncology. We are the only center in Kazakhstan that performs irradiation for prostate cancer with metastases in skeletal bones: ribs, vertebrae, pelvic bones - by a single plan, that is, both the main tumor and metastases. Doctors keep in touch with all patients who have undergone radiation therapy in our center, and we see the results: they are socially adapted, live with preserved organ functions.

No one except us performs radiation therapy for cancer patients with severe cardiovascular pathology. These patients are mostly elderly, many of them have implanted artificial pacemakers, cardiostimulators, cardiodefibrillators. And if, for example, such patients have esophageal cancer, then it is impossible to conduct radiation therapy on other traditional linear accelerators. We can perform radiation therapy for esophageal cancer with the protection of these implanted cardiac devices.

Our team of medical physicists has achieved a reduction in the dose that pacemakers receive to 0.1-0.3 Gy over the entire treatment period, despite the fact that according to world standards the total dose can reach 0.5 Gy. None of the oncology centers in Kazakhstan, except for ours, today undertakes the treatment of such oncological patients with implanted pacemakers, and in general, the presence of cardiac devices is a contraindication to radiation therapy. We take such patients for treatment at any age - the oldest patient was 91 years old.

- You are the only private medical center in Kazakhstan accredited by the JCI. Why is it important and what is the benefit for patients? How do you prepare for re-accreditation?

- We have been accredited in 2021. The accreditation confirms the compliance of our center with international treatment standards, including the building itself, equipment, all treatment rooms - all of these should ensure the patient safety. Such accreditation gives us the opportunity to develop medical tourism, inspires confidence of patients, as the center works according to international standards in the treatment of oncological diseases, including radiation therapy, chemotherapy, specialist consultations, etc.

The JCI is a kind of charter about how things should be. For example, let's take a parameter such as "client path". It should be as short as possible so that the client can easily find us. To do this, we maintain an active presence on social networks, on YouTube, on television, on search engines. Our website works in 4 languages: Kazakh, Russian, English and Chinese.

To date, only 1034 clinics worldwide have received such JCI accreditation. It can be said that we are working for the country's image: there is a clinic in Kazakhstan that works according to world standards. And also the importance is that the direction of medical tourism includes not only treatment, but also introductory programs with the historical sights of Kazakhstan.

Accreditation is issued for 3 years. Next year we will confirm the accreditation. Although the entire team complies with all JCI requirements, from the nurse, the call center, the registry and to the medical staff, the requirements are increasing every year. Changes to the conditions are constantly sent to us, and we immediately implement them into our work.

- You are implementing the MIM software, artificial intelligence technologies. What are these programs and why do patients need them?

- Before the introduction of the MIM program, the treatment planning process lasted 4-5 days, after the introduction it was reduced to 1 day. Then we upgraded the program and achieved a reduction in treatment planning time to 1-2 hours.

What does it look like in practice? A patient sends information about his disease to our e-mail. Our doctors, as part of a multidisciplinary team, review each case and invite the patient for treatment at the center. The patient undergoes an initial consultation with specialists and goes to a CT simulation, where a series of the tumor images is taken. Based on the obtained images, the MIM system performs contouring of all organs that need protection. If earlier this work was done by oncologists-radiologists using special programs on computers, now the MIM does this work in just 5-10 minutes. The radiologist only outlines the tumor itself - the area that needs to be irradiated. Physicists then proceed to dose calculations according to international treatment protocols.

After that, a "radiation map" is drawn up, which is checked on a phantom - a special device that imitates patient's body. The phantom is being irradiated on a tomotherapy machine to provide data for radiologists. All this happens without human intervention, that is, at all stages, human errors are minimized. The plan was drawn up correctly, the doses were chosen correctly, critical areas were protected - and only then the patient can be taken for treatment.

This approach provided a sharp decrease in post-radiation complications such as esophagitis, gastritis, cystitis, dermatitis, etc.

The MIM program has a cloud database, each new case is also uploaded to this database, and with each new case the MIM automatically learns - from our experience and the experience of other clinics.

- Your specialists took part in the international ESTRO 2023 congress. Tell us what kind of congress it is and what is its significance?

- ESTRO is the European scientific society of radiation oncologists, which annually holds international conferences, bringing together specialists from all over the world. Scientific seminars, master classes, personal communication between doctors - all this greatly enriches specialists. For example, Tanjas Shayakhmetov, the head of the center's medical physicists, talked there with the inventor of the tomotherapy machine, Doctor Thomas Rockwell Mackie.

Participation in such conferences gives us confidence that our center is developing in the right direction. We work according to international protocols, which are updated weekly. I can say that we keep up with the world practice, and on some issues we even anticipate changes, which confirms the professional level of our team.

The staff of the “UMIT” center - radiation oncologists, medical physicists are members of the ESTRO.

Staff of the “UMIT” center - radiation oncologists

- Who else does the oncology center cooperate with?

- We had a business trip to Kyrgyzstan, Uzbekistan and Tajikistan, where together with the NSMC we represented our medicine. The best clinics of Kazakhstan took part in these trips and demonstrated our achievements. I gave a paper on these trips.

We have also started cooperation with the Association of Medical Tourism of the Akimat of Astana. The head of the association Christina Krismus, having familiarized herself with the work of our tomotherapy center and having learned about our international JCI accreditation, now invites us to international exhibitions. We went to an exhibition in the capital of Azerbaijan - Baku, where we presented our poster.

- As a result of your work, the citizens of Kazakhstan have the opportunity to receive the most modern oncology treatment according to international standards without traveling to foreign countries.

- Not all of our citizens have the opportunity to travel abroad for oncology treatment. And even those who travel, for example, to popular clinics in Turkey or South Korea, can now hear from them the question: why did you come, you have the “UMIT” oncological center in Kazakhstan, where radiation therapy and chemotherapy are carried out at the highest international level.

Our center is in partnership with all oncology hospitals in Kazakhstan. Many difficult cases, such as tumors of the medulla oblongata, which are very difficult to irradiate, are immediately sent to our center. For 5 years, almost all oncologists in Kazakhstan have learned about us and, if necessary, refer their patients for treatment to the “UMIT” tomotherapy center. This is a big progress of our small private cancer center.

- From what other countries do people come for treatment? Where do they most often learn about the possibilities of your clinic? What are the main advantages of oncology treatment in your center for a foreign patient?

- As I said before, we try to be present in all communication channels - social networks, YouTube, television, news sites of different countries with press releases in the languages of these countries.

We have developed the program "100 steps for the development of medical tourism", where we have determined step by step all the stages for ourselves.

Unfortunately, there are still barriers in this direction. For example, at the state level, a law on medical tourism has not been adopted and, accordingly, taxation issues have not been regulated. We, as a medical center that accepts foreign currency payments from foreign tourists, fall under taxation.

In the pre-Covid period, we had medical tourists from America, France, and neighboring countries. In China, they are also interested in the tomotherapy services in our center. Requests come from Russia, the CIS, Eastern Europe, and Central Asia countries. We consider each case, hold correspondence, invite for treatment. Compared to the last year, the growth of applications amounted to 200%.

- Tell us about the plans for the center development in the next few years.

- We define our direction as early cancer diagnostics, therefore, in addition to the tomotherapy department, we opened the oncomammology center and the endoscopy department. We have everything we need for early cancer detection.

Definitely a unique trade product that we offer to the international community is tomotherapy.

Since radiotherapy is usually combined with chemotherapy, we have opened an outpatient chemotherapy unit. Surgical treatment of oncology is carried out within the framework of cooperation at the NSMC. Therefore, for a cancer patient who comes to us for treatment, we provide both radiation therapy and chemotherapy, and, if necessary, we perform surgical interventions within the framework of oncological surgery - this is neurosurgery, gastrointestinal surgery, oncogynecology, oncourology.

We undertake the treatment of cancer patients with concomitant cardiovascular pathology and who need coronary artery bypass grafting. First, the cardiac surgeons perform the intervention, and as soon as they finish, the oncosurgeons step in and operate on the tumor simultaneously, under the same anesthesia. Similarly, patients with concomitant diseases of other systems are operated on, that is, two serious pathologies are treated under one anesthesia. Such types of interventions are not carried out in any clinic in Kazakhstan.

In the near future, we plan to upgrade one of the tomotherapy machines, which will significantly reduce the treatment time. When we first started, preparation and treatment of one patient lasted up to 50 minutes. But gradually, with the accumulation of experience, the time was reduced, and now we have reached 20 minutes. After the upgrade, we hope to reduce the time to 10-15 minutes. Of course, with maintaining the treatment quality, and in compliance with all safety standards and all international treatment protocols. By reducing the preparation and treatment time, we will be able to receive many more patients who need tomotherapy.

We also plan to launch a TBI procedure for adult patients, for which we need to increase the aperture of computed tomography from 70 cm to 90 cm.

After the upgrade, we will have a breath synchronization function. It is very difficult to irradiate tumors of moving organs, such as lungs, liver, without such synchronization. The upgrade will allow for more accurate radiation therapy.

Also one of the priorities is the further development of medical tourism. We have passed the preparatory period, now we will actively develop it on the world market.

In addition, it is time to open a scientific department and summarize our experience in oncology treatment.

Our mission is: cancer is not a verdict. We have arranged a psychological support for cancer patients, we conduct educational work among patients in order to convey the main idea: cancer is easier to treat in the early stages.

I am very proud of our team. Our team is close-knit, friendly, always supporting each other, always striving for new knowledge. And I sincerely believe that our center will become known throughout the world as one of the leading scientific medical centers for cancer treatment.