2024 Technical Fellowships, Bourses pour l'Afrique Francophone, Becas para América Latina awarded Fellows

Liga Nacional Contra el Cáncer-INCAN, es una organización sin fines de lucro y el único centro oncológico integral para adultos en Guatemala ubicado en el área metropolitana, lo que hace que se requiera que los pacientes viajen largas distancias para acceder al tratamiento. Este centro cuenta con la primera Unidad de Cuidados Paliativos del país y, durante la pandemia, comenzó a ofrecer cuidados paliativos por telemedicina para continuar apoyando a sus pacientes.

El objetivo de mi visita a la Universidad de Colorado Anschutz es, a través de reuniones con actores clave, visitas de seguimiento en la clínica ambulatoria y en áreas rurales, adquirir experiencia de primera mano en un programa de telemedicina ya establecido, con el fin de desarrollar una propuesta para mejorar y adquirir habilidades en métodos de investigación que permitan evaluar el impacto del Programa de Telemedicina de Cuidados Paliativos en Guatemala en la atención de pacientes con cáncer.

Este proyecto tiene el potencial de ser replicado en otros países de América Latina y en países de ingresos medios bajos, donde las poblaciones más vulnerables se beneficiarían del acceso remoto a cuidados paliativos.

Newer innovations are introduced in cancer screening, early detection, and cancer therapeutics at a rapid rate. While these are highly recommended in resource-rich countries, it may be challenging to introduce them in developing countries. Challenges include lack of infrastructure, cost issues, lack of trained personnel, and inequity in resource distribution. I am a Gynecologic Oncologist working in this specialty in the government sector since 2014. Along with my expertise in therapeutics, I am expected to play a leading role in policymaking and infrastructure development in my state of Kerala, India.

A structured training in health economics will help in obtaining a better perspective on the utilization of health resources. The training will transfer skills in the application of health economics theory and models to cancer prevention, screening, diagnosis, treatment, and survivorship in low-resource settings like India.

I have been working in the Department of Pathology at Regional Cancer Centre, Thiruvananthapuram, Kerala, India, since 2007 and am involved in cancer diagnosis. We diagnose more than 10,000 new cancer cases per year. Thyroid cancer is the third most common cancer in our female patients. We also receive cases for opinion from other centers, and thyroid cancer constitutes a significant proportion of these cases as well. I am involved in the pathological diagnosis of thyroid cancers at my center.

Pathological diagnosis of thyroid neoplasms is challenging even for experts in this area. Specialized diagnostic tests like molecular tests and immunostains are routinely used in this field for accurate categorization, which has a great impact on treatment decisions. My center has the basic infrastructure to perform these specialized tests. A fellowship at NCC, Korea, will be beneficial for developing skills in this area. If I get an opportunity to undergo this training, I am confident that these specialized tests can be incorporated into our routine diagnostic services, leading to better patient management. The skill gained can also be transferred to other pathologists in my region through academic programs organized by my institute.

Brain tumors, either primary or metastatic, are a heterogeneous disease. Treatment of brain tumors is the most challenging due to intrinsic tumor biology, resistance to conventional treatment, and critical tumor location. Radiation therapy plays an integral part in the management of brain tumors.

In brain tumors, radiation delivery is complex, and precision is the key to safe and successful treatment. Stereotactic radiosurgery allows treatment of benign and malignant brain tumors with precision and safety. It can be delivered with Gamma Knife, CyberKnife, and modern linear accelerators. Technical developments have enabled us to deliver treatment with greater conformity and increased tumor dose with reduced planning margins, which improves treatment outcomes with reduced toxicities.

These advances have gradually improved treatment outcomes and survivorship, especially in pediatric brain tumors. Reducing short- and long-term toxicity as survivorship improves is of utmost priority, as it impacts the quality of life and global health. Improving the quality of life of brain tumor patients includes comprehensive care: managing treatment side effects, addressing symptoms impacting daily activity, cognitive impairments, emotional challenges affecting mental health, rehabilitation, and caregiver support.

In India, until the last decade, 60-70% of breast cancers presented in locally advanced stages where breast preservation was challenging. However, in the last 5 years, we are seeing more cases of early breast cancer. For early breast cancer, the standard of care is breast-conserving surgery.

Currently, we are also witnessing an increased number of breast cancer cases in young females, who are not only concerned about breast conservation but also about aesthetic outcomes. Breast reconstruction not only offers the opportunity to regain a natural breast contour but also helps in reclaiming a sense of femininity and confidence.

In India, only 0.3% of mastectomy patients undergo autologous or implant-based breast reconstruction due to limited expertise and infrastructure. Considering this, it has become essential to be equipped with all available options for breast reconstruction, so both young breast cancer patients and those with hereditary breast cancer can opt for reconstruction, even in prophylactic surgeries.

Currently, implant-based breast reconstruction, especially ADM-based pre-pectoral implants, is limited in India, while it has become routine in the Western world. Therefore, it is crucial to provide suitable breast reconstruction options for Indian patients.

This observership aims to enhance psychosocial support for children with cancer at the Uganda Cancer Institute (UCI) by leveraging insights and techniques from St. Jude Children’s Research Hospital.

The four-week visit will focus on observing and learning from St. Jude’s advanced social work and psychosocial programs, including play therapy, music therapy, and art therapy. The goal is to acquire practical skills and knowledge to integrate these innovative approaches into UCI’s existing services.

During the visit, I will engage in hands-on learning, collaborate with multidisciplinary teams, and evaluate the effectiveness of St. Jude’s programs. The fellowship will also involve developing a tailored adaptation plan to address the unique needs of UCI’s pediatric oncology patients and their families.

By implementing these strategies, we aim to enhance patient care, improve family support, and address gaps in psychosocial services at UCI. This experience will build on my background in social work and program development, positioning me to drive significant improvements in psychosocial care for children with cancer in Uganda.

Purpose
To learn from NCC Korea about activating a cancer registry step by step and to integrate and redesign it for developing the first population-based cancer registry in Laos.

Background
Currently, there are only hospital-based cancer registries (initiated 2019-current) in Lao PDR, based at the National Cancer Centre. It captured 406 patients in 2022, and no other information about the burden of cancer has been generated in the country. This lack of reliable data poses a significant challenge for the Ministry of Health.

The aim is to increase the availability and quality of cancer-related data to inform policymaking processes and resource allocation decisions in the Ministry of Health in Lao PDR. We plan to build a population-based registry through the integration of data generated in five central hospitals in Vientiane Capital.

The information in the cancer registry will be integrated into the CanReg5 registration system at the National Cancer Center to produce the first population-based cancer registration report in Lao PDR.

This project aims to advance knowledge and refine expertise in nutritional care for cancer patients. Over 2 weeks at Ajou University Hospital, Korea, I will work with the Nutrition Team under the mentorship of the team leader. I will observe and learn how individualized diets can enhance cancer patients' outcomes, understand the role of nutrition in mitigating treatment side effects, and integrate nutritional care into comprehensive cancer treatment plans.

After completing the fellowship, I expect to acquire practical knowledge on developing and implementing effective nutritional strategies to support cancer patients throughout their treatment journey. Upon returning to Vietnam, I will adapt and apply best practices and evidence-based approaches in my home institution and disseminate them across the cancer care network of related institutions and organizations, with the continued guidance and support of my mentor from Ajou University Hospital.

As AUH is a long-term official partner of Hanoi Oncology Hospital, I plan to cultivate ongoing collaboration between the two hospitals to exchange experiences and improve nutritional care services for cancer patients in the future.

This observership visit to St. Jude Children's Research Hospital aims to enhance expertise in childhood cancer survivorship, focusing on program design, implementation, and management.

The primary objectives are to acquire comprehensive knowledge of survivorship programs, including the After Completing Therapy (ACT) Clinic, St. Jude Lifetime (SJLIFE) cohort study, and the Childhood Cancer Survivor Study (CCSS). The visit will enable the development of collaborative networks with experts and researchers, fostering future partnerships for advancing childhood cancer care in Uganda and sub-Saharan Africa.

Additionally, the fellowship will provide training in effective grant writing and management, essential for securing funding for survivorship research. Key activities include observing and participating in program sessions, engaging in collaborative meetings, and attending skill-building workshops.

The four-week duration is strategically chosen to ensure intensive engagement with the programs, effective skill development, and initial planning for applying the knowledge gained. This visit will set the foundation for implementing improved survivorship strategies and fostering research collaborations, contributing significantly to childhood cancer care improvements in Uganda.

Le cancer du sein est le plus répandu dans le monde, devant le cancer du poumon, avec 2 261 419 nouveaux cas en 2020, soit 11,7 % de tous les cas de cancer et 684 996 décès, soit 6,9 %. En outre, les cancers ORL représentent le 4e cancer chez l'homme de plus de 50 ans au Cameroun.

La radiothérapie garde une place de choix dans la prise en charge et l'amélioration de la survie chez les patients atteints de ces pathologies. Les techniques d'irradiation évoluent à une vitesse exceptionnelle.

L'installation de nouveaux appareils de radiothérapie au Cameroun va accroître le flux des patients demandeurs de soins, notamment dans la sous-région Afrique Centrale. Ces réalités nécessitent que nous, futurs praticiens camerounais en radiothérapie, soyons mieux préparés en nous inspirant de l'expérience des centres de haut niveau dans ce domaine, pour le bien-être de nos populations.

Screening with low-dose CT for high-risk individuals has been shown to reduce lung cancer mortality rates. In Vietnam, lung cancer has the highest mortality rate among all cancers. However, early detection efforts face significant challenges due to the lack of policies supporting lung cancer screening. Public awareness about the importance of screening is low, and healthcare professionals often lack expertise in indications, result evaluation, and post-screening follow-up.

Through this program, we aim to enhance our skills in screening, early diagnosis, and comprehensive care for lung cancer to achieve better treatment outcomes. During the training, we will participate in multidisciplinary consultations to gain expertise in diagnosis, treatment, and managing adverse treatment effects. After completing the program, we plan to contribute to the hospital’s screening programs, communication initiatives, and consultation subcommittees at both the hospital and regional levels. We will also perform patient screenings and conduct research to evaluate the effectiveness of lung cancer screening in Vietnam.

Le présent projet vise à acquérir/renforcer des compétences en immunophénotypage des cancers du sang, afin de rendre disponible cet examen au Cameroun. Cela permettra de confirmer rapidement les suspicions de cas de leucémies lymphoïdes chroniques, de lymphomes et de leucémies aiguës, qui sont actuellement les cancers pédiatriques les plus fréquents au Cameroun. Ceci au bénéfice de toute l'Afrique Centrale, dont les populations convergent vers le Cameroun en cas de suspicion d'un cancer du sang. À l'heure actuelle, le diagnostic de ce groupe de pathologies au Cameroun se limite aux suspicions de cas, ce qui retarde la prise en charge, voire la rend impossible. Pourtant, la disponibilité des examens tels que l’immunophénotypage permettrait de confirmer rapidement la malignité des cellules et de les classifier. Rendre cet examen disponible garantirait les possibilités de diagnostic précoce, gage d’une prise en charge efficace, et permettrait également de prévenir les récidives importantes post-chimiothérapie que nous observons, qui sont de pronostic péjoratif. Ce projet viendra compléter l'action des organismes internationaux et des groupes de professionnels de la santé qui luttent pour augmenter l'index de suspicion de ce groupe de cancers mal maîtrisé au Cameroun.

In the Indian population, esophageal cancer is the 5th most common cancer (70,637 new cases, or 5%) and the 7th most common cause of cancer-related death (66,410 deaths annually). External beam radiotherapy along with concurrent chemotherapy is the treatment of choice when the cancer becomes totally unresectable or medically inoperable. The impact of esophageal cancer is multifaceted, significantly affecting the quality of life and psychological well-being of both patients and caregivers. Oncologists, gastrosurgeons, and allied health teams, including nurses and dietitians, play a crucial role in comprehensive care management before, during, and after concurrent chemoradiation to achieve the best treatment outcomes and improve the quality of life for survivors. Acute and late toxicities require evaluation and evidence-based intervention. The learning opportunity and comprehensive experience will enable me to enhance my practice back home in India, where the burden of esophageal cancer is high, and patients are primarily treated with radiotherapy. This will positively impact the development of clinical skills in our department, leading to better treatment outcomes. In addition to benefiting my clinical practice and research at home, this fellowship will facilitate further education and provide our department with much-needed expertise for treating esophageal cancer, which is of national importance.

High-risk human papillomaviruses (HPV) are the main cause of cervical cancer (CC), and vaccination in adolescents is considered the most effective strategy to prevent this disease. Within the WHO Global Strategy to eliminate CC, it is crucial to evaluate and monitor the effects of vaccination interventions. Previous studies in Argentina have shown a decrease in the prevalence of vaccine-HPV genotypes, cross-protection, and no genotype replacement, but the identification of escape vaccine-HPV genotypes. Therefore, deepening the knowledge of the genomic variations of vaccine HPV-genotypes identified in vaccinated women can help clarify their potential effect on vaccine effectiveness. The application of next-generation sequencing (NGS) technology is recommended to analyze the complete genome of HPV sequences, but it is not available in Argentina. NGS technology involves both molecular biology and bioinformatics analysis stages. The aim of the proposed fellowship visit is to acquire knowledge and training on NGS technology, focusing on bioinformatics analysis. This visit will strengthen public health policies for preventing CC, taking advantage of new technologies and available resources in Argentina and the Latin American region.

Glioblastomas are the most common astrocytic tumors and also the most common primary malignant brain tumors worldwide, with a recent increase in incidence in Nigeria. Histomorphologic diagnosis of astrocytic tumors needs to be supplemented with molecular studies to ensure accurate diagnosis, prognostication, and precise treatment modalities. However, these molecular studies, including gene sequencing, are expensive and largely unavailable in resource-poor countries. Surrogate, highly sensitive, and specific immunohistochemical markers like IDH1/2, ATRX, p53, p16, EGFR, H3 K27M, H3 K27Met, and BRAFV600E may provide an alternative in resource-poor countries. This study aims to analyze astrocytic tumors collected over 10 years at four tertiary institutions in Southwestern Nigeria, using the aforementioned surrogate markers that have diagnostic, prognostic, and predictive significance. Diagnostic accuracy tests will be used to compare the three diagnoses/classifications of astrocytic tumors made using histomorphology, immunohistochemistry, and standard molecular studies. The correlation between the prognostic immunohistochemical markers and tumor grades ± clinical outcomes will be analyzed. The outcome of this study may provide a basis for the possible adoption of these surrogate immunohistochemical markers in the routine diagnostic algorithm of astrocytic tumors in resource-poor countries, improving the overall management of these patients.

Genetic counseling for cancer patients and their family members is one of the most effective methods for early detection and prevention of future malignancies. However, there is a significant unmet need for genetic counseling for cancer patients and their families in Vietnam. Therefore, I am applying for the UICC Technical Fellowship to undertake a clinical observership at the Abramson Cancer Center, University of Pennsylvania, which is rated “Exceptional” by the US National Cancer Institute. My goals are to (1) acquire comprehensive skills in genetic counseling for cancer patients and their families, (2) learn how to establish a genetic counseling unit and integrate genetic counseling into clinical cancer care in preparation for the establishment of a Genetic Counseling Unit at our hospital, and (3) build lasting connections with experts at the University of Pennsylvania for future training and collaboration opportunities. With the increasing availability and affordability of genetic testing in Vietnam, and our hospital’s plan to launch a genetic counseling unit in 2025, approved by the Ministry of Health, I can immediately apply the knowledge and skills I acquire upon returning to Vietnam, ensuring the sustainability and impact of this fellowship.

The applicant's international multi-institution study focuses on laparoscopic precise hepatectomy for liver cancer. Laparoscopic surgery, a minimally invasive approach, has revolutionized the treatment of liver cancer by reducing surgical trauma, blood loss, and hospital stays. Our project aims to evaluate the feasibility, safety, and effectiveness of laparoscopic precise hepatectomy in treating liver cancer across different medical centers (China, Singapore, and Japan). By combining advanced laparoscopic techniques with precise resection strategies, we aim to improve surgical outcomes and patient recovery. The study involves collecting and analyzing data from multiple institutions to gain a comprehensive understanding of this innovative surgical approach. Our findings will contribute to the development of standardized protocols for laparoscopic precise hepatectomy, potentially making it a standard treatment option for liver cancer in the future.

In LMICs, the incidence rate of locally advanced breast cancer (LABC) in women is between 33% and 77%. For these patients, neoadjuvant chemotherapy (NAC) is recommended to reduce the extent of surgery and facilitate breast-conserving surgery. NAC is considered an integral part of the multi-modality therapeutic approach. After patients have undergone NAC and surgery, clinical investigations are conducted to evaluate the pathological complete response (pCR) to NAC. It is documented that cancer diagnosis and NAC are linked to significant psychological distress, such as depression and anxiety. Also, patients seek to adopt coping strategies against negative life changes imposed during treatment. Therefore, this project aims to evaluate the association between the coping strategies adopted by Moroccan women with locally advanced breast cancer (LABC) and their rates of pathological complete response (pCR) to NAC and recurrence-free survival. Through this research, it will be possible to develop and implement individualized holistic care programs to help LABC patients cultivate effective coping strategies. The findings from this study will have a major impact in several ways, such as preventing and/or managing mental illnesses in cancer patients, and improving rates of pathological complete response (pCR) to treatment and recurrence-free survival (RFS) rates.

Le cancer du sein est un problème de santé publique dans le monde et en Afrique subsaharienne en particulier. C'est la première cause de décès par cancer chez les femmes, avec une survie à 5 ans inférieure à 50 % en Afrique subsaharienne, ce qui signifie qu'une femme sur deux diagnostiquée d'un cancer du sein décède au cours des 5 années suivant le diagnostic. Cela s'explique par un manque de programme de dépistage au sein de la population et le diagnostic à des stades avancés. Nous sollicitons cette bourse pour suivre une formation complémentaire de 8 semaines axée sur la connaissance des modalités et indications de la chirurgie du sein, améliorer ma technique de chirurgie radicale du sein (mammectomies), améliorer la qualité esthétique des cicatrices, acquérir les techniques d'oncoplastie mammaire, des techniques du ganglion sentinelle et la reconstruction mammaire. Ce projet me permettra d'acquérir des aptitudes théoriques et pratiques au centre de cancérologie Hartmann afin de les restituer dans mon pays et dans la sous-région.

El proyecto "Desarrollo de estrategias para la implementación de la oncología geriátrica en México" busca adquirir conocimientos y habilidades específicas a través de la observación y participación en un programa de oncología geriátrica de un centro de cáncer en Estados Unidos designado por el Instituto Nacional de Cáncer (NCI), para implementar un programa similar en México. Actualmente, en la institución en donde me encuentro no existe un programa formal que sirva como enlace entre los departamentos de oncología y geriatría para atender las necesidades y reducir las desigualdades que existen actualmente en las personas mayores que viven con cáncer. Además, en esta visita participaré en talleres de redacción de artículos científicos y en el desarrollo de proyectos de investigación en cáncer y envejecimiento. Durante mi estancia en la Universidad de Colorado, obtendré entrenamiento para escribir propuestas de investigación y para desarrollar proyectos de investigación enfocados en la solución de las necesidades actuales de las personas mayores que viven con cáncer en México.

CyberKnife is a form of stereotactic body radiation therapy (SBRT) used for treating tumors with high precision. Its precision allows for high doses of radiation to be delivered to tumors while sparing surrounding healthy tissues. Patient-specific QA is an important task for plan verification when delivering a very high dose to the tumor. This study focuses on optimizing patient-specific quality assurance (QA) protocols for CyberKnife treatments through a comparative analysis of small-volume ion chambers and Gafchromic films. PSQA involves a series of tests and checks ensuring that the treatment plan created using imaging data and software is correctly implemented. It also verifies that the CyberKnife system's mechanical components (e.g., robotic arm) are functioning correctly. This comparative analysis aims to enhance the precision of QA protocols, ultimately improving treatment outcomes and patient safety.

Strengthening Lesotho Cancer Registry capabilities and management will help the government achieve its national cancer control strategic plan 2019–2029 thematic goals.

This fellowship will equip the Lesotho cancer registry with the required practical skills crucial for producing quality data that will necessitate better cancer surveillance and evidence-based national cancer policies and research.

L’imagerie par échographie, en tant qu’imagerie sûre, sans rayonnement et relativement abordable, jouera un rôle central dans ce processus. Les thérapies et interventions guidées par échographie au point de service (POCUS IGT) permettent le diagnostic et le traitement au chevet du patient, que ce soit dans un hôpital urbain, une clinique rurale ou une unité de soins mobiles. En tant que tel, POCUS IGT peut transcender les frontières géographiques et socio-économiques et ainsi se rapprocher de l’idéal de démocratisation de l’accès aux soins. Au Sénégal, les procédures POCUS IGT pourraient être utilisées dans d’innombrables cas dans le diagnostic et la prise en charge du cancer. L’équipe d’accueil de l’Université Queen’s, au Canada, a développé une famille de systèmes de navigation POCUS IGT entièrement basés sur des logiciels open-source gratuits qui prennent en charge les appareils à ultrasons à faible coût, les trackers spatiaux à faible coût et les consommables à faible coût. Ces ressources gratuites POCUS IGT ont été utilisées dans le monde entier.

Les hémopathies malignes forment un groupe de pathologies hétérogènes tant par leur pronostic que par leur oncogénèse, et représentent un modèle d'étude des mécanismes de cancérogenèse chez l'homme, en raison des anomalies génétiques récurrentes impliquées. Les techniques de biologie moléculaire (par exemple la FISH) sont indispensables pour le diagnostic, l’évaluation du pronostic, la prise de décision thérapeutique et le suivi. Dans les nouvelles classifications des hémopathies 2022 de l'OMS, certaines anomalies moléculaires révélées apparaissent désormais comme utiles, voire nécessaires, et apportent des précisions cruciales pour la prise en charge thérapeutique et le suivi des patients. Dans ce contexte, nous proposons de réaliser un stage pratique dans un laboratoire utilisant ces techniques afin de les appliquer dans notre établissement pour une meilleure prise en charge des patients. En effet, le Centre Hospitalier National Dalal Jamm, fondé en 2016, dispose de plusieurs laboratoires, dont celui d’hématologie, qui est équipé pour le diagnostic des hémopathies malignes, notamment par la cytologie et l’immunophénotypage. Récemment, le laboratoire a acquis un appareil de NGS. Ainsi, cette expérience implique que le laboratoire nécessite du personnel qualifié pour mener à bien sa mission, d’où le besoin de formation pratique dans ce domaine.

With 4,887 deaths and 7,122 new cases reported by Globocan 2022, cancer remains a major health concern in Rwanda. Patients frequently experience psychological problems associated with diagnosis, side effects of therapy, fear of recurrence, survivorship challenges, and financial burdens. If left unaddressed, these issues negatively impact survival rates. The Rwandan government has made significant strides in combating cancer through early detection, prevention, and treatment. However, efforts to address the psychosocial aspects of care remain insufficient, as evidenced by the lack of integrated psychosocial services in cancer care. This observership at Princess Margaret Cancer Centre l in Toronto, Canada is aimed to provide learning at an internationally renowned center proficient in psycho-oncology and supportive care . By leveraging the expertise and practices of such a center, the applicant can better understand the needs of Rwandan cancer patients and develop tailored psycho-oncology and supportive care services at the Rwanda Cancer Center.

Le cancer du col de l’utérus est le quatrième cancer le plus courant chez la femme dans le monde, avec 604 000 nouveaux cas et 342 000 décès estimés en 2020. Au Burundi, la situation du cancer demeure préoccupante. Le cancer du col utérin reste le plus fréquent et entraîne la plus forte mortalité parmi les cancers féminins. Dans notre CHU, il représente 37,3% des cancers gynécologiques. L'absence de personnel qualifié, le manque de dépistage systématique des lésions précancéreuses et l'absence de vaccination contre le HPV sont des défis majeurs dans notre pays. Les symptômes de ce cancer étant non spécifiques et souvent tardifs, la meilleure approche pour le combattre de manière radicale est de mettre en place des stratégies de prévention et de détection précoce. En effet, une détection et un traitement précoces peuvent conduire à une guérison. Après cette formation, nous nous engageons à retourner au pays avec des connaissances renforcées, nous permettant d'améliorer la qualité des soins, en particulier pour la détection précoce du cancer du col utérin. Le partage des connaissances acquises sera l'un de nos objectifs prioritaires.

Lung cancers are largely underdiagnosed and undertreated in Nigeria, often presenting at an advanced stage. Diagnosis and treatment are challenging due to the lack of screening programs and the scarcity of Minimally Invasive Surgery (MIS). Federal Medical Center Asaba and Nnamdi Azikiwe University Teaching Hospital in Nnewi are the two tertiary care hospitals in Delta and Anambra States that offer Thoracic Surgery Services. The combined population of these states is about 10 million. Lung cancers are underdiagnosed and undertreated because of limited diagnostic and treatment options, and the establishment of a reliable lung cancer registry is crucial. I have secured a two-month Observership at the University of Chicago Medical Center, from April 1 to May 30, 2025, under the supervision of Professor Mark Ferguson. The institution is well-equipped for diagnosing and treating lung cancers and offers an excellent training program. This opportunity aligns perfectly with my project’s objectives. The knowledge and skills I acquire will help strengthen my institution's capacity to diagnose and treat early lung cancer, improve the lung cancer registry, and develop a screening program. I will also share this experience at society meetings and training sessions.

Gastrointestinal and pancreaticobiliary cancers are a significant burden in India. The scope of molecular profiling and actionable targets is rapidly evolving, with current NCCN guidelines recommending the use of wide next-generation sequencing (NGS) panels. However, this area remains challenging due to cost implications and limited expertise in our country. Additionally, the global trend toward integrated surgical and molecular pathology reporting has led to more comprehensive diagnoses and improved delivery of precision medicine. To stay abreast of advancements in molecular testing, I wish to undertake a one-month fellowship at Memorial Sloan Kettering Cancer Center (MSKCC) in New York, USA, under the guidance of gastrointestinal (GI) pathologist Dr. Amitabh Srivastava. This training will allow me to better understand the process of selecting molecular tests based on clinical and histopathological parameters and to implement cost-efficient, comprehensive NGS testing for GI cancers at a large tertiary care cancer center, thereby facilitating personalized care for advanced GI cancers.

Gynecological cancers are on the rise in India, and Sikkim, one of the North Eastern States, lacks advanced oncological services, often relying on neighboring states. The absence of reliable and comprehensive cancer care facilities and specialists (medical oncologists) in the state, coupled with the need for referrals to higher centers outside the state, has resulted in a significant economic burden. As a result, surgery has become the mainstay of treatment for women in Sikkim. Even in advanced gynecological malignancies, surgery plays a crucial role in management and survival. Therefore, the development of advanced surgical skills is vital for Sikkim. I am a gynecologic oncologist working in Sikkim, with a special interest in cervical cancer prevention and treatment. Sikkim is a research-naive state in the field of cancer. I am currently involved in collaborative multicentric studies in India and with international institutions on cervical cancer prevention and treatment. My objectives for visiting NCC Korea include learning various surgical techniques for managing gynecological malignancies and observing how NCCK applies cervical cancer screening and preventive strategies. The knowledge gained will help strengthen screening and prevention programs for cervical cancer in Sikkim, India.

Prostate cancer presents a significant health burden in India, driven by changing lifestyles and increasing life expectancy, with over 25,000 new cases annually.

The lengthy duration of conventional radiation therapy (7-9 weeks) poses challenges for both patients and resource-limited healthcare systems. Stereotactic body radiation therapy (SBRT) and stereotactic ablative radiotherapy (SABR) offer promising alternatives, typically delivered in 4-5 treatments over 1-2 weeks.

This fellowship project aims to develop a comprehensive SBRT/SABR training program for prostate cancer and implement suitable protocols in resource-constrained settings like India. The project addresses critical challenges such as equipment shortages, high patient volumes, and geographic barriers to care access. A prospective study will assess the feasibility, efficacy, and cost-effectiveness of SBRT/SABR in the Indian context.

Expected outcomes include the establishment of a sustainable training program, the implementation of tailored protocols at other centers, and the generation of data to guide treatment in resource-limited environments.

This project has the potential to improve prostate cancer outcomes, optimize resource utilization, and serve as a model for countries facing similar challenges in providing high-quality radiotherapy. By enhancing access to efficient treatment, it aims to significantly impact prostate cancer management in India and beyond.

Thoracic cancers (lung and esophageal) are prevalent in India. Most patients present with cancers at advanced stages and are in poor general condition, making them unfit for complex open thoracic surgeries. Minimally invasive approaches have significantly reduced the morbidity and mortality of thoracic cancer surgeries and have improved patient outcomes globally. South Korea is a leader in thoracic oncology and minimally invasive surgery techniques. Our hospital, PSG Institute of Oncology, is a newly established cancer center in Coimbatore, India. The goal of this fellowship is to observe and learn minimally invasive thoracic cancer surgeries, as well as to understand the nuances of establishing a successful thoracic oncology unit. This fellowship will enable me to establish a successful thoracic oncology program at our hospital. Additionally, it will help build a long-term relationship between NCC Korea and our hospital, with the potential for exchange programs and collaborative research.

El uso de inhibidores del punto de control inmune (PD1, PDL1 y CTL4) ha prolongado la supervivencia de pacientes con neoplasias sólidas. Estos anticuerpos son una de las terapias más utilizadas en la actualidad para tratar diferentes tipos de cáncer y han sido recientemente introducidos como parte de los esquemas disponibles a la población que no cuenta con algún grado de respaldo para cobertura de gastos médicos en nuestro país, México. A pesar de su eficacia, esta terapia no está exenta de efectos adversos, estos se originan con la alteración de la activación linfocitaria tipo T, caracterizada por el incremento de la inmunogenicidad a diversos antígenos tanto endógenos como exógenos. La descripción de los efectos adversos inmunomediados se ha documentado en los ensayos clínicos donde se demostró su seguridad, sin embargo, la aparición de los efectos inmunomediados aún carece de una descripción completa o detallada, resaltando que se adolece de marcadores específicos para su anticipación y evolución. Su aparición resulta en la interrupción del tratamiento potencialmente efectivo o ser lo suficientemente grave para condicionar la incapacidad o muerte del paciente, por lo que su adecuada caracterización y la creación de protocolos pioneros para documentar la descripción de estos efectos.

With this project, I aim to improve and revolutionize the treatment of bone cancers in India by leveraging 3D printing technology.

3D printing assists surgeons in planning and executing cancer surgeries with greater precision. This directly leads to fewer complications, improved surgical outcomes, and better quality of life for patients with bone and soft tissue tumors. Implementing advanced 3D printing technology will significantly enhance functional outcomes, ambulatory capabilities, and activity levels, bringing them in line with the standards of care seen in Western countries. Recognizing the unique challenges faced by bone cancer patients in India, especially children, my goal is to provide cutting-edge treatment that is accessible to a broader population, increasing survival rates due to advancements in chemotherapy, imaging, and surgical techniques.

As 3D printing in orthopedics is still a relatively new technology, specialized training is crucial for its effective utilization. This project will help me harness the full potential of this technology, ensuring high-quality, safe, and effective outcomes for bone cancer patients.

Interstitial Brachytherapy is an advanced form of radiotherapy that offers targeted and effective treatment for various cancers but remains underutilized in India. The primary challenges include limited access to specialized equipment or brachytherapy applicators, a shortage of skilled practitioners and supporting staff, lack of dedicated operating theaters and anesthetics, and the time-intensive process of planning and executing treatments. Additionally, financial constraints and lack of patient awareness often lead to apprehension about the procedure.

In most hospitals across India, brachytherapy is primarily used for intracavitary treatments, with only a few specialized centers practicing interstitial brachytherapy. Given the high incidence of cervical cancer in India, where it is the second most common cancer among women and approximately 80% of cases are locally advanced (FIGO stages IIB, III, and IV), the need for better treatment options is critical.

This project focuses on developing expertise in and applying image-guided interstitial brachytherapy for gynecological cancers. The knowledge and experience gained will significantly enhance my skills, improve decision-making, and ultimately benefit patient care. Moreover, the insights acquired will guide the establishment of a new brachytherapy unit at AIIMS Rajkot, a tertiary care center in Gujarat, India.

Radiotherapy plays a crucial role in cancer treatment, with a significant number of patients receiving this treatment at our institute. Prostate, colorectal, and bladder cancers are the most common malignancies treated, presenting challenges in delivering precise tumor doses while sparing adjacent healthy organs. The high radiation doses required for these cancers increase the risk of toxicity to surrounding tissues. Volumetric Modulated Arc Therapy (VMAT) is a superior modality, offering improved tumor coverage, reduced toxicity to adjacent organs, and shorter treatment times. However, managing organ motion during treatment remains a critical issue, which is addressed through Image Guided Radiation Therapy (IGRT) techniques for enhanced treatment precision. At my home institute, IRNUM in Peshawar, Pakistan, a shortage of VMAT-trained personnel hinders optimal service delivery. The proposed fellowship will focus on 3D contouring, dose optimization, treatment plan evaluation, and treatment delivery using the Image Guidance system. The fellowship at Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, Italy, will enhance my expertise in VMAT. This will facilitate skills transfer and local training initiatives at IRNUM Peshawar. The project aims to expand our institute's radiotherapy capabilities, ultimately improving treatment outcomes and the quality of life for patients.

Background to the problem:
Molecular subtyping has emerged as a valuable tool for characterizing the heterogeneity of breast cancer and guiding personalized treatment strategies. The prevalence of molecular subtypes in metastatic breast cancer (MBC) patients varies across populations, with luminal A and triple-negative tumors being most commonly observed in Nigeria and other West African countries. Through rigorous research and multidisciplinary collaboration, it is possible to enhance our understanding of the molecular drivers of MBC and improve outcomes for patients in Nigeria and beyond.

Methods:
A retrospective analysis will be performed on patients with metastatic breast cancer treated at the University of Chicago from 2010 to 2019. Patients with different molecular subtypes, including luminal A & B, HER-2 enriched, and triple-negative, will be analyzed. Both initial and final outcome variables, including overall survival, will be evaluated.

Conclusion:
The management and survival of metastatic breast cancer patients at a tertiary institution like the University of Chicago could be significantly influenced by the quality of medical care and the availability of advanced treatment options.

Brain metastases, which occur when cancer cells spread to the brain from other parts of the body, are a challenging aspect of cancer treatment. Currently, most centers in India primarily use whole brain radiotherapy and some stereotactic radiosurgery (SRS) techniques to manage these cases. While effective, these methods could benefit significantly from technological advancements, improving symptom control and quality of life for patients.

My project aims to explore and implement the latest innovations in SRS and stereotactic radiotherapy (SRT) for brain metastases. By visiting an institution renowned for its cutting-edge approaches, I seek to enhance my understanding and skills in the most advanced SRS/SRT techniques. This includes learning about state-of-the-art equipment and novel treatment strategies that can offer more precise and effective targeting of tumors, potentially leading to better outcomes and fewer side effects for patients.

This fellowship will enable me to bring these advanced practices back to our center, improving our treatment capabilities and providing the best possible care for our patients. Ultimately, this project seeks to bridge the gap between current practices and emerging innovations in brain metastasis treatment.

With rapid socioeconomic development, an aging population, and changes in the prevalence of carcinogenic risk factors, China is facing unprecedented challenges in cancer prevention and control. In 2022, an estimated 4.8 million new cancer cases were reported in China, accounting for 24% of global cancer cases. Understanding the epidemiological profile of cancer incidence can provide policymakers with insights on how to tailor cancer control policies and optimize the allocation of health resources. However, the geographical and temporal variations in cancer incidence across China have not been systematically evaluated.

This project aims to quantify the latest geographic variation at the provincial level and analyze temporal trends in the incidence rates of all cancer types from 1978 to 2017 in China. It will also examine the effects of birth cohort and period on these trends to better identify populations at increased risk of cancer and provide clues regarding the causal factors driving the changing trends. Additionally, the project aims to predict future cancer incidence by 2050, in terms of both the number of new cases and incidence rates, in absolute numbers and trends. Furthermore, it will compare the current and projected cancer burdens.