TATA MEMORIAL CENTRE Grant in Aid Institution of

TATA MEMORIAL CENTRE Grant in Aid Institution of The Dept. Of Atomic Energy (DAE), Govt. of India Tata Memorial Hospital (TMH) Advanced Centre for Treatment, Research & Education in Cancer (ACTREC)

TMH Commissioned by the House of TATAs 1941 CRI Commissioned 1952 TMH transferred under administrative control of DAE 1962 Tata Memorial Centre (TMC) – TMH and CRI 1966 ACTREC – CRI moves to new campus 2002 ACTREC – CRC inaugurated 2005 Homi Bhabha Block 2011 Centre for Women and Children 2020 TMC Proton Therapy Centre 2020

New Case File Registrations State-wise Distribution Haryana 70 Jammu & Kashmir 175 Chandigarh 20 Uttaranchal 82 Punjab 89 Delhi 94 Rajasthan 672 Daman & Diu 11 Himachal Pradesh 10 Gujarat 485 Sikkim 10 Uttar Pradesh 4630 Madhya Pradesh 2018 Dadra & Nagar Haveli 19 Mumbai 5383 Goa 199 Arunachal Pradesh 41 Maharashtra (excl. Mumbai) 15030 Bihar 2694 Nagaland 22 Assam 720 Meghalaya Manipur 27 244 Jharkhand W. Bengal 1120 Tripura Mizoram 3643 139 47 Orissa 1029 Chhattisgarh 492 Andhra Pradesh Karnataka 201 275 Total - 62162 Patients - 35199 Kerala 86 Tamil Nadu Andaman & Nicobar 3 59 Pondicherry 3 Preventive - 5739 Referals- 16444

Institutional Ethics Committee (IEC) • Review • Monitoring (DSMSC) Research Infrastructure • Designated space • Personnel • Pharmacy/ Labs • Logistic support etc Institutional Administrative Support • Financial support • Admin / Policy TMC IEC I/ III DSMSC TMH Research Admin. Council (TRAC) HRPP Co-ordinator Quality Manager Clinical Research Secretariat (CRS) Legal Advisor “Human Research Protection Program (HRPP)” DCGI, SIDCER, AAHRPP Accredited

RESEARCH AREAS ● Problems unique to our country/developing countries ● Development of Low Cost technology: Broad Applicability ● Test new technology ● Challenging existing dogma ● Efficacy ● Multicentre Randomized trials ● Screening trials ● Effectiveness ● Quality of life studies ● Epidemiological studies ● Cost effectiveness analysis • Hypothesis testing • Audits • Retrospective studies • New Drugs • New Treatment • Lab studies • Overviews • Meta-analysis

Total Area : 3, 287, 263 Sq. km Total Population (X 1000) : 1. 2 Billion Official languages : 14 Life Expectancy : 64. 7 years Rural/urban population : 70/30 Literacy Rate : 59% Infant Mort. Rate : 54. 6 deaths /1000 Live Births Infectious Diseases : Still major heath care burden New Cancer Cases/ Yr : 1 million (approx)

Health Insurance coverage: 15% Governmental Initiatives: Rashtrya Swasthiya Bima Yojana (RSBY) - 302 million citizens (National Scheme) Rajiv Arogyasri Scheme – Andhra Pradesh Chief Ministers Health Insurance Scheme – Tamil Nadu Vajpayee Arogyashree Scheme – Karnataka Self Employed Women’s Organization Limited funding Lancet Oncology 2014

The “Hub & Spoke Model” & National Cancer Grid (NCG) Established in August 2012 – At the Tata Memorial Center, Mumbai Funded by The Govt. of India through the Dept. of Atomic Energy (DAE) Objective – Patient Care: Link Cancers Centers across the country Evolving uniform standards of care across India Adopt evidence based management guidelines Peer review of centers for self-evaluation & improvement Education & Training: Exchange of expertise & mentoring Manpower training Creation of “National Cancer Library” – Share journals/ e-resources Collaborative Research: Multicentric studies Basic, Translational & Clinical research – Common cancers Currently – 105 Centres Networked

Infrastructure at TMH • • Surgical Oncology Radiation Oncology Surgical Pathology Hemato Pathology Biochemistry Cytopathology Molecular Pathology Microbiology Transfusion Medicine Cancer Cytogenetics • • • Medical Oncology Radiography: 3 Ultrasonography : 5 Mammography : 2 CT Scan : 3 MRI : 2 Interventional Radiology : 2 PET CT : 2 SPECT CT: 1 OPG : 1 Category No. of Beds Inpatients 477 Day Care 96 ICU & Recovery 56 Casualty 11 Total Beds 640

TMH Infrastructure Cobalt: 5 Linac: 6 Tomo: 2 Brachytherapy Patients/ Year: 6000

Indigenous Technology Development

Indigenous Technology Development VIETNAM NIGERIA MONGOLIA ZAMBIA

PROTON BEAM THERAPY EQUIPMENT Most advanced PT system • 3 treatment rooms (Gantries) • Pencil Beam Scanning (PBS) • Intensity Modulated Proton Therapy (IMPT) • 6 D patient couch • Image guidance • Anaesthesia for children “ 20% Equipment Manufactured in India”

PTCOG Database Updated July 2016 Proton Carbon Functional 59 10 Under Construction 29 3 Under Planning 17 0 Pts Treated Till Date 1, 18, 195 15, 736 Functional Facilities: Proton: 59 (Japan – 8, China – 1, S Korea – 1) Carbon: 10 (Japan – 4, China – 1) Facilities Under Construction: Proton: 29 (Japan – 4, China – 1, S Arabia – 1, S Korea – 1, Taiwan – 1, India - 2) Carbon: 4 (Japan – 1, China – 2)

NATIONAL SIGNIFICANCE Service • In India 30 -40% of all Pts. receive RTh with Curative Intent • 10 -20% of pts. receiving RTh would benefit with Proton Beam Therapy TMC RT Infrastructure Cobalt: 5 Linac: 6 Tomo: 2 Brachytherapy Ref. for RT: 12000 (Approx) Pts. Treated / Year: 6000 Total Number to be treated at TMC Proton Therapy facility = 800 Pts. Yearly (Approx) • Cost of Proton Therapy: In USA / Course (100 -150 thousand USD) = 1 Cr INR (Approx) Research • Opportunity to generate robust scientific evidence (PTCOG, RTOG, COG, EORTC) • Radiation Biology Research (BARC, TIFR, NCI) • Heavy Particle Accelerator Technology (IIT, RRCAT, C-DAC, CERN) • Indigenous Technology Development (Indian Industries) Education • National Centre for Training in Hadron Beam Therapy • Human Resource Development

Advanced Centre for Treatment, Research & Education in Cancer (ACTREC) Proposed Hemat & Paediatric Block • • Clinical Research Centre Cancer Research Institute Centre for Cancer Epidemiology Proton Therapy Centre Hematolymphoid & Pediatric Radiation Research Unit Phase I Clinical Trials Facility

National Hadron Beam Therapy Facility Tata Memorial Centre, Mumbai MILESTONES Jan 2013 1 st Mtg with Vendors July 2014 Global Tender Floated Mar 2015 Contract Signed with IBA Aug 2016 Civil Tender Floated Nov 2017 Expected Construction Start Early 2020 Expected Commissioning