THE GUSTAVE ROUSSY / INSERM PLATFORM

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1 Retrospective dose reconstruction in external beam radiotherapy for use in epidemiology: THE GUSTAVE ROUSSY / INSERM PLATFORM Dimitri Lefkopoulos PhD, Medical Physics Medical physics Department Gustave Roussy France Ibrahima Diallo PhD, Medical Physics Cancer & Radiations Team CESP-U1018 Inserm France

2 Current status of the project leader Dimitri Lefkopoulos > PhD, Medical Physics, > Head of Gustave Roussy medical Physics Department > National and European Projects : BIOMED Project: Advanced Techniques in Radiotherapy ( ). Coordinator of the Radiosurgery group, Hôpital Tenon Collaborative projects Medical Physics / Radiotherapy Gustave Roussy Collaborative projects in clinics Medical Physics department Radiotherapy department Gustave Roussy Collaborative projects - Gustave Roussy / U1018 Inserm (Dosimetry to support radiation epidemiology) > Teaching activities : DQPRM, DES-DIS Oncology, DU stereo-radiotherapy, others modules. > Training activities : DQPRM, Masters 2, PhD Students > Scientific societies : French Society of Medical Physics (SFPM), European Society of Therapeutic Radiation Oncology (ESTRO), American Society of Medical Physicists (AAPM). > Publications (PubMed) [ ] : 107 > Director of Ph.D Thesis [ ] : 10 > Intellectual Property and Patents : ARTEMIS-3D stereotactic irradiation planning software CQ phantom of virtual simulation. (Patent number : CA C) Ibrahima Diallo > PhD, Medical Physics > Research Engineer since 2007 INSERM > Leader of the dosimetry group of the Cancer and Radiations team - U1018 Inserm > Dosimetry tools and methodology to support radiation Epidemiology Publications (PubMed) [ ] : 67 National and European Projects : PL Inca 2005, SARI (PHRC-2011), GENE-RAD-RISK (Euratom), PancareSurf (Health), Procardio (Health), Cerebrad (Health), Pirates (NCI), DIGEST (U1018), PHRC 2010, PeridoseQuality ( ); THYRAD (CEA) Intellectual Property and Patents : IDDN.FR S.P Programme pour la modélisation du rayonnement secondaire autour des faisceaux de radiothérapie et fantômes de corps-entier de patients en position de traitement. AAP IDDN FR D.P Bibliothèque de fantômes de patients de radiothérapie en position de traitement. AAP

3 Summary of recent years' work Innovative Strategies in Clinical Radiotherapy (Radiotherapy and Imaging Departments - GR) > Optimized Radiotherapy Radiation Therapy Methodologies Imaging Dose Levels in image-guided radiotherapy (Mège et al., 2016), Clinical innovations in radiotherapy (Paumier et al., 2015). Quantification in image guided adaptive brachytherapy (PhD Thesis, Mazeron 2016). Image Guided Radiotherapy (PhD Thesis, R de Crevoisier 2007) Quality control and optimization of data acquisition in multimodal imaging for external beam radiotherapy (PhD Thesis A. Isambert 2009) Support for the development of radiobiology (U1030-INSERM) > Dose metrology, optimized irradiation experimental set-ups Dosimetry dedicated to epidemiological studies of radiation (Cancer & Radiations Team, U1018-INSERM) > Methodological research and development in whole-body dosimetry. > Dosimetric study and modeling of peripheral dose components for electron beams in external beam radiotherapy (PhD Thesis, M. Alabdoaburas, 2017). > Optimization and validation of out-of-field dose calculation methods for application in epidemiological and clinical studies (PhD Thesis, Jérémi Vũ Bezin, 2015) > Retrospective Reconstructions of Active Bone Marrow Dose-Volume Histograms (Veres et al, 2014) > Individual radiation therapy patient whole-body phantoms for peripheral dose evaluations: method and specific software. (Alziar et al, 2009) 3

4 Contribution to scientific production since 2010 Scientific publications and international communications (Gustave Roussy / Inserm) Web Of Sciences : 96 > Categories: ONCOLOGY : 68 RADIOLOGY NUCLEAR MEDICINE MEDICAL IMAGING : 53 HEMATOLOGY : 6 PEDIATRICS : 5 other : 16 Collaborations > European projects in Medical Physics and Radiotherapy MAESTRO European project. Coordinator of the clinical validations of the project ( ) INSPIRA French project (Informatics for the Safety of Processes and Installations in Radiotherapy) ( ) ARTFORCE European project Several Clinical research project (PHRC) > Dosimetry for several national and European projects in Radiation Epidemiology SARI (PHRC-2011), GENE-RAD-RISK (Euratom), PancareSurf (Health), Procardio (Health), Cerebrad (Health), Pirates (NCI), DIGEST (U1018), THYRAD (CEA), PL Inca, PHRC 2010, PeridoseQuality ( ) 4

5 Team proposal Theme: Dosimetry - Medical Physics 2 research axes: AXIS-1: DOSIMETRY IN THE IRRADIATION FIELD Optimized use of new clinical strategies involving high-precision irradiation techniques in radiotherapy and imagingradiotherapy interfaces. AXIS-2: WHOLE BODY DOSIMETRY Doses delivered to patient in irradiated areas and control of whole body doses. Team members Permanents Inserm : - Research Engineer Inserm (IR1) Medical Physicist : 1 FTE (Full-Time-Equivalent) Permanents Gustave Roussy : - Medical Physicist Clinicians : 1 FTE - Radiotherapists, Radiologists : 0.2 FTE - Administrative: 0.5 FTE Non-permanent positions: - Engineers (Dosimetrist-CCQ in Medical Physics): 3 FTE - Medical Physicist Research: 1 FTE - PhD students, PostDocs, Master2 trainees and engineering schools, radiation therapist trainees. 5

6 Scientific project: AXIS 1 - DOSIMETRY IN THE IRRADIATED VOLUME CLINICAL ACTIVITIES RADIOTHERAPY /PHYSICS FACILITIES OF GUSTAVE ROUSSY multi modal Imaging for RT and brachy RT/Brachy Adaptative RT/Brachy Image Guided Transit in-vivo dosimetry. Homogenize the dosimetric planning protocols (dose-volume constraints, other significant factors,...) according to the type of the tumor Optimization of treatment plans Performed by physicists / dosimetrists / Radiotherapists For a patient, and for different techniques. PERSONALISED MEDECINE PERSONNEL CLINICIANS Objets DICOM RT OPTIMIZED CLINICAL USE OF THE HIGH TECHNOLOGY RADIOTHERAPY MACHINES AVAILABLE AT GUSTAVE ROUSSY ACCORDING TO TYPES OF TUMORS Developments Software platform for calculation of: all dose-volume and radiobiological indices of the international literature (U1030 Inserm), Evolved indices that will be developed by the PLATFORM Long-term risks based indices for certain types of tumors (U1018 Inserm). PERSONNEL PLATFORME GR-INSERM Possibility of industrial partnership with the company RAYSEARCH INTERNATIONAL COMPARATIVE STUDIES BETWEEN DIFFERENT TECHNIQUES FOR DIFFERENT TYPES OF TUMORS (Hao Wu 2016) A great inhomogeneity was observed regarding the analysed dosimetric end points HETEROGENEITE DES PROTOCOLES D IRRADIATION (NCS report 24, 2015) R & D activities COMPARATIVE STUDIES FOR DIFFERENT LOCATIONS CARRIED OUT WITH PATIENTS TREATED WITH A GIVEN TECHNIQUE AT GUSTAVE ROUSSY (GR) BASED ON REPLANNING WITH DIFFERENT EXISTING TECHNIQUES IN GUSTAVE ROUSSY CONFRONTATION OF THE STUDIES OF GR WITH INTERNATIONAL COMPARATIVE STUDIES USING INDICES PROPOSED BY DIFFERENT TEAMS PERSONNEL PLATFORME GR-INSERM 6 6

7 Scientific Project AXE 2 WHOLE BODY DOSIMETRY DOSE CONTROL / RISK OF NEW RT TECHNOLOGIES Numerous gaps in the dose / volume data for the prediction of toxicities induced by radiotherapy (Marks, 2010). The QUANTEC stressed the limitations of NTCP models, particularly with regard to the anatomical dose distribution (Gagliardi et al, 2010). PERSONNEL PLATEFRME GR-INSERM PERSONNEL HOSPITAL Provision of Services Dosimetry for research projects Cohort FCCSS (U1018 Inserm) Other Cohorts National projects (PHRC, Inca, ) European projects (Health, EURATOM ) Radiotherapy / Brachytherapy / Radiobiology Long term follow-up clinic at Gustave Roussy Provide clinical and epidemiological studies with improved quality dose/volume data. Evaluation of the doses to sensitive organs at distance from the target-volume, carried-out by/for radiotherapists - medical physicists - dosimetrists for patients treated at GR Dosimetry for specific clinical conditions Fetus, pacemaker, ovaries, testes, Legal implications/expertise PERSONNEL RESEARCH UNITS R & D activities Methodologies and technologies to produce accurate dose/volume data to support research on iatrogenic effects of radiotherapy: Radiations epidemiology Radiotherapy / Brachytherapy Radiation biology Radiology / Scanner (1) Software for dose calculations in clinical situations where standard TPS cannot. (2) Protocols for accurate measurements of whole body doses Low doses to distant structures. (3) Additional doses from imaging procedures during radiotherapy. (4) Monte Carlo simulations, where relevant. PERSONNEL PLATEFRME GR-INSERM Industrial partnership Comparative studies of the doses for any organ of interst (OI), for the different irradiation techniques used in Radiotherapy at Gustave Roussy. Inter-Center comparisons of the doses to the OIs : Gustave Roussy and others RT Centres in France and in Europe. Develop improved and clinically relevant models for the Normal Tissues Complications Probability (NTCP) in radiotherapy. Translate to the clinic : use of the NTCP models for a better optimisation of RT treatment plans applied at Gustave Roussy, 7 7

8 Thank you for your attention