Course Directors : Teaching Staff : Guest Lecturer: Local Organiser: ESTRO coordinators: Melissa Vanderijst and Marta Jayes, project managers (BEL)

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ESTRO Teaching Course on Image-guided radiotherapy & chemotherapy in gynaecological cancer - With a special focus on adaptive brachytherapy Florence, Italy 28 September -2 October 2014 Course

1 ESTRO Teaching Course on Image-guided radiotherapy & chemotherapy in gynaecological cancer - With a special focus on adaptive brachytherapy Florence, Italy 28 September -2 October 2014 Course Directors : Christine Haie-Meder, Radiation Oncologist, Institut Gustave Roussy, Villejuif (FRA) Richard Pötter, Radiation Oncologist, medical University Hospital, Vienna (AUT) Teaching Staff : Daniel Berger, Physicist, Medical University Hospital, Vienna (AUT) Umesh Mahantshetty, Radiation Oncologist, Tata Memorial Hospital, Mumbai (IND) Primoz Petric, Radiation Oncologist, National Centre for Cancer Care and Research, Doha, Qatar (QAT) Johannes Dimopoulos, Radiation Oncologist, Metropolitan Hospital, Athens (GRE) Taran Paulsen-Hellebust, Physicist, DNR Norwegian Radium Hospital, Oslo (NOR) Ina Jürgenliemk-Schulz, Radiation Oncologist, Medical Center Utrecht (NLD), Peter Petrow, Radiologist, Institut Curie, Paris (FRA) Kari Tanderup, Physicist, University Hospital, Århus (DEN) Guest Lecturer: n.n, MD, Radiation Oncologist, Florence (ITA) Local Organiser: Lorenzo Livi, Radiation Oncologist, University of Firenze, Florence (ITA) ESTRO coordinators: Melissa Vanderijst and Marta Jayes, project managers (BEL)

2 Day 1- Sunday 28 September Anatomy, pathology and imaging of the female pelvis and of gynaecologic malignancies CTV, PTV, OAR assessment and treatment planning EBRT Contouring workshops for CTV and OAR in EBRT Chair: (15min) Welcome address (30min) Anatomical considerations, role of clinical gynaecological examination, and staging (45min) 3D Image based normal anatomy: uterus, parametria, organs at risk and nodes US, CT, MRI Coffee Break Chair: Radiologic pathology of gynaecologic tumours (incl. nodes) : (50min) At time of diagnosis At time of brachytherapy (15min) Imaging protocols MRI and CT: patient preparation for EBRT and BT planning (25min) Histologic and molecular pathology of gynaecologic malignancies (35min) CTV contouring in EBRT Lunch N.N P. Petrow P. Petrow J. Dimopoulos N.N, (pathologist) Chair: (45min) Image guidance and PTV (30min) Treatment techniques EBRT physics aspects T. Paulsen- Hellebust (30min) Clinical evidence for EBRT techniques and medical dose constraints including DVH parameters Coffee break (75min) EBRT workshops for MDs: Clinical Target Volume (Nodal) and organs at risk [15 Introduction, 30 Contouring, 30 discussion ] 16:00 17:15 (75min) Plenary session for Physicists (frontal presentations) CTV and organs at risk contouring (one physician in the room) T. Paulsen- Hellebust N.N. (physician)

3 Day 2 - Monday 29 September Topic Case discussion, clinical results, treatment strategies for EBRT ±chemotherapy in gynaecological malignancies BT: cervix cancer techniques, GTV Diag, GTV Res, CTV Diag, CTV Adapt Tumor Imaging and clinical diagrams (60min) Chair: Case Presentation plenary and case discussion in groups: *cervix cancer, squamous cell carcinoma, FIGO IB1, pelvic node *uterine endometroid adenocarcinoma (IB, Grade 2, 65 years) - 6 different discussion groups each with a group proposal - Parallel session (one break out room): Physics discussion session: EBRT image guidance (40min) Cervix Cancer: Results of clinical trials including chemotherapy J. Dimopoulos Coffee break (30min) (50min) Chair: Endometrium Cancer: Techniques and clinical evidence for post-op. EBRT. Results of clinical trials in low/intermediate-risk patients Plenary case discussion (cervix cancer IB1, uterine ca. IB G2) based on group proposals (morning session) and trial results Lunch (Video viewing plenary, IGABT (I), 20 minutes) Chair: (30min) Role of chemo/chemo-radiation in high-risk endometrium cancer 13:45-14:40 (55min) ICRU-GEC-ESTRO recommendation: GTV, CTVs at diagnosis and at time of brachytherapy for cervix cancer :10 (30min) Cervix cancer BT techniques: Fletcher/Manchester, Tandem/Ring, Moulage technique and limitations using standard loading patterns (30min) Interstitial techniques for cervix cancer J. Dimopoulos Coffee break Chair: (20min) Clinical diagrams: Cervix cancer and vaginal disease 16:30 17:00 (30min) Results and analysis of homework delineation examples

4 Day 3 - Tuesday 30 September IGABT: OAR delineation, applicator reconstruction, Dose volume reporting, BT techniques (vagina, vulva, endometrium) Workshops: Contouring (MDs), Applicator reconstruction (Physicists) Chair: (45min) Delineation of organs at risk (EBRT and IGABT) (45min) Applicator reconstruction using Sectional Imaging Coffee break Chair: (60min) ICRU-GEC-ESTRO recommendations on dose volume reporting Lunch (Video viewing plenary, IGABT (II), 20 minutes) Chair: (40min) Endometrium cancer:target volumes and BT techniques (60min) General and Image guided adaptive treatment strategies and BT techniques for vaginal and vulvar disease: Coffee break (120min) Workshops for MDs: cervix large-good response MRI/CT Special introduction into CT based contouring (U Mahantshetty) Workshops for Physicists: Reconstruction exercises in groups (Varian, Nucletron, Bebig)

5 Day 4 - Wednesday 01 October IGABT Treatment planning, physics, biology, clinical strategies Uncertainties, imaging and several BT fractions Nodal boost (EBRT), parametrial boost (IGABT, EBRT) Workshops: Contouring (MDs), Treatment Planning (Physicists) Chair: (20min) Basic physics and dose planning principles (25min) Radiobiological models to combine dose from external beam and brachytherapy (HDR, PDR) (45min) Medical aspects of treatment planning and dose constraints Coffee break Chair: (30min) Physics aspects of treatment planning in endometrium cancer (45min) (30min) Physics aspects of treatment planning intracavitary +/- interstitial techniques in cervix cancer Physics aspects of treatment planning interstitial techniques in vagina and vulva cancer Lunch (Video viewing plenary, IGABT (III), 20 minutes) (40min) Chair: Inter- and intra-fraction uncertainties and imaging strategies (MRI/CT) in brachytherapy (30min) Nodal boost: techniques, contribution of brachytherapy -> Ina? (30min) Parametrial boost and midline block: combination of EBRT and IGABT Coffee break Workshops for MDs: cervix large-bad response CT/MRI (80min) Workshops for Physicists: Treatment planning in groups (Varian, Nucletron, Bebig)

6 Day 5 - Thursday 02 October IGABT: Practical excercises treatment planning Clinical outcome, Morbidity and QoL, Practical implementation of IGABT Interactive feedback session (30min) Chair: Practical exercise for comprehensive dose reporting based on Excel-sheet including the LQ model (90min) Cervix cancer: treatment planning workshop All teachers Coffee break (45min) (60min) Chair: Morbidity and QoL outcome after IGABT: Rectum, sigmoid, bowel, bladder and vagina Lunch (Video viewing plenary, IGABT, local anaesthesia, 20 min) Chair: Disease Control after IGABT: Local control, lymph-node control, systemic control (45min) Practical implementation - Tips and tricks (15min) EMBRACE and GYN network :00 (60min) Interactive Feedback session: What have you learnt from this course? 16:00 Final Remarks and Closure of the Course J. Dimopoulos, K. Kirchheiner (psycho-oncologist) J. Dimopoulos

Course Directors: Teaching Staff: Guest Lecturers: Local Organiser: ESTRO coordinator: Melissa Vanderijst, project manager (BE)

Course Directors: Teaching Staff: Guest Lecturers: Local Organiser: ESTRO coordinator: Melissa Vanderijst, project manager (BE) ESTRO Teaching Course on Image-guided radiotherapy & chemotherapy in gynaecological cancer - With a special focus on adaptive brachytherapy Prague, Czech Republic 22-26 October 2016 Course Directors: Richard