ESTRO-CARO Teaching Course on Image-guided cervix radiotherapy - With a special focus on adaptive brachytherapy Hilton Hotel Toronto Toronto, Canada

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1 ESTRO-CARO Teaching Course on Image-guided cervix radiotherapy - With a special focus on adaptive brachytherapy Hilton Hotel Toronto Toronto, Canada 4 April - 6 April 2016 Course Directors: Richard Pötter, Radiation Oncologist, Medical University Hospital, Vienna (AUT) Kari Tanderup, Physicist, University Hospital, Århus (DEN) CARO Course Directors: Meredith Giuliani, Radiation Oncologist, Princess Margaret Cancer Centre, Toronto (CAN) Michael Milosevic, Radiation Oncologist, Princess Margaret Cancer Centre, Toronto (CAN) 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) Guest Lecturers: Israel Fortin, Radiation Oncologist, Centre Hospitalier de l Universite de Montreal, Montreal (CAN) Kathy Han, Radiation Oncologist, Princess Margaret Cancer Centre, Toronto (CAN) Kartik Jhaveri, Radiologist, Women's College Hospital, Toronto (CAN) Taymaa May, Gynaecology Oncologist, Princess Margaret Cancer Centre, Toronto (CAN) Michael Milosevic, Radiation Oncologist, Princess Margaret Cancer Centre, Toronto (CAN) ESTRO Coordinator: Melissa Vanderijst, Project Manager (BEL) CARO Coordinator: Mary Hooey, CMP (CAN) 1

2 Day 1 Monday 04 April Description of Topics Speaker (25min) Welcome Address Chair: - Toronto III Convention Level M. Milosevic E. Vigneault (30min) Anatomical considerations, role of clinical gynaecological examination, and staging T. May (30min) Diagnostic imaging of cervix cancer K. Jhaveri (20 min) Radiologic pathology at time of brachytherapy P. Petric Coffee Break Chair: (30min) Cervix cancer BT techniques: Fletcher/Manchester, Tandem/Ring, Moulage technique and limitations using standard loading patterns P. Petric (30min) Combined intracavity-interstitial technique for cervix cancer (20min) Clinical diagrams: Cervix cancer and vaginal disease (45min) Delineation of organs at risk (EBRT and IGABT) P. Petric Lunch Chair: P. Petric (45min) ICRU-GEC-ESTRO recommendation: GTV, CTVs at diagnosis and at time of brachytherapy for cervix cancer R.Pötter (45min) Applicator reconstruction, geometry and image fusion Coffee break 2

3 (120min) Workshop for Physicians: Contouring of the target volumes I Toronto III Block 1 Tata 002 Case (large with good response) 15:40-15:45 Case information overview (PP, UM) 15:45-16:20 Contouring attempt B* (participants & faculty) 16:20-16:30 Demonstration of reference ( master ) contours (PP, UM) Block 2 Vie 002 Case (large with good response) 16:30-16:35 Case information overview (PP, UM) 16:35-17:10 Contouring attempt B* (participants & faculty) 17:10-17:20 Demonstration of reference ( master ) contours (PP, UM) Block 3 Feedback on Tata 002 & Vie :20-17:40 Discussion on Homework & Workshop (participants & faculty) Workshops for Physicists: Reconstruction exercises in groups Governor General, 2 nd fl - Varian Richmond, 3rd fl - Elekta - Definition of reference points - Reconstruction of applicators - Image registration CT and MRI P. Petric I. Fortin *Contouring attempt A recommended at pre-course homework and attempt C at post-course homework. 7:00-9:00 Welcome Reception Brassaii Restaurant & Lounge 461 King Street West t:

4 Day 2 Tuesday 05 April Contents Chair: Toronto III, Convention Level Speaker (35min) CTV contouring in EBRT (including EMBRACE II) (45min) Image guidance, organ motion and ITV/PTV (including nodes) (including EMBRACE II protocol) (30min) Clinical evidence for EBRT techniques and medical dose constraints including DVH parameters (including EMBRACE II) Coffee break Chair: (45min) ICRU-GEC-ESTRO recommendations on dose volume reporting (45min) Clinical evidence for dose-effects for disease and morbidity/qol outcome: Dose prescription, dose constraints and planning aims in brachytherapy Lunch (Video viewing plenary, IGABT (I), 20 minutes) Chair: (45min) Physics aspects of treatment planning intracavitary +/- interstitial techniques in cervix cancer (25min) Radiobiological models to combine dose from external beam and brachytherapy (HDR, PDR) (40min) Inter- and intra-fraction uncertainties and imaging strategies (MRI/CT) in brachytherapy (45min) Canadian experience with implementation of MRI guided brachytherapy K. Han Coffee break 4

5 Workshop for Physicians: Contouring of the target volumes II Toronto III Block 1 Vie 003 Case (large with minor response) 16:25-16:30 Case information overview (PP, UM) 16:30-17:15 Contouring attempt B* (participants & faculty) 17:15-17:25 Demonstration of reference ( master ) contours (PP, UM) P. Petric I. Fortin (75min) Block 2 Feedback on Vie :25-17:40 Discussion on Homework & Workshop (participants & faculty) Workshops for Physicists: Treatment planning in groups Governor General, 2 nd fl - Varian Richmond, 3 rd fl - Elekta - Treatment planning intracavitary optimization - Treatment planning combined intracavitary/interstitial optimization - Radiobiological Dose reporting using the spread sheet *Contouring attempt A recommended at pre-course homework and attempt C at post-course homework. 5

6 Day 3 Wednesday 06 April Contents Speaker (30min) Chair: Toronto III, Convention Level Practical exercise for comprehensive dose reporting based on Excelsheet including the LQ model (80min) Cervix cancer: treatment planning demonstration Coffee Break Chair: P. Petric P. Petric/ (45min) Morbidity and QoL outcome after IGABT: Rectum, sigmoid, bowel, bladder and vagina (45min) Disease Control after IGABT: Local control, lymph-node control, systemic control (20min) EMBRACE, EMBRACE II and GYN network Lunch (Video viewing plenary, IGABT, local anaesthesia, 20 min) Chair: (45min) Practical implementation - Tips and tricks Canadian community practise CARO (90min) Introduction BCCA Experience Edmonton Experience London experience Quebec City experience Image-guided interstitial brachytherapy planning study Group discussion Mike Milosevic Francois Bachand, Juanita Crook Ericka Wiebe Vikram Velker William Foster, Eric Vigneault Eric Leung Everyone Introduced by M. Milosevic :05 (60min) Interactive Feedback session: What have you learnt from this course? 16:05 Final Remarks and Closure of the Course Thank you! 6

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

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