GYN Brachytherapy at General Hospital / Medical University of Vienna. Richard Pötter

Transcription

1 GYN Brachytherapy at General Hospital / Medical University of Vienna Richard Pötter

2 Vienna 1918 Clinical Evaluation MRI since 1990ies Vienna 1918 Diagram Radiography Wertheim, Schauta Adler: Strahlenth Since ~1983 CT since 1980ies Imaging in gynae brachytherapy

3 Recent History Vienna Gyn Since 1994 CT (US) based BT planning (3D 1997) Since 1998 MRI in brachytherapy Exploratory phase Systematic introduction MRI based gyn BT 2001 First cervix cancer, then vagina (US), endometrium, recurrent malignancies (US) >> 400 patients treated so far [> 100 publications in journals and textbooks]

4 Recent History 3D Gyn International GEC ESTRO meeting workshops 97/98/02/07 ICRU 38 revision (start in 1998, published 2016) Gyn GEC ESTRO Working Group (2000- ) Gyn GEC ESTRO Recommendat. I-IV (05-12) 16 ESTRO Teaching Courses Gyn 3D (2004- ) International Cooperation (transatl., Asia, ) Gyn GEC ESTRO network since 2005 workshops + EMBRACE Research group EMBRACE Study , Retro EMBRACE Starting EMBRACE II (012016)

5 Gyn GEC ESTRO NETWORK R&D, Educ.* since 5/2005, coordinator Medical University Vienna and Aarhus Aarhus Dublin Erlangen Leeds Leuven Lubljana Mount Vernon Nancy Oslo Paris IGR Utrecht Vienna N E T W O R K Sponsored by Nucletron since 1/2007 3D based contouring of GTV, CTV and OAR WP1 Applicator reconstruction WP2 Treatment planning WP3 Applicator development WP4 W O R K P A C K A G E S A C T I V I T I E S WORKSHOPS FOR CONTOURING Dub,Wash,Milwauk,Utrecht WS APPLICATOR RECONSTRUCT+CONTOURING, Utrecht2006 WORKSHOP FOR TREATMENT PLANNING Ljubljana 2007 WS FOR APPLICATOR DEVELOPMENT Leuven 2009 OUTCOME, UNCERTAINTIES Paris 2010,Aarhus 11 Athens 12 GEC ESTRO WS EMBRACE I/RetroEMBRACE, EMBRACE II *+ international centres PUBLICATIONS ON: 3D IMAGING INTER-OBSERVER VARIATIONS APPLICATOR RECONSTRUCTION TREATMENT PLANNING UNCERTAINTIES R&O 2013

6 DIAGNOSIS Inclusion criteria: 1. Biopsy proven cervical Ca 2. Treatment with curative intent 3. FIGO, TNM staged 4. MRI/CT pelvis and PAN at diagnosis 5. MR guided BT planned 6. Informed consent (copy to the study office) Registration form Status at diagnosis form (MRI + CRF + cartoons) Baseline morbidity form Baseline QoL TREATMENT EBRT+/- Chemo Status at BT form MRI guided BT Treatment and DVH form (EBRT +/- Chemo + BT1-n) End of treatment QoL form POSTREATMENT Follow-up Every 3 months for 2 years; Every 6 months for 3 years Local recurrence or toxicity G>2 COMPREHENSIVE REPORT TO STUDY OFFICE!!! Follow-up form QoL form Disease status Toxicity assessment Off study form

7 EMBRACE Start of patient accrual: July Vienna Aarhus Utrecht Leiden Leuven Lubljana London MVH Milwaukee Paris Arnhem Maastricht Kaposvar Pittsburgh Mumbai Tata Memorial patients October 2010 Trondheim Leeds Edmonton Chandigarh Pamplona patients 742 patients Oslo Kuopio Cambridge March 2013 December 2015 Iowa Amsterdam Sao Paolo Chiang Mai 842 patients 1412 patients

8 RChTh + BT in < 50 days EBRT Chemotherapy Brachy EMBRACE II Start 1/2016 LR CTV-T CTV-N IMRT + IGRT PTV- 45 CTV-E Initial GTV-T Initial HR CTV-T week 1 week 2 week 3 week 4 week 5 week 6 week 7 week 1 week 2 week 3 week 4 week 5 week 6 week 7 week 1 week 2 week 3 week 4 week 5 week 6 Initial GTV Initial GTV + Para-aortic High Risk Large pelvis Small pelvis Intermediate Risk Low Risk Initial GTV GTV res CTV HR CTV IR CTV LR Nodal CTV-E based on Risk Group Residual GTV-T, Adaptive HR CTV-T, IR CTV-T

9 Vienna Radio-oncological gynaecological Brachytherapy Team Claudia Tomas Knocke Fellner/ Natascha Gerstner Old Team Stephan Wachter Richard Pötter Waldhäusl Younger team Stefan Lang Hajo Weitmann Petra Georg Christian Kirisits Johannes Dimopoulos Daniel Berger

10 Team Vienna Petra Trnkova Elena Fidarova Alina Sturdza Nicole Nesvacil Max Schmid Susovan Banerjee Elena Magri Karen Nkiwane Christiane Lemaire Kathrin Kirchheiner Tijana Frank Katarina Majercakova Mario Federico Martine Franckena Henrike Westerveld Noha Jastaniyah Israёl Fortin Chatrawut Pattaweerakul Kenji Yoshida Laura Motisi Pittaya Dankulchai An Jusheng Neamat Hegazy Tracy shum

11 Acknowledgements Gyn GEC ESTRO network EMBRACE study and research group, ICRU report committee Sponsored by: Support: Facilitated through EMBRACE kick-off meeting Brussels 04/2008 ICRU report committee 2010 Cervix cancer brachytherapy Annual EMBRACE/EMBRACE II meeting Vienna 01/2016