Local Organiser: Madhup Rastogi, Radiation Oncologist, Ram Manohar Lohia Institute of Medical Sciences, Lucknow

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Aubrey Day
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2 nd ESTRO-AROI GYN Teaching Course 3D Radiotherapy with a Special Emphasis on Implementation of MRI / CT Based Brachytherapy in Cervical Cancer 8-11 March 2018 Lucknow, India AROI Course Directors:

Oncologist, Medical University Hospital, Vienna (AUT) Kari Tanderup, Physicist, University Hospital, Århus (DEN) Teaching Staff: Christine Haie Meder, Radiation Oncologist, Institut Gustave Roussy,

1 2 nd ESTRO-AROI GYN Teaching Course 3D Radiotherapy with a Special Emphasis on Implementation of MRI / CT Based Brachytherapy in Cervical Cancer 8-11 March 2018 Lucknow, India AROI Course Directors: Umesh, Radiation Oncologist, Tata Memorial Hospital, Mumbai (IN) Jamema Swamidas, Medical Physicist, ACTREC, Tata Memorial Centre, Mumbai (IN) ESTRO Course Directors: Richard Pötter, Radiation Oncologist, Medical University Hospital, Vienna (AUT) Kari Tanderup, Physicist, University Hospital, Århus (DEN) Teaching Staff: Christine Haie Meder, Radiation Oncologist, Institut Gustave Roussy, Villejuif (FR) DN. Sharma, Radiation Oncologist, AIIMS, Delhi (IN) Guest faculty: Ajeet K Gandhi, Radiation Oncologist, RMLIMS, Lucknow Anoop K Srivastava, Medical Physicist, RMLIMS, Lucknow Abhishek Basu, Assistant Professor, Radiation Oncology, RG Kar Medical College, Kolkota P K Shrivastava, Professor, Radiology, KGMU, Lucknow Local Organiser: Madhup Rastogi, Radiation Oncologist, Ram Manohar Lohia Institute of Medical Sciences, Lucknow ESTRO coordinator: Melissa Vanderijst, project manager (BEL)

2 Day 1- Thursday 08 March (30min) Anatomy, pathology and imaging of the female pelvis and of cervical cancer CTV, PTV, OAR assessment and treatment planning EBRT Contouring and planning workshops for EBRT Welcome address & Presentation on pre-workshop questionnaire results(08 minutes) / R. Pötter / AROI Representative/ Director or Dean RMLIMS A. Gandhi (30min) Anatomical considerations, role of clinical gynaecological examination, and staging (30min) Imaging normal anatomy: uterus, parametria, organs at risk and nodes US, CT, MRI P K Shrivastava Imaging pathology of cervix cancer (incl. nodes) Clinical drawings, CT, (30min) US, PET-CT, MRI: - At time of diagnosis - At time of brachytherapy Coffee Break Chair: (30min) Patient preparation for treatment planning & EBRT including immobilization, organ filling, reproducibility (30min) Imaging protocols for radiation planning: fluoroscopic simulation, CT, virtual simulation D.N. Sharma (30min) GTV - CTV - ITV in EBRT including EMBRACE II (30min) Management and treatment planning of Para-aortic nodal region Lunch Chair: K Tanderup (45min) Image guidance and ITV-PTV (30min) Treatment techniques EBRT physics aspects Jamema SV (30min) Clinical evidence for EBRT techniques and medical dose constraints including DVH parameters & EMBRACE II planning aims for EBRT / C. Haie- Meder (30min) Plenary session: Practical application of EBRT planning? Jamema SV/ Coffee break EBRT workshops for MDs: Clinical Target Volume (Nodal) and organs (105 min) at risk [15 Introduction, 30 Contouring, 45 discussion including evaluation of home work EBRT case] (105min) EBRT Planning Workshop [15 Introduction, 90 discussion including evaluation of home work EBRT case] / / D.N. Sharma / A Gandhi J. Swamidas / K. Tanderup/ A Srivastava

3 Day 2 - Friday 09 March (40min) (40min) PATIENT PREPARATION, PRINCIPLES & SELECTION OF BT TECHNIQUES, CLINICAL DRAWINGS, COMMISSIONING PROCESSES FOR BT Patient preparation and principles of BT application including, preparation, anaesthesia, procedure Cervix cancer BT techniques: Fletcher/Manchester, Tandem/Ring, Moulage technique and limitations using standard loading patterns (30min) Interstitial techniques for cervix cancer Coffee break Chair: (30min) Clinical diagrams: Cervix cancer Video presentation: AKH- VIENNA + IGR-PARIS + TATA / / (60min) (30min) Commissioning of BT Applicators J. Swamidas / Lunch Year 1: ICRU-GEC-ESTRO Recommendation: GTV, CTV s at diagnosis and at time of brachytherapy for cervix cancer (45min) Year 2: Videos of procedures by participants and follow-up (20min) Year 1: 2D & 3D Delineation of Organs at Risk Year 2: Videos of procedures by participants and follow-up Coffee break Physicists: BT Commissioning Workshop in 2 batches - Video on Commissioning of Applicators - Autoradiography on HDR machine area (125min) Year 1 physicians: BT Contouring workshop (TATA 03) Year 2 physicians: Discussions based on BT procedures related processes like anesthesia/ technique / imaging and discussion on case capsules by participants / U. DN Sharma / / J. Swamidas / K Tanderup / DN Sharma / A Basu / /

4 Day 3 - Saturday 10 March Target Concept, OAR delineation, Principles of BT planning of IC, IC+IS, Dose points and Volume reporting, applicator reconstruction, Radiobiology, Workshops: Contouring (MDs), Applicator reconstruction (Physicists) 08:30-09:35 (65 min) CT contouring and planning (and ultrasound) (30min) Principles of radiography based BT planning & CT information (25min) Clinical implications of Radiography based BT Planning Coffee break A Srivastava / J. Swamidas / / C. Haie- Meder (45min) (45min) (45min) Lunch Chair: Year 1 : ICRU-GEC-ESTRO recommandations on dose points & volume reporting Year 2: Group discussions on Contouring/ Imaging including CT and case capsule discussions Year 1: Applicator reconstruction, geometry and image fusion Year 2 : Group discussions on Contouring/ Imaging including CT and case capsule discussions Physics aspects of treatment planning intracavitary +/- interstitial techniques in cervix cancer / U J. Swamidas / / / (30min) (45min) (135min) including coffee break Chair: DN Sharma Year 1: Radiobiological models for BT, EBRT AND Combine (HDR) Year 2 : Group discussions (RO + MP) on treatment planning, protocols : dose, fractionation and OTT Parametrial and Nodal boost including midline block: combination of EBRT & BT Workshops for Physicists: Reconstruction & reference point exercises in groups (Varian, Elekta) Workshops for year 2 physicians: Discussion of implementation issues, difficulties, cases, etc. Open discussion Workshops for year 1 physicians : cervix large-good response MRI/CT Special introduction into CT based contouring () [15 Introduction, 45 Contouring, 90 discussion including evaluation of homework EBRT case] (TATA04) / J. Swamidas / / / J. Swamidas J. Swamidas / R Poetter / U / C. Haie- Meder / / DN Sharma

5 Day 4 Sunday 11 March (20min) 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) IGABT: Practical exercises treatment planning Interactive feedback session Chair: Feedback & Discussion on EBRT and BT Home Cases and on the parallel sessions / R. Pötter / (15min) Recap of BT planning principles: Radiography based/ CT information J. Swamidas / K Tanderup (70min) Cervix cancer: treatment planning workshop including with participants All Teachers (45min) Medical aspects of brachy treatment planning and dose constraints Coffee break (30min) Time Dose fractionation for EBRT + HDR BT / (60min) EMBRACE I & II studies / K Tanderup Lunch Workshops for year 1 physicians: TATA 04 / TATA 03 CT Based / [10 Introduction, 30 Contouring, 30 discussion] (70min) Workshops for Physicists and year 2 physicians: Treatment planning in / J. Swamidas groups (Varian, Elekta) (Same case as in the morning) Coffee break Chair: (45min) Clinical Outcome: Disease and Toxicities (45min) Practical implementation - Tips and tricks & Roadmap (30min) GYN Network / Indian network (45min) Discussion: Defining goals with timelines for each team Final Remarks and Closure of the Course J. Swamidas

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 2017 Course Directors: Richard