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 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 (FRA) Ina Jürgenliemk-Schulz, Radiation Oncologist, Medical Center Utrecht (NL) Taran Paulsen-Hellebust, Physicist, DNR Norwegian Radium Hospital, Oslo (NOR) Peter Petrow, Radiologist, Institut Curie, Paris (FRA) Guest Lecturers: Nicole Nesvacil, Physicist, Medical University Hospital, Vienna (AUT) Remi Nout, Radiation Oncologist, Leiden University Medical Center, Leiden (NL) Jamema Swamidas, Physicist, Tata Memorial Hospital (IN) Local Organiser: Hana Stankusova, Radiation Oncologist, University Hospital Motol (CZ) ESTRO coordinator: Melissa Vanderijst, project manager (BE)
Day 1- Sunday 22 October Anatomy, pathology and imaging of the female pelvis Introduction into gynaecologic malignancies Init. GTV-T, CTV-T, nodal CTV-E, ITV, CTV-N, PTV, OAR for EBRT treatment planning and techniques for EBRT Contouring workshops for Targets and OAR in EBRT Chair: 08.30 08.45 (15min) Welcome address 08.45-09.15 (30min) Anatomical considerations, role of clinical gynaecological examination, and staging 09.15-9.45 (30min) 3D Image based normal anatomy: uterus, parametria, organs at risk and nodes US, CT, MRI P. Petrow 9.45-10.15 Coffee Break Chair: 10.15-11.00 (45min) Radiologic pathology of gynaecologic tumours incl. nodes: At time of diagnosis At time of brachytherapy P. Petrow 11.00 11.15 (15min) Imaging protocols MRI and CT: patient preparation for EBRT and BT P. Petrow planning J. Dimopoulos 11.15 11.55 (40min) GTV and CTV contouring in EBRT and OARs 11.55-12.40 (45min) Image guidance, organ motion, ITV and PTV 12.40-13.40 Lunch 13.40-14.10 (30min) Chair: T. Hellebust Medical aspects of dose constraints including DVH parameters for EBRT planning 14.10 14.55 (45min) EBRT treatment techniques and optimisation physics aspects 14.55 15.25 (30min) Nodal boost: volumes, dose, techniques (including SIB) 15.25 15.55 Coffee break EBRT workshops for MDs: GTV and CTV (primary tumour related, 15.55-17.10 (75min) Elective Nodal) and organs at risk according to EMBRACE II [15 Introduction, 30 Contouring, 30 discussion] 15:55 17:10 (75min) Feedback on IMRT treatment planning homework feedback and presentation of treatment plans T. Paulsen- Hellebust
Day 2 - Monday 23 October 08.30-09.30 (60min) Topic Case discussion, clinical results, treatment strategies for EBRT ±chemotherapy in gynaecological malignancies BT : cervix cancer techniques, GTV Res,, CTV HR, CTV IR Tumor Imaging and clinical diagrams Chair: TBD 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: Plenary session for Physicists (frontal presentations) CTV and organs at risk contouring according to EMBRACE II 09.30-10.00 (30min) Cervix Cancer: Results of clinical trials including chemotherapy 10.00-10.30 Coffee break 10.30-11.00 (30min) 11.00-11.50 (50min) Chair: Endometrium Cancer: Techniques and clinical evidence for post-op. EBRT. Results of clinical trials in low/intermediate-risk patients Physicians session: Plenary case discussion (cervix cancer IB1, uterine ca. IB G2) based on group proposals (morning session) and trial results Physicists and RTTs session: Discussion of EBRT image guidance in small groups 11.50-12.20 (30min) Role of chemo/chemo-radiation in high-risk endometrium cancer 12.20-13.20 Lunch (Video viewing plenary, IGABT (I), 20 minutes) 13:20-14:05 (45min) 14.05 14:35 (30min) Chair: ICRU89-GEC-ESTRO recommendation: GTV, CTVs at diagnosis and at time of brachytherapy for cervix cancer and OAR contouring Cervix cancer BT techniques: Fletcher/Manchester, Tandem/Ring, Moulage technique and limitations using standard loading patterns 14.35 15.05 (30min) Interstitial techniques for cervix cancer 15.05-15.35 Coffee break Chair: 15.35 16.05 (20min) Clinical diagrams: Cervix cancer and vaginal disease 16:05 16:50 (45min) Results and analysis of homework delineation + day 1 and treatment planning feedback from physician and physicist sessions
Day 3 - Tuesday 24 October IGABT: OAR delineation, applicator reconstruction, Dose volume reporting, BT techniques (vagina, vulva, endometrium) Workshops: Contouring (MDs), Applicator reconstruction (Physicists & RTTs) Chair: 08.30 08.50 (20min) Basic physics and dose planning principles 08.50 9.35 (45min) Applicator commissioning, reconstruction, geometry and image fusion 9.35 10.15 (40min) Endometrium cancer: Target volumes and BT techniques for definitive and post-operative treatment 10.15 10.45 Coffee break Chair: 10.45 11.30 (45min) ICRU-GEC-ESTRO recommendations on dose volume reporting 11.30 12.15 (45min) 12.15 13.15 General and Image guided adaptive treatment strategies and BT techniques for vaginal and vulvar disease Lunch (Video viewing plenary, IGABT (II), 20 minutes) Chair: 13.15-13.45 Farewell to teachers 13.45 15.45 (120min) included coffee break Workshops for MDs: cervix large-good response MRI/CT Special introduction into CT based contouring (Tata I or Vienna III) Workshops for Physicists & RTTs: Reconstruction exercises in groups (Varian, Elekta, Bebig)
Day 4 - Wednesday 25 October IGABT Treatment planning, physics, biology, clinical strategies Uncertainties, imaging and several BT fractions Nodal boost (EBRT) Workshops: Contouring (MDs), Treatment Planning (Physicists) 08.30 08.55 (25min) 08.55 9.40 (45min) 9.40 10.25 (45min) 10.25 10.55 Coffee break 10.55 11.25 (30min) Chair: Radiobiological models to combine dose from external beam and brachytherapy (HDR, PDR) Clinical evidence for dose effect for disease, morbidity/qol: dose prescription, dose constraints and planning aims in cervix brachytherapy Physics aspects of treatment planning for intracavitary +/- interstitial techniques in cervix cancer Chair: T. Paulsen Hellebust Physics aspects of treatment planning for interstitial techniques in vagina and vulva cancer 11.25 11.55 (30min) Physics aspects of treatment planning in endometrium cancer 11.55 12.55 Lunch (Video viewing plenary, IGABT (III), 20 minutes) Chair: 12.55 13.15 (20min) Inter- and intra-fraction uncertainties in brachytherapy 13.15 14.00 (45min) Feedback on brachytherapy contouring homework and treatment planning examples 14.00-14.30 (30min) Combination of images and use of image registration in brachytherapy 14.30 15.00 Coffee break 15.00 16.20 (80min) Workshops for MDs: cervix large-bad response CT/MRI Workshops for Physicists: Treatment planning in groups (Varian, Elekta, Bebig), R. Nout
Day 5 - Thursday 26 October IGABT: Practical excercises treatment planning Clinical outcome, Morbidity and QoL, Practical implementation of IGABT Interactive feedback session Chair: 08.30-09.00 (30min) Time, dose and fractionation 09.00-10.30 (90min) Cervix cancer: treatment planning workshop All teachers 10.30 11.00 Coffee break Chair: Morbidity, patient reported outcome, and QoL outcome after IGABT: 11.00 11.45 (45min) Rectum, sigmoid, bowel, bladder and vagina 11.45 12.45 Lunch (Video viewing plenary, IGABT, local anaesthesia, 20 min) Chair: Disease Control after IGABT: 12.45 13.30 (45min) Local control, lymph-node control, systemic control 13.30 14.15 (45min) Practical implementation - Tips and tricks 14.15 14.45 (30min) EMBRACE studies and GYN network 14.45 15.45 (60min) Interactive Feedback session: What have you learnt from this course? 15.45 16.00 (15min) Final Remarks and Closure of the Course