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)
Day 1- Thursday 08 March 08.30 09.00 (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 09.00-09.30 (30min) Anatomical considerations, role of clinical gynaecological examination, and staging 09.30-10.00 (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, 10.00-10.30 (30min) US, PET-CT, MRI: - At time of diagnosis - At time of brachytherapy 10.30-10.50 Coffee Break Chair: 10.50-11.20 (30min) Patient preparation for treatment planning & EBRT including immobilization, organ filling, reproducibility 11.20-11.50 (30min) Imaging protocols for radiation planning: fluoroscopic simulation, CT, virtual simulation D.N. Sharma 11.50-12.20 (30min) GTV - CTV - ITV in EBRT including EMBRACE II 12.20-12.50 (30min) Management and treatment planning of Para-aortic nodal region 12.50-13.30 Lunch Chair: K Tanderup 13.30-14.15 (45min) Image guidance and ITV-PTV 14.15-14.45 (30min) Treatment techniques EBRT physics aspects Jamema SV 14.45-15.15 (30min) Clinical evidence for EBRT techniques and medical dose constraints including DVH parameters & EMBRACE II planning aims for EBRT / C. Haie- Meder 15.15-15.45 (30min) Plenary session: Practical application of EBRT planning? Jamema SV/ 15.45 16.15 Coffee break EBRT workshops for MDs: Clinical Target Volume (Nodal) and organs 16.15-18.00 (105 min) at risk [15 Introduction, 30 Contouring, 45 discussion including evaluation of home work EBRT case] 16.15-18.00 (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
Day 2 - Friday 09 March 08.30-09.10 (40min) 09.10-09.50 (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 09.50-10.20 (30min) Interstitial techniques for cervix cancer 10.20-10.40 Coffee break Chair: 10.40-11.10 (30min) Clinical diagrams: Cervix cancer Video presentation: AKH- VIENNA + IGR-PARIS + TATA / / 11.10-12.10 (60min) 12.10 12.40 (30min) Commissioning of BT Applicators J. Swamidas / 12.40-13.20 Lunch Year 1: ICRU-GEC-ESTRO Recommendation: GTV, CTV s at diagnosis and at time of brachytherapy for cervix cancer 13.20 14.05 (45min) Year 2: Videos of procedures by participants and follow-up 14.05-14.25 (20min) Year 1: 2D & 3D Delineation of Organs at Risk Year 2: Videos of procedures by participants and follow-up 14.25-14.55 Coffee break Physicists: BT Commissioning Workshop in 2 batches - Video on Commissioning of Applicators - Autoradiography on HDR machine area 14.55-17.00 (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 / /
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) 09.35-10.05 (30min) Principles of radiography based BT planning & CT information 10.05-10.30 (25min) Clinical implications of Radiography based BT Planning 10.30 11.00 Coffee break A Srivastava / J. Swamidas / / C. Haie- Meder 10.30-11.15 (45min) 11.15-12.00 (45min) 12.00-12.45 (45min) 12.45-13.30 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 / / / 13.30-14.00 (30min) 14.00-14.45 (45min) 14.45 17.00 (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
Day 4 Sunday 11 March 08.15 08.35 (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 / 08.35-08.50 (15min) Recap of BT planning principles: Radiography based/ CT information J. Swamidas / K Tanderup 08.50-10.00 (70min) Cervix cancer: treatment planning workshop including with participants All Teachers 10.00-10.45 (45min) Medical aspects of brachy treatment planning and dose constraints 10.45-11.15 Coffee break 11.15 11.45 (30min) Time Dose fractionation for EBRT + HDR BT / 11.45-12.45 (60min) EMBRACE I & II studies / K Tanderup 12.45-13.30 Lunch Workshops for year 1 physicians: TATA 04 / TATA 03 CT Based / [10 Introduction, 30 Contouring, 30 discussion] 13.30-14.40(70min) Workshops for Physicists and year 2 physicians: Treatment planning in / J. Swamidas groups (Varian, Elekta) (Same case as in the morning) 14.40-15.00 Coffee break Chair: 15.00-15.45 (45min) Clinical Outcome: Disease and Toxicities 15.45-16.30 (45min) Practical implementation - Tips and tricks & Roadmap 16.15-16.45 (30min) GYN Network / Indian network 16.45-17.30 (45min) Discussion: Defining goals with timelines for each team 17.30 Final Remarks and Closure of the Course J. Swamidas