1. science
2. medicine
3. oncology

NEWSLETTER JANUARY - FEBRUARY
ESTRO | EUROPEAN SOCIETY FOR RADIOTHERAPY & ONCOLOGY
SOCIETY LIFE
The ESTRO vision on
multidisciplinarity by the President
NATIONAL
SOCIETIES
Relationship between ESTRO
and the national societies:
survey results
ESTRO
CONFERENCES
3rd ESTRO Forum:
Topics, highlights and sessions
not to be missed
N° 98 | BIMONTHLY | JANUARY - FEBRUARY 2015
CONTENTS
Editorial
Society Life
NEWSLETTER N° 98
JANUARY - FEBRUARY 2014
3
6
Clinical
10
Read it before your patients
16
Brachytherapy
30
Physics
40
RTT
54
Radiobiology
66
ESTRO School
83
Young ESTRO
104
Health Economics
Institutional Membership
119
National Societies
123
ESTRO Conferences
128
Calendar of events
115
154
View of Barcelona, Spain, where the 3rd ESTRO FORUM will take place, 24-28 April 2015.
ESTRO | EUROPEAN SOCIETY FOR RADIOTHERAPY & ONCOLOGY
EDITORIAL
“In the Society Life
Corner you will be able to
find an important note on
multidisciplinary cancer
care indicating ESTRO’s
position on the topic. This
is an important matter
that affects all of us in our
daily work”
Dear friends and colleagues,
I hope you all had a relaxing holiday season to
finish 2014 happily, and that the year 2015 will
be full of promise and plenty of opportunities for
you to flourish.
Just before the end of last year, we held an Extraordinary General Assembly at the ESTRO
office on 16 December 2014. The outcome of the
meeting can be read in the Society Life Corner.
The Board will again present the material at the
General Assembly at the 3rd ESTRO Forum in
Barcelona on 27 April, for information for those
who could not be present.
The 3rd ESTRO Forum is now just a few months
away and the busy work continues more than
ever. I would like to thank all of you who submitted an abstract to the Forum as we have just hit
a new record for our fora with an amazing 1,637
abstracts received, just slightly below the ESTRO
33 total of 1,737… not bad for such a young
event! This record was reached through a generally high number of submissions, with a large
increase in clinical abstracts. Congratulations,
and especially to the RTTs for their highest ever
total of 197 submitted abstracts.
I would like to point out that a joint ALATRO,
SEOR and SPRO national day will take place
onsite, in the afternoon of 24 April. The agenda
will focus on breast cancer and young radiation
oncology professionals with Spanish and Portuguese as the scientific language.
Work has also continued on the decisions taken
at the June strategy review (JSR). We propose to
adapt the structure of ESTRO to the changing
environment. Three councils, focusing on scientific dissemination, stakeholder policy and education respectively, will be better suited to the
modern needs of an international organisation
like ESTRO. Another suggestion is that standing committees will no longer report to just one
council; instead they will be active in their own
right and approached by each council for their
specific expertise. An indirect consequence
of the work resulting from the JSR is that the
young task force will become a standing committee, which will be launched officially at the
3rd ESTRO Forum. We will keep you informed
of upcoming actions resulting from the JSR in
subsequent newsletters.
Finally, in the Society Life Corner you will be
able to find an important note on multidisciplinary cancer care indicating ESTRO’s position
on the topic. This is an important matter that
affects all of us in our daily work.
I wish you all a successful 2015 and hope to see
you in the splendid city of Barcelona to experience and enjoy together the 3rd ESTRO Forum.
Philip Poortmans
ESTRO President
CLINICAL & TRANSLATIONAL MEETING
PHYSICS BIENNIAL MEETING
24 - 28 April 2015
Barcelona, Spain
GEC - ESTRO - ISIORT MEETING
PREVENT AND TARGET MEETING
RTT MEETING
WWW.ESTRO.ORG
SOCIETY LIFE
INTRODUCTION
ESTRO WORKS WITH ECCO TO RESTORE BALANCE
IN GAME OF THRONES IN EUROPE
SOCIETY LIFE
“The nature of
multidisciplinary
relationships within
the European oncology
landscape is changing”
Dear friends and colleagues,
The nature of multidisciplinary relationships within the European
oncology landscape is changing. ESMO’s decision to end its collaboration
with ECCO on the European Cancer Congress will have a big impact and
raises serious questions about the future balance between all the different
disciplines involved in caring for the cancer patient.
To keep you informed of the latest developments and ESTRO’s views on
this issue, I have included a brief description in this newsletter; we will
update you whenever we have any further news. Our priority will always
be to enable radiation oncology professionals to care for patients in the best
possible way.
PHILIP POORTMANS
Philip Poortmans
ESTRO President
EXTRAORDINARY GENERAL ASSEMBLY
The ESTRO Extraordinary General Assembly (EGA) took place on
Tuesday 16 December 2014 at 18.30-19.00 hrs CET at the ESTRO office in
Brussels. In accordance with the framework of good governance, the EGA
was called to approve the budget for 2015 and to approve ESTRO’s choice
of the external auditor.
The EGA was quorate and both issues were voted on and approved.
Members were invited to participate in the EGA either by being present
at the ESTRO office or by joining using the teleconferencing system and
INTRODUCTION
voting using an electronic voting system (the same as that used for the last
two Board members and President elections).
The budget will be presented again at the General Assembly at the 3rd
ESTRO Forum in Barcelona at the end of April, for information for those
who could not be present.
The full minutes of the Extraordinary General Assembly are available to
all members upon request from the ESTRO office (info@estro.org).
ESTRO WORKS WITH ECCO TO RESTORE BALANCE
IN GAME OF THRONES IN EUROPE
SOCIETY LIFE
ESTRO WORKS
WITH ECCO TO
RESTORE BALANCE
IN GAME OF THRONES
IN EUROPE
PHILIP POORTMANS
INTRODUCTION
After a separation of two years, ESMO joined
ECCO again in 2007. This followed a period of
negotiations about money and about the reorganisation of the former European Federation
of Cancer Societies (FECS). According to the contract, a period of ten years was agreed to rebrand
this organisation with an agreement for joint congresses up to and including 2017. However, at the
ESMO congress in Madrid, the board supported
the ESMO president Rolf Stahel in his decision to
stop the collaboration with ECCO for the organisation of the annual congresses after 2015. On
the other hand, ESMO wants to stay in the part
of ECCO (currently under reorganisation) that is
related to relations with their stakeholders. Moreover, ESMO invited the other founding members
of ECCO (ESSO, EACR, EONS, SIOPE, ESTRO)
to contribute every two years to the annual
ESMO congress, which will be an annual event
from 2016 onwards.
It goes without saying that the ESMO decision
has a huge impact on multidisciplinary relationships in the European oncological landscape and
puts great pressure on the viability of the ECCO
congress because of the important relationship
between the pharmaceutical companies and the
medical oncologists. ESMO’s proposal for the
other societies to join their congress cannot be
accepted because it impacts heavily on the fairness of the, sometimes difficult, oncological equilibrium in Europe by overemphasising the central
role of medical oncologists. This is especially
disturbing as, with a high variation from one Eu-
ropean country to another, medical oncologists
prescribe only an estimated 30-40% of all cancer
drugs in Europe and even more so as it is neglecting and even denigrating the contribution of the
non-drug based oncological disciplines, including
all related and supporting healthcare workers.
The ESTRO Board decided to make an effort to
take the opportunity created by ESMO and view
it as a founding phase for the future of multidisciplinary cancer care. Therefore, we will support
ECCO and its members in their quest to find a
solution to the current challenge. We have started joint discussions and preparatory work to
increase the speed at which ECCO undergoes
its restructuring, opening itself completely to all
healthcare workers that are active in the field of
oncology so that they can participate at an equal
level. The goal should be to support the best oncological cure and care for all patients, taking
into account their personal, socio-cultural and
spiritual circumstances. This should be, of course,
in a fully multidisciplinary environment that
respects the role of all those who contribute on an
equal basis.
I am sure that we will succeed in our goal to restore the balance in the game of thrones of oncology in Europe.
Philip Poortmans
ESTRO President
ESTRO WORKS WITH ECCO TO RESTORE BALANCE
IN GAME OF THRONES IN EUROPE
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CLINICAL
INTRODUCTION
INITIATIVE FOR CREATING A DATA EXCHANGE
STRATEGY FOR RADIOTHERAPY RESEARCH
CLINICAL
“Data exchange
becomes increasingly
important for research
in radiation oncology”
Dear colleagues,
Data exchange is becoming increasingly
important for research in radiation oncology.
There are many complexities, such as handling
of dose plans, advanced imaging, large-scale
bioinformation, high quality outcome parameters
and, of course, legal issues. However, major
research institutions in Europe and worldwide
have identified this area as a priority area for
future research because of its importance in
generating evidence, as well as its use as a novel
technology in radiation oncology. Below is a
report from a multi-institutional workshop held
in Dresden last year organised by OncoRay/
German Research Consortium for Translational
research and EUROCAN. If you have comments
or an interest in joining such an initiative, please
let me know: daniel.zips@med.uni-tuebingen.de
DANIEL ZIPS
Daniel Zips
Chair of the Clincal Committee
INTRODUCTION
INITIATIVE FOR CREATING A DATA EXCHANGE
STRATEGY FOR RADIOTHERAPY RESEARCH
CLINICAL
INITIATIVE FOR
CREATING A
DATA EXCHANGE
STRATEGY FOR
RADIOTHERAPY
RESEARCH
MECHTHILD KRAUSE
INTRODUCTION
TOMAS SKRIPCAK
This report summarises the fundamental ideas
behind a new initiative for a data exchange strategy in radiotherapy, described in greater detail
within a white paper (Radiother Oncol, epub).
On 26 November 2013 a workshop organised by
the German Cancer Consortium (DKTK) and
EurocanPlatform was hosted in Dresden, Germany, to examine radiotherapy-research-specific
IT platforms established within Europe. Current
IT solutions from the European Society for Radiotherapy and Oncology (ESTRO) and several
regional, national and international initiatives
were presented. This workshop resulted in a conclusion, where all participating parties agreed on
the necessity of setting up a collaborative effort
to accelerate and harmonise ongoing data collection activities (via the utilisation of international,
vendor neutral standards) and to promote open
access to reusable radiotherapy research datasets.
The main reason for rapid pooling of study data is
an acceleration of translational research to speed
up the application of healthcare innovations in
the day-to-day treatment of cancer patients. The
possibilities of reproducing the original study
results, performing further analyses on existing
research data to generate new hypotheses, or developing computational models to support
Figure 1 Large-scale multi-centre studies produce raw data pools, which can be used to generate application-specific
prediction models or knowledge bases (adapted from Skripcak et al., manuscript submitted)
INITIATIVE FOR CREATING A DATA EXCHANGE
STRATEGY FOR RADIOTHERAPY RESEARCH
medical decisions (e.g.risk/benefit analysis of
treatment options) represent just a fraction of
the potential benefits of medical data-pooling.
Distributed machine learning and knowledge
exchange from federated databases are among
several attractive approaches for knowledge generation within “Big Data”. Resulting research data
pools represent the primary input for the generation of medical knowledge bases (see Figure
1) with a broad range of applications, including
predictive models for decision-support systems
based on clinical data [1] and discovery of prognostic features in radiomics [2]. Predictive model
research has the potential not only to improve
quality of life but also to increase survival, for
example by using isotoxic strategies [3].
The recent innovations in clinical data standardisation [4] together with the European Commission’s data protection reform in progress [5] suggest that now it is the ideal time to start analysing
and establishing the necessary processes for multi-institutional data exchange. The newly formed
initiative will trigger and harbour the activities
that will lead to a formal definition of the radiotherapy-specific data exchange strategy, which is
a fundamental prerequisite moving towards federated internationally interoperable research data
sets.
The initiative will include the following activities:
• Establishing an international network of multidisciplinary professionals involved in the radiotherapy research field in order to establish
INTRODUCTION
collaboration in data exchange strategy requirements analysis, development and maintenance
possibilities.
• Communication with other existing initiatives
to keep a track of recent developments and to
try to harmonise their activities with each other.
• Re-using, adopting or defining new guidelines
for radiotherapy research data collection, including recommendations for the utilisation of
clinical information models, ontologies, data
elements and medical terminologies.
• Analysing solutions for the protection of patient
privacy and the relation to informed consent, as
well as secondary use of research data in view
of the very different interpretation and application of confidentiality and privacy rules and
laws between different countries, different states
within countries, and sometimes even between
different ethical committees.
• Providing sustainable open source IT solutions
to support research data collection, analysis
and transparent data and medical knowledge
publication will make re-using research data
straightforward and thus will stimulate research
in radiation therapy and oncology.
In future, the data pools might even be used for
personalised medicine by means of generating
predictions on outcome for individual patients
based on analyses of their patient-tumour- and
treatment-related data, which would facilitate
treatment choice, either by physicians or through
shared decision-making. Additionally, this initiative could be of great importance from a health
economic perspective, by enabling evaluation
of the efficacy and cost-benefit of different approaches, such as new technologies and/or new
combined modality treatments.
Mechthild Krause
Radiation oncologist
TU Dresden, Med. Faculty Carl Gustav Carus
Dresden, Germany
Tomas Skripcak
IT scientist
TU Dresden, Med. Faculty Carl Gustav Carus
Dresden, Germany
All of this will require the sincere commitment
and engagement of involved professionals, but
may result in great benefit to clinical as well as
translational cancer research. When the first draft
of the data exchange strategy is released, an international “dummy run” will be set up as a test
case/prototype for evaluating its robustness.
INITIATIVE FOR CREATING A DATA EXCHANGE
STRATEGY FOR RADIOTHERAPY RESEARCH
REFERENCES
1. Lambin P, van Stiphout RGPM, Starmans MHW, Rios-Velazquez E, Nalbantov G, Aerts HJWL, et al. Predicting outcomes in radiation oncology – multifactorial
decision support systems. Nature Reviews Clinical Oncology 2012;10:27–40.
2. Aerts HJWL, Velazquez ER, Leijenaar RTH, Parmar C,
Grossmann P, Cavalho S, et al. Decoding tumour phenotype by noninvasive imaging using a quantitative radiomics approach. Nature Communications 2014;5.
3. Reymen B, van Baardwijk A, Wanders R, Borger J,
Dingemans A-MC, Bootsma G, et al. Long-term survival
of stage T4N0-1 and single station IIIA-N2 NSCLC patients treated with definitive chemo-radiotherapy using
individualised isotoxic accelerated radiotherapy (INDAR). Radiotherapy and Oncology 2014;110:482–7.
4. J. de Montjoie A. Introducing the CDISC Standards:
New Efficiencies for Medical Research. CDISC; 2009.
<http://www.cdisc.org>.
5. Data Protection Day 2014: Full Speed on EU Data
Protection Reform. <http://europa.eu/rapid/press-release_MEMO-14-60_en.htm>
INTRODUCTION
INITIATIVE FOR CREATING A DATA EXCHANGE
STRATEGY FOR RADIOTHERAPY RESEARCH
DYNAMIC ONCOLOGY
VIRTUAL ESTRO
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Society: the Green Journal articles, conference
abstracts, webcasts, e-posters, slides, access to
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newsletter, etc.
HOW DOES IT WORK?
DOVE works as a search engine encompassing all kinds of data in radiation oncology. Just type in your
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INTRODUCTION
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Too important to miss...
A digest of essential
reading for all radiation
oncologists
PHILIPPE LAMBIN
BY PHILIPPE LAMBIN, DIRK DE RUYSSCHER AND HANS KAANDERS
DIRK DE RUYSSCHER
HANS KAANDERS
INTRODUCTION
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Cognitive function after
the initiation of adjuvant
endocrine therapy in earlystage breast cancer: an
observational cohort study.
Ganz PA, Petersen L, Castellon SA, Bower JE, Silverman
DH, Cole SW, Irwin MR, Belin TR.
J Clin Oncol. 2014 Nov 1;32(31):3559-67. doi: 10.1200/
JCO.2014.56.1662. Epub 2014 Sep 29.
PURPOSE
This report examines cognitive complaints and
neuropsychological (NP) testing outcomes in
patients with early-stage breast cancer after the
initiation of endocrine therapy (ET) to determine
whether this therapy plays any role in posttreatment cognitive complaints.
PATIENTS AND METHODS
One hundred seventy-three participants from the
Mind Body Study (MBS) observational cohort
provided data from self-report questionnaires
and NP testing obtained at enrolment (T1,
before initiation of ET), and six months later
(T2). Bivariate analyses compared demographic
and treatment variables, cognitive complaints,
depressive symptoms, quality of life, and NP
functioning between those who received ET
versus not. Multivariable linear regression models
examined predictors of cognitive complaints at
T2, including selected demographic variables,
depressive symptoms, ET use, and other medical
variables, along with NP domains that were
identified in bivariate analyses.
differences in NP test performance. Multivariable
regression on LC at T2 found higher LC
complaints significantly associated with T1 LC
score (P < .001), ET at T2 (P = .004), interaction
between ET and past hormone therapy (HT)
(P < .001), and diminished improvement in NP
psychomotor function (P = 0.05). Depressive
symptoms were not significant (P = 0.10).
CONCLUSION
Higher LC complaints are significantly associated
with ET six months after starting treatment and
reflect diminished improvements in some NP
tests. Past HT is a significant predictor of higher
LC complaints after initiation of ET.
RESULTS
Seventy percent of the 173 MBS participants
initiated ET, evenly distributed between
tamoxifen or aromatase inhibitors. ET-treated
participants reported significantly increased
language and communication (LC) cognitive
complaints at T2 (P = .003), but no significant
INTRODUCTION
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Circulating tumour cells and
response to chemotherapy
in metastatic breast cancer:
SWOG S0500.
Jeffrey B. Smerage, William E. Barlow, Gabriel N.
Hortobagyi, Eric P. Winer, Brian Leyland-Jones, Gordan
Srkalovic, Sheela Tejwani, Anne F. Schott, Mark A.
O’Rourke, Danika L. Lew, Gerald V. Doyle, Julie R.
Gralow, Robert B. Livingston and Daniel F. Hayes.
Presented in part as an oral presentation at the San Antonio
Breast Cancer Symposium, San Antonio (USA), December
10-14, 2013.
INTRODUCTION
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PURPOSE
and 13 months, respectively (P < 0.001).
Increased circulating tumour cells (CTCs; five
or more CTCs per 7.5 mL of whole blood) are
associated with poor prognosis in metastatic
breast cancer (MBC). A randomised trial of
patients with persistent increase in CTCs tested
whether changing chemotherapy after one cycle
of first-line chemotherapy would improve the
primary outcome of overall survival (OS).
PATIENTS AND METHODS
CONCLUSION
This study confirms the prognostic significance
of CTCs in patients with MBC receiving firstline chemotherapy. For patients with persistently
increased CTCs after 21 days of first-line
chemotherapy, early switching to an alternate
cytotoxic therapy was not effective in prolonging
OS. For this population, there is a need for more
effective treatment than standard chemotherapy.
Patients with MBC who did not have increased
CTCs at baseline remained on initial therapy
until progression (arm A). Patients with initially
increased CTCs that decreased after 21 days of
therapy remained on initial therapy (arm B).
Patients with persistently increased CTCs after
21 days of therapy were randomly assigned to
continue initial therapy (arm C1) or change to an
alternative chemotherapy (arm C2).
RESULTS
Of 595 eligible and evaluable patients, 276
(46%) did not have increased CTCs (arm A). Of
those with initially increased CTCs, 31 (10%)
were not retested, 165 were assigned to arm B,
and 123 were randomly assigned to arm C1 or
C2. No difference in median OS was observed
between arm C1 and C2 (10.7 and 12.5 months,
respectively; P = 0.98). CTCs were strongly
prognostic. Median OS for arms A, B, and C (C1
and C2 combined) were 35 months, 23 months,
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Vasectomy and risk of
aggressive prostate cancer: a
24-year follow-up study.
Siddiqui MM, Wilson KM, Epstein MM, Rider JR, Martin
NE, Stampfer MJ, Giovannucci EL, Mucci LA.
J Clin Oncol. 2014 Jul 7. pii: JCO.2013.54.8446. [Epub
ahead of print]
PURPOSE
Conflicting reports remain regarding the
association between vasectomy, a common form
of male contraception in the United States, and
prostate cancer risk. We examined prospectively
this association with extended follow-up and an
emphasis on advanced and lethal disease.
PATIENTS AND METHODS
Among 49,405 US men in the Health
Professionals Follow-Up Study, age 40 to 75 years
at baseline in 1986, 6,023 patients with prostate
cancer were diagnosed during the follow-up to
2010, including 811 lethal cases. In total, 12,321
men (25%) had vasectomies. We used Cox
proportional hazards models to estimate the
relative risk (RR) and 95% CIs of total, advanced,
high-grade, and lethal disease, with adjustment
for a variety of possible confounders.
disease. Additional analyses suggested that the
associations were not driven by differences in sex
hormone levels, sexually transmitted infections,
or cancer treatment.
CONCLUSION
Our data support the hypothesis that vasectomy
is associated with a modest increased incidence of
lethal prostate cancer. The results do not appear
to be due to detection bias, and confounding by
infections or cancer treatment is unlikely.
RESULTS
Vasectomy was associated with a small increased
risk of prostate cancer overall (RR, 1.10; 95%
CI, 1.04 to 1.17). Risk was elevated for highgrade (Gleason score 8 to 10; RR, 1.22; 95%
CI, 1.03 to 1.45) and lethal disease (death or
distant metastasis; RR, 1.19; 95% CI, 1.00 to
1.43). Among a sub-cohort of men receiving
regular prostate-specific antigen screening, the
association with lethal cancer was stronger (RR,
1.56; 95% CI, 1.03 to 2.36). Vasectomy was not
associated with the risk of low-grade or localised
INTRODUCTION
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Relationship between male
pattern baldness and the risk
of aggressive prostate cancer:
an analysis of the prostate,
lung, colorectal, and ovarian
cancer screening trial.
Zhou CK, Pfeiffer RM, Cleary SD, Hoffman HJ, Levine
PH, Chu LW, Hsing AW, Cook MB.
J Clin Oncol. 2014 Sep 15. pii: JCO.2014.55.4279. [Epub
ahead of print]
PURPOSE
Male pattern baldness and prostate cancer appear
to share common pathophysiologic mechanisms.
However, results from previous studies that
assess their relationship have been inconsistent.
Therefore, we investigated the association of
male pattern baldness at age 45 years with
risks of overall and subtypes of prostate cancer
in a large, prospective cohort – the Prostate,
Lung, Colorectal and Ovarian (PLCO) Cancer
Screening Trial.
METHODS
We included 39,070 men from the usual care and
screening arms of the trial cohort who had no
cancer diagnosis (excluding non-melanoma skin
cancer) at the start of follow-up and recalled their
hair-loss patterns at age 45 years. Hazard ratios
(HRs) and 95% CIs were estimated by using Cox
proportional hazards regression models with age
as the time metric.
0.97; 95% CI, 0.72 to 1.30) prostate cancer risk
but was significantly associated with increased
risk of aggressive prostate cancer (HR, 1.39;
95% CI, 1.07 to 1.80). Adjustment for covariates
did not substantially alter these estimates.
Other classes of baldness were not significantly
associated with overall or subtypes of prostate
cancer.
CONCLUSION
Our analysis indicates that frontal plus moderate
vertex baldness at age 45 years is associated
with an increased risk of aggressive prostate
cancer and supports the possibility of common
pathophysiologic mechanisms.
RESULTS
During follow-up (median, 2.78 years), 1,138
incident prostate cancer cases were diagnosed,
571 of which were aggressive (biopsy Gleason
score ≥ 7, and/or clinical stage III or greater, and/
or fatal). Compared with no baldness, frontal plus
moderate vertex baldness at age 45 years was not
significantly associated with overall (HR, 1.19;
95% CI, 0.98 to 1.45) or non-aggressive (HR,
INTRODUCTION
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Impact of adjuvant
radiotherapy on survival of
patients with node-positive
prostate cancer.
Abdollah F, Karnes RJ, Suardi N, Cozzarini C, Gandaglia
G, Fossati N, Vizziello D, Sun M, Karakiewicz PI, Menon
M, Montorsi F, Briganti A.
J Clin Oncol. 2014 Sep 22. pii: JCO.2013.54.7893. [Epub
ahead of print]
PURPOSE
The role of adjuvant radiotherapy (aRT) in
treating patients with pN1 prostate cancer is
controversial. The authors tested the hypothesis
that the impact of aRT on cancer-specific
mortality (CSM) in these individuals is related to
tumour characteristics.
score 7 to 10, pT3b/pT4 stage, or positive surgical
margins (HR, 0.30; P = .002); and (2) patients
with PLN count of 3 to 4 (HR, 0.21; P = .02),
regardless of other tumour characteristics. These
results were confirmed when OM was examined
as an end point.
CONCLUSION
METHODS
A total of 1,107 patients with pN1 prostate
cancer treated with radical prostatectomy and
anatomically extended pelvic lymph node
dissection between 1988 and 2010 at two tertiary
care centres were evaluated. All patients received
adjuvant hormonal therapy with or without
aRT. Regression tree analysis stratified patients
into risk groups on the basis of their tumour
characteristics and the corresponding CSM rate.
Cox regression analysis tested the relationship
between aRT and CSM rate, as well as overall
mortality (OM) rate in each risk group separately.
The beneficial impact of aRT on survival in
patients with pN1 prostate cancer is highly
influenced by tumour characteristics. Men
with low-volume nodal disease (≤ two PLNs)
in the presence of intermediate- to high-grade,
non-specimen-confined disease and those with
intermediate-volume nodal disease (three to four
PLNs) represent the ideal candidates for aRT after
surgery.
RESULTS
Overall, 35% of patients received aRT. At
multivariable analysis, aRT was associated with
more favourable CSM rate (hazard ratio [HR],
0.37; P < .001). However, when patients were
stratified into risk groups, only two groups
of men benefited from aRT: (1) patients with
positive lymph node (PLN) count ≤ 2, Gleason
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Comment by Professor Dr
Karin Haustermans, Department of Radiation Oncology, University Hospital
Leuven, Belgium
This paper by Abdollah and
colleagues discusses the
impact of adjuvant radiotherapy on the survival
of patients with node positive prostate cancer. The
authors evaluated 1,107 patients with pN1 prostate
cancer who underwent a radical prostatectomy and
extended lymph node dissection between 1988 and
2010 performed in two expert centres. All patients
received hormonal treatment with or without
adjuvant radiotherapy. Overall, 35% of the patients
received adjuvant radiotherapy. Adjuvant radiotherapy was associated with an improved cancer
specific survival. Patients with low volume nodal
disease (not more than two pathological lymph
nodes) and intermediate to high grade prostate
cancer with positive section margins and patients
with three to four pathological lymph nodes benefitted most. The authors validated their model by
using the National Cancer Institute’s Surveillance,
Epidemiology and End Results program (SEER)
data set from 1999 to 2009, which consisted of
3,158 patients with node positive disease.
With these data the authors confirm their previous findings on a smaller patient group. Moreover, they introduce further substratification for
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patients with more than two pathological lymph
nodes. This study suffers from a few limitations.
Firstly, it is a retrospective study and not a phase
III randomised trial. Secondly, use of adjuvant
radiotherapy was left to the clinical judgement of
the treating physician, which might have introduced a selection bias. Thirdly, this study covers
a long time period during which staging, surgery
techniques and radiotherapy might have changed
as well as the clinical judgement of the treating
physicians. Fourthly, a pathology review was not
performed. We know from previous studies that
a central pathology review is important in this
disease (van der Kwast et al., 2006).
Although this study has some drawbacks, it also
clearly demonstrates that prostate cancer patients
with node positive disease are a heterogeneous
group of patients with cancer specific survival at
eight years varying between 72% and 99% and
an overall survival of 78%, which is a very good
result. Although patients treated with adjuvant
radiotherapy had worse disease characteristics,
adjuvant radiation did still improve outcome.
These results do not come as a surprise. We know
from three phase III randomised trials (Stephenson et al., 2012) that patients with pT3 pT4 pN0
prostate cancer benefit from adjuvant radiotherapy without adjuvant hormonal treatment. We
also know from the Messing trial (Messing et al.,
2006) that patients with pN1 disease benefit from
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immediate hormonal treatment versus delayed
hormonal treatment. Ideally, a randomised phase
III trial should be performed. Carefully selected
patients (and this paper could be used as a guidance) should be randomised after surgery between
adjuvant hormonal treatment alone or adjuvant
hormonal treatment with adjuvant radiotherapy.
A large patient number would be required and
surgeons would need to be trained in the technique of extended lymphadenectomy. Central pathology review and quality assurance of radiotherapy would be essential. Moreover, we have shown
in our own studies that, with superextended lymphadenectomy, 13% affected nodes were found
that would not have been detected with a classical
extended lymphadenectomy (Joniau et al., 2013).
Also, serial sectioning of all removed lymph nodes
and the addition of cytokeratin staining led to the
detection of 15% more positive lymph nodes compared to routine pathological examination with
H&E staining (unpublished data).
On top of this we have to face the fact that urologists remain reluctant to refer patients for adjuvant radiotherapy and prefer the “early salvage”
approach. Given all these concerns, such a trial
would have a high risk of failing. But let’s remain
optimistic: there is a clear tendency today to be
much more aggressive towards patients with highrisk disease, offering them a trimodality treatment. And the paper of Abdollah and colleagues
provides strong evidence for this approach.
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Phase III randomized trial of
induction chemotherapy in
patients with N2 or N3 locally
advanced head and neck
cancer.
Cohen EE, Karrison TG, Kocherginsky M, Mueller J, Egan R,
Huang CH, Brockstein BE, Agulnik MB, Mittal BB, Yunus F,
Samant S, Raez LE, Mehra R, Kumar P, Ondrey F, Marchand P,
Braegas B, Seiwert TY, Villaflor VM, Haraf DJ, Vokes EE.
J Clin Oncol. 2014 Sep 1;32(25):2735-43. doi: 10.1200/
JCO.2013.54.6309. Epub 2014 Jul 21.
PURPOSE
Induction chemotherapy (IC) before
radiotherapy lowers distant failure (DF) rates in
locally advanced squamous cell carcinoma of the
head and neck (SCCHN). The goal of this phase
III trial was to determine whether IC before
chemoradiotherapy (CRT) further improves
survival compared with CRT alone in patients
with N2 or N3 disease.
PATIENTS AND METHODS
Treatment-naive patients with non-metastatic N2
or N3 SCCHN were randomly assigned to CRT
alone (CRT arm; docetaxel, fluorouracil, and
hydroxyurea plus radiotherapy 0.15 Gy twice per
day every other week) versus two 21-day cycles of
IC (docetaxel 75 mg/m(2) on day 1, cisplatin 75
mg/m(2) on day 1, and fluorouracil 750 mg/m(2)
on days 1 to 5) followed by the same CRT
regimen (IC + CRT arm). The primary end point
was overall survival (OS). Secondary end points
included DF-free survival, failure pattern, and
recurrence-free survival (RFS).
more common in the IC arm (47% v 28%; P =
.002). With a minimum follow-up of 30 months,
there were no statistically significant differences in
OS (hazard ratio, 0.91; 95% CI, 0.59 to 1.41), RFS,
or DF-free survival.
CONCLUSION
IC did not translate into improved OS compared
with CRT alone. However, the study was
underpowered because it did not meet the
planned accrual target, and OS was higher
than predicted in both arms. IC cannot be
recommended routinely in patients with N2 or
N3 locally advanced SCCHN.
RESULTS
A total of 285 patients were randomly assigned.
The most common grade 3 to 4 toxicities during
IC were febrile neutropenia (11%) and mucositis
(9%); during CRT (both arms combined), they
were mucositis (49%), dermatitis (21%), and
leukopenia (18%). Serious adverse events were
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p16 protein expression and
human papillomavirus status
as prognostic biomarkers of
nonoropharyngeal headand
neck squamous cell
carcinoma.
Chung CH, Zhang Q, Kong CS, Harris J, Fertig EJ, Harari PM,
Wang D, Redmond KP, Shenouda G, Trotti A, Raben D, Gillison ML, Jordan RC, Le QT.
J Clin Oncol. 2014 Sep 29. pii: JCO.2013.54.5228. [Epub
ahead of print]
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PURPOSE
Although p16 protein expression, a surrogate
marker of oncogenic human papillomavirus
(HPV) infection, is recognised as a prognostic
marker in oropharyngeal squamous cell
carcinoma (OPSCC), its prevalence and
significance have not been well established in
cancer of the oral cavity, hypopharynx, or larynx,
collectively referred as non-OPSCC, where HPV
infection is less common than in the oropharynx.
PATIENTS AND METHODS
p16 expression and high-risk HPV status
in non-OPSCCs from RTOG 0129, 0234,
and 0522 studies were determined by
immunohistochemistry (IHC) and in situ
hybridisation (ISH). Hazard ratios from Cox
models were expressed as positive or negative,
stratified by trial, and adjusted for clinical
characteristics.
and non-OPSCC, patients with p16-positive
OPSCC have better PFS and OS than patients with
p16-positive non-OPSCC, but patients with p16negative OPSCC and non-OPSCC have similar
outcomes.
CONCLUSION
Similar to results in patients with OPSCC,
patients with p16-negative non-OPSCC have
worse outcomes than patients with p16-positive
non-OPSCC, and HPV may also have a role in
outcome in a subset of non-OPSCC. However,
further development of a p16 IHC scoring
system in non-OPSCC and improvement of HPV
detection methods are warranted before broad
application in the clinical setting.
RESULTS
p16 expression was positive in 14.1% (12 of 85),
24.2% (23 of 95), and 19.0% (27 of 142) and HPV
ISH was positive in 6.5% (six of 93), 14.6% (15 of
103), and 6.9% (seven of 101) of non-OPSCCs from
RTOG 0129, 0234, and 0522 studies, respectively.
Hazard ratios for p16 expression were 0.63 (95%
CI, 0.42 to 0.95; P = .03) and 0.56 (95% CI, 0.35 to
0.89; P = .01) for progression-free (PFS) and overall
survival (OS), respectively. Comparing OPSCC
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Importance of surveillance
and success of salvage
strategies after definitive
chemoradiation in patients with
oesophageal cancer.
Sudo K, Xiao L, Wadhwa R, Shiozaki H, Elimova E, Taketa T,
Blum MA, Lee JH, Bhutani MS, Weston B, Ross WA, Komaki
R, Rice DC, Swisher SG, Hofstetter WL, Maru DM, Skinner
HD, Ajani JA.
J Clin Oncol. 2014 Oct 20;32(30):3400-5. doi: 10.1200/
JCO.2014.56.7156. Epub 2014 Sep 15.
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PURPOSE
Patients with oesophageal carcinoma (EC) who
are treated with definitive chemoradiotherapy
(bimodality therapy [BMT]) experience frequent
relapses. In a large cohort, we assessed the
timing, frequency, and types of relapses during an
aggressive surveillance programme and the value
of the salvage strategies.
PATIENTS AND METHODS
Patients with EC (N = 276) who received BMT
were analysed. Patients who had surgery within
six months of chemoradiotherapy were excluded
to reduce bias. We focused on local relapse (LR)
and distant metastases (DM) and the salvage
treatment of patients with LR only. Standard
statistical methods were applied.
compared with those patients with LR only who
were unable to undergo surgery (9.5 months; 95%
CI, 7.8 to 13.3).
CONCLUSION
Unlike in patients undergoing trimodality
therapy, for whom surveillance/salvage treatment
plays a lesser role, in the BMT population
approximately eight percent of all patients (or
36% of patients with LR only) with LRs occurring
more than six months after chemoradiotherapy
can undergo salvage treatment, and their
survival is excellent. Our data support vigilant
surveillance, at least in the first 24 months after
chemotherapy, in these patients.
RESULTS
The median follow-up time was 54.3 months (95%
CI, 48.4 to 62.4). First relapses included LR only in
23.2% (n = 64), DM with or without LR in 43.5%
(n = 120), and no relapses in 33.3% (n = 92) of
patients. Final relapses included no relapses in
33.3%, LR only in 14.5%, DM only in 15.9%, and
DM plus LR in 36.2% of patients. Ninety-one
percent of LRs occurred within two years and 98%
occurred within three years of BMT. Twenty-three
(36%) of 64 patients with LR only underwent
salvage surgery, and their median overall survival
was 58.6 months (95% CI, 28.8 to not reached)
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Use of thoracic radiotherapy
for extensive stage small-cell
lung cancer: a phase III
randomised controlled trial.
Slotman BJ, van Tinteren H, Praag JO, Knegjens JL, El Sharouni
SY, Hatton M, Keijser A, Faivre-Finn C, Senan S.
Lancet Oncol. 2014 Sep 12. pii: S0140-6736(14)61085-0.
doi: 10.1016/S0140-6736(14)61085-0. [Epub ahead of
print]
BACKGROUND
Most patients with extensive stage small-cell lung
cancer (ES-SCLC) who undergo chemotherapy,
and prophylactic cranial irradiation, have
persistent intrathoracic disease. The investigators
assessed thoracic radiotherapy for treatment of
this patient group.
METHODS
The investigators did this phase III randomised
controlled trial at 42 hospitals: 16 in Netherlands,
22 in the UK, three in Norway, and one in
Belgium. Patients were enrolled with WHO
performance score 0-2 and confirmed ESSCLC who responded to chemotherapy. They
were randomly assigned (1:1) to receive either
thoracic radiotherapy (30 Gy in ten fractions)
or no thoracic radiotherapy. All underwent
prophylactic cranial irradiation. The primary
endpoint was overall survival at one year in
the intention-to-treat population. Secondary
endpoints included progression-free survival.
survival at one year was not significantly different
between groups: 33% (95% CI 27-39) for the
thoracic radiotherapy group versus 28% (95% CI
22-34) for the control group (hazard ratio [HR]
0.84, 95% CI 0.69-1.01; p=0.066). However, in
a secondary analysis, two-year overall survival
was 13% (95% CI 9-19) versus 3% (95% CI
2-8; p=0.004). Progression was less likely in the
thoracic radiotherapy group than in the control
group (HR 0.73, 95% CI 0.61-0.87; p=0.001).
At six months, progression-free survival was
24% (95% CI 19-30) versus 7% (95% CI 4-11;
p=0.001). We recorded no severe toxic effects.
The most common grade 3 or higher toxic effects
were fatigue (11 vs 9) and dyspnoea (three vs
four).
INTERPRETATION
Thoracic radiotherapy in addition to prophylactic
cranial irradiation should be considered for
all patients with ES-SCLC who respond to
chemotherapy.
FINDINGS
The investigators randomly assigned 498 patients
between February 18, 2009, and December 21,
2012. Three withdrew informed consent, leaving
247 patients in the thoracic radiotherapy group
and 248 in the control group. Mean interval
between diagnosis and randomisation was 17
weeks. Median follow-up was 24 months. Overall
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Comment by Professor
Dr Ursula Nestle, University Hospital Freiburg,
Germany
Treatment of small cell
lung cancer (SCLC) is still
a mostly disappointing
issue. In contrast to non-small cell lung cancer,
where quite a lot of promising development on
local and systemic treatment is going on, this
disease is subject more to therapeutic nihilism than to good news. Beyond the backbone
of – still improvable – systemic therapy, which
is mandatory due to the tendency for early disseminated (ED) metastatic spread, current practice involves standard thoracic radiotherapy for
patients with limited disease (LD) only. From
this population we know about the positive effect of local treatment to the main tumour burden on local control and survival. For years, we
have also been aware about the benefit of PCI
on the incidence of brain metastases in both ED
and LD responding after first line treatment.
The Slotman study confirms again that - even
with disseminated disease - in regions of high
tumour burden, the addition of radiotherapy
may help to overcome the deficits of systemic
treatment.
Until now, thoracic radiotherapy in ED-SCLC
patients has been limited to patients needing
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palliative treatment or may have been given
beyond current guidelines in individual cases
with very limited metastatic spread, good performance status and excellent response.
Therefore, due to the encouraging increase of
the rate of long-time survival and despite the
negative result with respect to the primary
endpoint, this study will definitively be practice-changing. Also, the low rate of toxicity reported by Slotman et al. will encourage us to offer modern thoracic radiotherapy more often to
patients with ED-SCLC with good performance
status who respond after first line systemic
treatment. Depending on more detailed analyses of these data, future studies with advanced
radiotherapy techniques may investigate giving
even higher doses of thoracic radiotherapy as
compared to the 30 Gy in 10 fractions given by
Slotman et al.
factors predicting the benefit of such an approach (biomarkers? quality of staging? limited
vs. disseminated metastatic spread? site of metastases?) and to ensure the intelligent inclusion
of thoracic radiotherapy into future guidelines
and clinical pathways for ED-SCLC.
Yet the survival rates in SCLC are still disappointing and leave room for improvement.
Therefore, in comparison to the oligometastatic approaches in other cancers, future studies
on ED-SCLC should now include multimodal
concepts combining – optimised – systemic
treatment with more aggressive local treatments
like thoracic radiotherapy and radiotherapy to a
limited burden of distant metastases.
Furthermore, it will be our task to identify other
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PURPOSE
To provide the four-week prevalence estimates of
mental disorders in cancer populations.
PATIENTS AND METHODS
PSYCHOSOCIAL
Four-week prevalence of
mental disorders in patients
with cancer across major
tumour entities.
Mehnert A, Brähler E, Faller H, Härter M, Keller M, Schulz H,
Wegscheider K, Weis J, Boehncke A, Hund B, Reuter K, Richard M, Sehner S,Sommerfeldt S, Szalai C, Wittchen HU, Koch
U.
J Clin Oncol. 2014 Nov 1;32(31):3540-6. doi: 10.1200/
JCO.2014.56.0086. Epub 2014 Oct 6.
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We enrolled adult patients with cancer from
in- and outpatient care facilities, using a
proportional stratified random sample based on
the nationwide cancer incidence in Germany.
Patients who scored nine or above on the
Patient Health Questionnaire (PHQ-9) were
administered to the standardised computerassisted Composite International Diagnostic
Interview for mental disorders adapted for cancer
patients (CIDI-O). A random sample of those
with a PHQ-9 score that was less than nine were
selected for a CIDI-O.
dependence (0.3%; 95% CI, 0.1% to 0.6%), any
mental disorder resulting from general medical
condition (2.3%; 95% CI, 1.7% to 2.9%), and any
eating disorder (0%). The highest prevalence for
any mental disorder was found in patients with
breast cancer (41.6%; 95% CI, 36.8% to 46.4%),
followed by patients with head and neck cancer
(40.8%; 95% CI, 28.5% to 53.0%). The lowest
prevalence was found in patients with pancreatic
cancer (20.3%; 95% CI, 8.9% to 31.6%) and
stomach/oesophagus cancers (21.2%; 95% CI,
12.8% to 29.6%).
CONCLUSION
Our findings provide evidence for the strong
need for psycho-oncological interventions.
RESULTS
A total of 5,889 patients were identified, which
led to 4,020 participants (a 68.3% response
rate); of those, 2,141 patients were interviewed.
The four-week total prevalence for any mental
disorder was 31.8% (95% CI, 29.8% to 33.8%);
this included any anxiety disorder (11.5%;
95% CI, 10.2% to 12.9%), any adjustment
disorder (11.1%; 95% CI, 9.7% to 12.4%), any
mood disorder (6.5%; 95% CI, 5.5% to 7.5%),
any somatoform/conversion disorder (5.3%;
95% CI, 4.3% to 6.2%), nicotine dependence
(4.5%; 95% CI, 3.6% to 5.4%), alcohol abuse/
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BRACHYTHERAPY
INTRODUCTION
EDITORS’ PICKS
GEC-ESTRO HEAD AND NECK BRACHYTHERAPY
WORKING GROUP REPORT 2014
BRACHYTHERAPY
“We look forward to
sharing GEC-ESTRO
brachytherapy
activities with you
in 2015”
Welcome to the Brachytherapy Corner.
We wish you a Happy New Year and look forward
to sharing GEC-ESTRO brachytherapy activities
with you in 2015.
In this Corner you will find three reports on
recent brachytherapy highlight papers. Read on
to learn more about:
• Vaginal morbidity after image-guided
brachytherapy in cervix cancer
• 3D dosimetry in low energy brachytherapy
• Brachytherapy boosting in rectal cancer.
You can also read about the activities of the GECESTRO head and neck working group, chaired
by György Kovacs. And last but not the least, we
invite you to take part in a competition for which
there is a prize to win. See the end of this Corner.
PETER HOSKIN
BRADLEY PIETERS
Peter Hoskin, Bradley Pieters and Kari Tanderup
KARI TANDERUP
GEC-ESTRO ASSEMBLY
Sunday 26 April 2015
at the 3rd ESTRO Forum, Barcelona
13.30-14.30
INTRODUCTION
EDITORS’ PICKS
GEC-ESTRO HEAD AND NECK BRACHYTHERAPY
WORKING GROUP REPORT 2014
EDITORS’ PICKS
BRACHYTHERAPY
Manifestation pattern of early-late vaginal
morbidity after definitive radio(chemo)therapy
and image guided adaptive brachytherapy for
locally advanced cervical cancer – an analysis
from the EMBRACE study
Kathrin Kirchheiner
Int J Radiat Oncol Biol Phys. 2014 May 1;89(1):88-95.
Highlight Brachytherapy Papers
Long-term results of a randomised trial in locally
advanced rectal cancer: no benefit from adding a
brachytherapy boost
Ane Appelt
Int J Radiat Oncol Biol Phys. 2014 Sep 1;90(1):110-8. doi: 10.1016/j.
ijrobp.2014.05.023. Epub 2014 Jul 8.
On the feasibility of polyurethane based 3D
dosimeters with optical CT for dosimetric
verification of low energy photon brachytherapy
seeds
Justus Adamson
Med Phys. 2014 Jul;41(7):071705. doi: 10.1118/1.4883779.
INTRODUCTION
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GEC-ESTRO HEAD AND NECK BRACHYTHERAPY
WORKING GROUP REPORT 2014
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BRACHYTHERAPY
MANIFESTATION PATTERN OF EARLYLATE VAGINAL MORBIDITY AFTER
DEFINITIVE RADIO(CHEMO)THERAPY
AND IMAGE GUIDED ADAPTIVE
BRACHYTHERAPY FOR LOCALLY
ADVANCED CERVICAL CANCER – AN
ANALYSIS FROM THE EMBRACE STUDY.
Kirchheiner K, Nout RA, Tanderup K, Lindegaard JC, Westerveld
H, Haie-Meder C, Petrič P, Mahantshetty U, Dörr W, Pötter R.
Int J Radiat Oncol Biol Phys. 2014 May 1;89(1):88-95.
Corresponding author:
Kathrin Kirchheiner
Department of Radiation Oncology
Medical University of Vienna, Vienna, Austria
Kathrin.Kirchheiner@akhwien.at
Highlight Brachytherapy Papers
WHAT WAS YOUR MOTIVATION
FOR INITIATING THIS STUDY?
Brachytherapy in the treatment of locally advanced cervical cancer has changed substantially
due to the introduction of combined intracavitary/
interstial applicators and an adaptive target concept, which is the focus of the prospective, multi-institutional EMBRACE (European study on
MRI-guided brachytherapy in locally advanced
cervical cancer) study (www.embracestudy.dk) on
image-guided adaptive brachytherapy (IGABT).
This new target concept has improved local control
substantially and also significantly impacts on the
dose to some organs at risk. Especially for the vagina, the dose can vary, with some patients receiving
much less dose to the vagina and some receiving
considerably more. However, the information on
the clinical consequences of these doses in the vagina, and the impact on the patient’s quality of life,
is very limited. Therefore, the motivation for this
EMBRACE report was to evaluate as a first step
the ways in which vaginal morbidity manifests
itself during the first two years of follow-up.
WHAT WERE THE MAIN
CHALLENGES DURING THE WORK?
KATHRIN KIRCHHEINER
INTRODUCTION
The main challenge of this work was to report the
vaginal morbidity in a comprehensive way, that
EDITORS’ PICKS
gives insight into individual vaginal symptoms
with regard to their contribution to the overall
vaginal morbidity and to the manifestation pattern of symptoms over time in a large, multi-institutional patient cohort.
Therefore, crude incidence rates, actuarial probabilities and prevalence rates were analysed in 588
patients with a median follow-up of 15 months
and information on vaginal morbidity. Vaginal
morbidity was prospectively assessed at baseline,
every three months during the first year and
every six months in the second year according to
CTCAE v3.0 regarding vaginal stenosis, dryness,
mucositis, bleeding, fistula and other symptoms.
WHAT ARE THE MOST IMPORTANT
FINDINGS OF YOUR STUDY?
Two years after treatment, there was a low actuarial probability of developing any serious vaginal
side effects (G3 and G4: 3.6%), but a high probability of having any G≥1 vaginal morbidity (89%),
of which the majority occurred already within
the first six months after treatment. Vaginal
stenosis was most frequent, with the highest actuarial probability rates both for G≥1 (75%) and for
G≥2 (22%), followed by vaginal dryness
GEC-ESTRO HEAD AND NECK BRACHYTHERAPY
WORKING GROUP REPORT 2014
EDITORS’ PICKS
Highlight Brachytherapy Papers
(G≥1: 62% and G≥2: 8%). Both the prevalence
rates of vaginal stenosis and dryness increased
during follow-up. In contrast, vaginal bleeding
decreased substantially after treatment and, together with mucositis, remained stable at low
levels during follow-up.
WHAT ARE THE IMPLICATIONS OF
THIS RESEARCH?
gradually increase or stabilise over time.
Nevertheless, quality of life studies have shown
that mild and moderate vaginal symptoms
and associated sexual dysfunction can cause
long-term distress in cervical cancer survivors.
Therefore, future research on dose adaption and
optimisation is necessary to establish a highly
individualised and tailored treatment.
Severe G3/G4 vaginal morbidity following definitive radio(chemo)therapy including IGABT for
locally advanced cervical cancer within two years
is limited and significantly less than in previous
studies with radiographic treatment planning.
Thus, the new adaptive target concept including
the use of intracavitary/interstitial techniques
seems to be a safe treatment with regard to major
morbidity in the vagina being an organ at risk.
However, mild to moderate morbidity occurs in
the majority of patients within the first two years
after the end of treatment and is still a substantial
problem, which deserves further attention. With
additional follow-up in the present EMBRACE
study, it is expected that the findings will be further substantiated and will provide more insight
into the question whether the overall vaginal
morbidity and/or the individual symptoms will
INTRODUCTION
EDITORS’ PICKS
GEC-ESTRO HEAD AND NECK BRACHYTHERAPY
WORKING GROUP REPORT 2014
EDITORS’ PICKS
BRACHYTHERAPY
ON THE FEASIBILITY OF
POLYURETHANE BASED 3D
DOSIMETERS WITH OPTICAL
CT FOR DOSIMETRIC VERIFICATION OF LOW ENERGY PHOTON
BRACHYTHERAPY SEEDS.
Adamson J, Yang Y, Juang T, Chisholm K, Rankine L, Adamovics J,
Yin FF, Oldham M
Med Phys. 2014 Jul;41(7):071705. doi: 10.1118/1.4883779.
Corresponding author:
Justus Adamson
Assistant Professor
Department of Radiation Oncology
Duke University Medical Center, USA
justus.adamson@duke.edu
Highlight Brachytherapy Papers
WHAT WAS YOUR MOTIVATION
FOR INITIATING THIS STUDY?
We had previously applied polyurethane based
3D dosimetry to some low energy applications
(keV micro-irradiator) and to brachytherapy
(Cs-137). The natural next step was to combine
knowledge learned from these two for application
to LDR brachytherapy sources.
for these very low energy brachytherapy sources.
That is surprising given their very low energy,
and is encouraging for application in other challenging settings. Another advantage we found for
3D dosimetry about a symmetric source is that
the dose falloff with distance from the source is
partially offset by the increased number of sample points at distance.
WHAT WERE THE MAIN
CHALLENGES DURING THE WORK?
WHAT ARE THE IMPLICATIONS OF
THIS RESEARCH?
Using the 3D dosimeter with the LDR sources
requires a channel in the centre of the dosimeter
to place the source. This causes a number of challenges including accurate machining of the channel, registration of the source within the channel,
and dealing with potential artefacts created in the
tomographic dose reconstruction due to the presence of the channel.
I think the overall takeaway message is that 3D
dosimetry technology is developing to the point
where it can be applied in diverse settings now,
including those for which dosimetry is difficult
(low energy, low dose rate, high dose gradient). It
can serve as a great complement to Monte Carlo
simulations and point dose measurements.
WHAT ARE THE MOST IMPORTANT
FINDINGS OF YOUR STUDY?
JUSTUS ADAMSON
INTRODUCTION
One of the most interesting things we found is
that with some of the new polyurethane formulations there is potential to create a dosimeter that
has the same attenuation characteristics as water
EDITORS’ PICKS
GEC-ESTRO HEAD AND NECK BRACHYTHERAPY
WORKING GROUP REPORT 2014
EDITORS’ PICKS
BRACHYTHERAPY
LONG-TERM RESULTS OF A RANDOMISED TRIAL IN LOCALLY
ADVANCED RECTAL CANCER:
NO BENEFIT FROM ADDING A
BRACHYTHERAPY BOOST.
Appelt AL, Vogelius IR, Pløen J, Rafaelsen SR, Lindebjerg J, Havelund BM, Bentzen SM, Jakobsen A.
Int J Radiat Oncol Biol Phys. 2014 Sep 1;90(1):110-8. doi:
10.1016/j.ijrobp.2014.05.023. Epub 2014 Jul 8.
Corresponding author:
Ane Appelt
Department of Oncology, Vejle Hospital, Vejle, Denmark
and Faculty of Health Sciences,
University of Southern Denmark, Odense, Denmark
ane.lindegaard.appelt@rsyd.dk
Highlight Brachytherapy Papers
WHAT WAS YOUR MOTIVATION
FOR INITIATING THIS STUDY?
Locally advanced (T3-4) rectal cancer (LARC)
is commonly treated with neoadjuvant (chemo-)
radiotherapy, followed by total mesorectal excision. The role of radiation dose has not been well
understood, and consequently this randomised
phase III study was initiated to improve our
knowledge of rectal cancer dose-response. A
combination of brachytherapy and external beam
radiotherapy was chosen: the extensive nodal
targets in the pelvis require external beam irradiation, while brachytherapy allowed for localised
tumour dose escalation. A promising phase II
trial based on this concept had previously been
conducted in our department. For the phase II
trial, we tested whether the addition of a 2 x 5Gy
endocavitary brachytherapy boost to preoperative long-course chemoradiotherapy (50.4 Gy plus
UFT) would improve tumour response and patient outcome.
We have previously reported on the primary trial
endpoint, pathological complete response (pCR)
at the time of surgery. The study was negative
– the rate of pCR was similar in the two arms –
but there was an increase in near-complete tumour regression amongst patients receiving
ANE APPELT
INTRODUCTION
EDITORS’ PICKS
brachytherapy boost, especially in T3 tumours.
Tumour regression has been shown to correlate
with late outcome, so this was encouraging. However, tumour regression has not been confirmed
as a valid surrogate endpoint for LARC, so for the
present publication we wanted to assess disease
control and survival.
WHAT WERE THE MAIN
CHALLENGES DURING THE WORK?
The trial was initiated in our tertiary cancer centre, and all patients (except a small group in Canada) received neoadjuvant therapy here. Patients
were subsequently re-referred to surgical departments all over Denmark and followed there after
treatment completion. This setup complicated
data collection, and two aspects proved particularly challenging: recording of local recurrences
and scoring of late toxicity.
Neoadjuvant chemoradiotherapy for LARC has
only been shown to prevent local recurrences,
not improve overall survival, so a major point of
interest was the rate of locoregional failure. The
trial protocol did not provide a detailed definition of locoregional recurrence, and some pelvic
recurrences occurring secondary to distant metastatic disease were not biopsy confirmed. We
GEC-ESTRO HEAD AND NECK BRACHYTHERAPY
WORKING GROUP REPORT 2014
EDITORS’ PICKS
Highlight Brachytherapy Papers
reviewed patient records (and archived imaging
when necessary) for all recurrences, to ensure
consistent classification of locoregional failures.
This was obviously a time-consuming task.
with external beam radiotherapy alone – to treatment responders, but those patients apparently
did not do better in the long run.
Despite follow-up visits generally conducted as
per protocol, the majority of patients were not
evaluated for late radiotherapy side effects as
planned; thus we were unable to collect reliable
late toxicity data. However, our group is currently
planning a quality-of-life study, including patient-reported outcome, among disease-free survivors.
WHAT ARE THE IMPLICATIONS OF
THIS RESEARCH?
WHAT ARE THE MOST IMPORTANT
FINDINGS OF YOUR STUDY?
We found no difference in five-year overall survival (70.6% vs 63.6%) or progression-free survival (63.9% vs 52.0%) in the standard compared
to the boost arm for the 221 patients analysed.
Freedom from locoregional failure was borderline
worse in the control arm (93.9% vs 85.7%).
More detailed data analysis indicated the presence of “response migration”: the brachytherapy
boost seemed to convert some patients – who
would not have had major tumour regression
INTRODUCTION
Despite increased tumour regression at the time
of surgery, we observed no benefit on late clinical
outcome, and possibly an adverse effect on local
control. Consequently, dose escalation using a
brachytherapy boost for preoperative treatment
of LARC cannot be recommended based on the
findings of this trial. The role of brachytherapy
for other patient groups, such as patients with
early rectal cancer treated with definite chemoradiotherapy or patients treated with palliative
intent, remains open.
Moreover, improved tumour regression does
not necessarily lead to a relevant clinical benefit
when the neoadjuvant treatment is followed by
high quality surgery. Tumour regression score is a
well-established prognostic factor, but we did not
find it to be a useful surrogate endpoint.
EDITORS’ PICKS
GEC-ESTRO HEAD AND NECK BRACHYTHERAPY
WORKING GROUP REPORT 2014
BRACHYTHERAPY
In the past year the GEC-ESTRO ENT working
group (ENT-GEC WG) focused on the following
activities:
1. ENT COBRA PROJECT
GEC-ESTRO
HEAD AND NECK
BRACHYTHERAPY
WORKING GROUP
REPORT 2014
By György Kovács, coordinator
The project represents a retrospective and later
prospective registry data pool between experienced centres in order to perform effective data
mining and acquire evidence for the advantages
and disadvantages of head and neck brachytherapy. There is a particular focus on oropharynx/oral
cavity tumours as well as recurrences following
previous radiotherapy. The participating groups
agreed previously to a time schedule proposal as
well as to the participation rules. Information on
the set-up status of the project was given at the
first GEC-ESTRO workshop in Brussels. In the
past year we finished all preparations according
to the planned timeline. Now a dummy run of
the web-based data transfer is running to prove
the software changes according to sharpened EU
data transfer guidelines. Luca Tagliaferri, from the
Catholic University in Rome, presented a report
on the details at the second GEC-ESTRO workshop in Brussels on 4 December 2014.
2. INTERDISCIPLINARY ENT
BRACHYTHERAPY TEACHING
COURSE
A couple of years ago we started a course series
of interdisciplinary teaching in ENT brachytherapy at the Kiel, and later at the Lübeck UniverGYÖRGY KOVÁCS
INTRODUCTION
EDITORS’ PICKS
sity in Germany. The last edition of this ESTRO
endorsed course was held 27-30 November 2014
at the Catholic University in Rome, Italy. An announcement, including the course flyer with the
final programme, is at http://www.brachiterapiaitalia.it/ENTcourse/ENT_course/Home.html; it
is also posted on the ESTRO homepage and on
the educational site of the home page of ELEKTA´s
BrachyAcademy (https://www.brachyacademy.
com/?s=ENT+teaching+course). The teaching
staff include members of the GEC-ESTRO ENT
working group (from Europe and India), as well
members of ENT surgical societies. As a new topic
in the teaching programme, a separate session focussing on findings of molecular biology and their
influence on patient selection for different kinds of
treatments was included. Due to the high degree
of interest, it is also planned to offer the course
more frequently than in the past. We plan to alternate the course between Europe and India, with
the first course starting in India in 2015. There is
agreement with the Tata Hospital experts in India that, in the future, they take care of the local
organisation to cover the education needs in ENT
brachytherapy and interdisciplinary cooperation
of the region. A participant report is planned for
one of the future newsletters.
3. UPDATE OF THE GEC- ESTRO
HEAD AND NECK BRACHYTHERAPY
RECOMMENDATIONS
The ENT working group published the first issue
of recommendations in 2009 in the Green
GEC-ESTRO HEAD AND NECK BRACHYTHERAPY
WORKING GROUP REPORT 2014
Journal (Mazeron et al. Radiother Oncol. 2009
May; 91(2):150-6. doi: 10.1016/j.radonc.2009.01.005.
Epub 2009 Mar 28.). Since the time of the preparation of this paper, several developments in image guidance, interdisciplinary cooperation, as
well hardware and software for head and neck
brachytherapy technology has improved. Now, it is
time to update the recommendations.
Therefore, a writing group was organised on the
ENT working group meeting in Brussels and a
completed "ACROP Check-list" will be sent to
ACROP (Advisory Committee on Radiation Oncology Practice) in order to perform the necessary
formal registration of the future manuscript.
4. PUBLICATIONS BY ENT-BT WORKING MEMBERS IN 2013/2014
1. Chapter 18: ENT tumours. In: Strnad V, Pötter R, Kovács G (Eds) “Practical handbook
of brachytherapy”. UNI-MED Verlag, Bremen-London-Boston, pp 166-183, 2014
2. Strnad V, Lotter M, Kreppner S, et al. “Re-irradiation with interstitial pulsed-dose-rate
brachytherapy for unresectable recurrent head
and neck carcinoma”, Brachytherapy 13(2):187195, 2014
3. Kovács G. “Modern head & neck brachytherapy: From radium towards intensity modulated
interventional radiotherapy (IMBT)”, Journal of
Contemporary Brachytherapy, in review, 2014
4. Takácsi-Nagy Z, Oberna F, Koltai P, et al.
INTRODUCTION
“Long-term outcomes with high-dose-rate
brachytherapy for the management of base of
tongue cancer”. Brachytherapy 12(6):535-541,
2013
5. Guinot J-L, Arriba L, Tortajada MI, et al. “From
low-dose-rate to high-dose-rate brachytherapy
in lip carcinoma: equivalent results but fewer
complications”. Brachytherapy , 12:528-534,
2013
6. Teudt I, Meyer JE, Ritter M, et al. “Perioperative
image-adapted brachytherapy for the treatment
of paranasal sinus and nasal cavity malignancies”. Brachytherapy 13(2):178-186, 2013
The next formal meeting of the head and neck
working group will be organised during the third
GEC-ESTRO workshop in 2015, where all ENT-BT
interested ESTRO members are cordially invited.
In the meantime, for information/remarks related
to the work or different working packages of the
ENT working group or in other ENT brachytherapy-related issues, please contact the coordinator of
the group (kovacsluebeck@gmail.com).
IRIDIUM 192 IMAGE COMPETITION
GEC-ESTRO is looking for an appropriate
image for the Iridium 192 award. At present
the award carries the face of the awardee. This
will now change to have a standard image appear on all awards. To this end, GEC-ESTRO
is inviting all brachtherapy enthusiasts and
creative minds to take part in a competition
to decide on the best and appropriate image
to be used. The image or design should capture the spirit of the Iridium 192 award.
Interested?
Please submit your proposal of an image to
Evelyn at echimfwembe@estro.org
Deadline for submission: 31 March 2015
The winner of the competition will be announced at the 3rd GEC-ESTRO workshop,
19 November 2015, and will receive €200.00
as prize.
The Current Iridium award medal carries the face
of the awardee
EDITORS’ PICKS
GEC-ESTRO HEAD AND NECK BRACHYTHERAPY
WORKING GROUP REPORT 2014
PHYSICS
INTRODUCTION
PHYSICS MEMBERS SURVEY
WORKSHOP ON TRANSLATIONAL RESEARCH
IN ION BEAM CANCER THERAPY
EDITORS’ PICKS
Dear colleagues,
PHYSICS
First of all, we wish you the very best for 2015. This year we plan
to work hard on making this Corner a success.
“This year we plan to
work hard on making
this Corner a success”
During the summer of 2014 the physics committee conducted
a survey among the ESTRO physics members. The survey
comprised questions on background information, ESTRO
meetings, education, and other ESTRO physics activities. In this
edition, Catharine Clark presents the results of this survey.
MISCHA HOOGEMAN
Emanuele Scifoni has written a comprehensive report on the
workshop on Translational Research in Ion Beam Cancer
(TRIBCT 2014). The report describes a very successful meeting,
demonstrating the definite need for fundamental physics and
biology research in the field of particle therapy.
Finally, four editor’s picks, highlighting recent papers on a wide
range of physics topics, make this winter edition very worthwhile
reading.
LUDVIG MUREN
Mischa Hoogeman (m.hoogeman@erasmusmc.nl)
Ludvig Muren (ludvmure@rm.dk),
Frank Van den Heuvel (frank.vandenheuvel@oncology.ox.ac.uk),
FRANK
VAN DEN HEUVEL
PHYSICS MEMBERS ASSEMBLY
Saturday 25 April 2015 at the 3rd ESTRO
Forum, Barcelona
13.30-14.30
INTRODUCTION
PHYSICS MEMBERS SURVEY
WORKSHOP ON TRANSLATIONAL RESEARCH
IN ION BEAM CANCER THERAPY
EDITORS’ PICKS
PHYSICS
ESTRO PHYSICS
MEMBERS
SURVEY
CATHARINE CLARK
INTRODUCTION
During the summer of 2014 the physics committee (PC) conducted a survey of the physics members of ESTRO with the aim of better engaging
with their needs and interests. This took the form
of a Survey Monkey questionnaire with questions
on background information, ESTRO meetings,
education and other physics ESTRO activities.
aspects were the teaching lectures (42%), followed
by symposia (24%), proffered papers (17%) and
debates (14%). Ninety-two percent go in person
to look at the paper posters and 57% look at the
e-posters, with 23% doing this at the meeting and
35% after they return home. The majority agree
that the number of paper posters should be limited. Overall, 90% said that the
A total of 708 responses were ‘Seventy percent did not realise that it balance between the different
received (54% of physics
is now possible to submit suggestions aspects of the meeting was apmembers) from 62 different
to the physics committee for topics for propriate for their needs.
countries (mainly in Europe, future meetings’
but all over the world); 48%
The new format of having a
were medical physics experts, 35% qualified medForum with a multi-disciplinary approach is
ical physicists and 8% in training with 65% being
popular with two thirds of respondents; howmale. Sixty percent work full time in radiotheraever, many acknowledged that this did come at
py, with the rest having a range of duties, but prethe cost of some loss of visibility for the physics
dominantly in imaging and protection. Sixty-two
meeting. Seventy percent did not realise that it is
percent spend more than 80% of their time in
now possible to submit suggestions to the physics
the clinic, while only five percent are in full time
committee for topics for future meetings, so look
research.
out in your email inbox for information on how
to do this.
A third of members attend the annual ESTRO
meeting each year, with a further third having
Pre-meetings are popular and a third of memonly ever attended between one and three meetbers have already attended one or more. Many
ings. The most important reasons for attending
interesting suggestions were made for future
a scientific meeting were to be updated on the
pre-meetings, as well as for the topics within the
latest scientific advances; however, 40% and 26%
main meeting. The physics scientific advisory
also cited continuing professional development
committee will be looking carefully at these sugand networking as two of their main reasons for
gestions to identify the best combinations for the
attending. After this, presenting their own recoming years.
search and visiting the technical exhibition were
important. With regards to specifically attendAt the last two ESTRO meetings there has been a
ing an ESTRO meeting, the top most important
physics members assembly; however, 62%
PHYSICS MEMBERS SURVEY
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IN ION BEAM CANCER THERAPY
EDITORS’ PICKS
replied that they did not realise that this had happened. At the 3rd Forum in Barcelona, the physics members assembly will be held on Saturday
25 April from 13.30-14.30 hrs, so put it in your
diary. Overall, the majority would like to hear a
presentation of the PC activities as well as have
the opportunity to have an open floor discussion
of these activities at future physics meetings.
This is your opportunity to have a face-to-face
meeting with your representatives in ESTRO, so
come along and make the most of it. However, if
you cannot make it, then please contact us at the
email address at the bottom of this report.
‘Two thirds of ESTRO physics members have
attended an ESTRO course’
Figure 2 The choices of journal for submission of physics
research work.
Figure 1 The ESTRO courses which have been attended
by physics members.
INTRODUCTION
PHYSICS MEMBERS SURVEY
Two thirds of ESTRO physics members have attended an ESTRO course (see figure 1). The most
popular is physics for clinical radiotherapy (38%),
closely followed by IMRT and other conformal
techniques in practice (35%), dose modelling and
dose verification for external beam radiotherapy
(29%) and basic clinical radiobiology (27%). There
were also many suggestions given for future
courses and the PC, with the education committee, is actively considering appropriate new
courses. Some of the suggestions were for topics
that already exist in the current courses, so it may
be that not everyone is fully up-to-date with what
is available. There is lots of information on the
website for all the courses, including all the new
developments (http://www.estro.org/school).
WORKSHOP ON TRANSLATIONAL RESEARCH
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EDITORS’ PICKS
The Physics Corner in the newsletter is read by
Following this survey the PC want to follow up
79% of members, although only 13% manage to
actively on your suggestions and will be addressread all, 66% manage to read
ing the lack of information on
most or occasional issues. Of ‘The Physics Corner in the newsletter course content and the links
is read by 79% of members’
the 12% who don’t read it,
to the core curricula. We will
26% lack the time, but 68%
be looking into new effective
didn’t know it was here. The most useful sections
communication channels and will hold a physics
are the recent paper highlights (33%), the classic
members’ assembly at the 3rd Forum in Barcemedical physics papers (28%) and the “back to
lona with an open floor discussion so that we
school” section (25%).
can continue this conversation with you. In the
meantime, if you wish to contact the PC about
For information on daily practice the top four
any of the issues addressed in this survey or any
most popular journals are Medical Physics, Radiother ESTRO physics matter please contact physotherapy and Oncology, International Journal of
ics@estro.org.
Radiation Oncology Biology Physics, and Physics
in Medicine and Biology. These are also the first
choices for submission of work (see figure 2).
Catharine Clark
Physics committee member
A new PC endeavour is to provide mentors to
National Physical Laboratory
help applicants contact centres for mobility grant
Teddington, UK
placements; 84% did not know this, so please
remember that you have this opportunity if you
want to apply for a mobility grant and you don’t
know who to contact in the centre you’d like to
go to. When asked how the PC could engage better with members, mailshots were the most popular suggestion, with a discussion forum on the
ESTRO website also popular; however, only 20%
thought that a Facebook page would work well
for communication.
INTRODUCTION
PHYSICS MEMBERS SURVEY
WORKSHOP ON TRANSLATIONAL RESEARCH
IN ION BEAM CANCER THERAPY
EDITORS’ PICKS
PHYSICS
WORKSHOP ON
TRANSLATIONAL
RESEARCH IN ION
BEAM CANCER
THERAPY
(TRIBCT 2014)
Nanoscale physics meets
particle therapy
EMANUELE SCIFONI
INTRODUCTION
Translational research, interdisciplinary approach,
multi-scale analysis: these phrases are often used
(and abused) in recent research programmes.
However, when it comes to particle therapy, also
called ion beam therapy, it is very clear that fundamental physics, as well as chemistry and biology, on a wide range of physical scales and biological contexts should play an important role. But
what can the nanoscale physicists, chemists and
biologists learn from those working on improving
and providing clinical radiotherapy protocols?
And what promises can this type of research offer
for improving the outcome of particle therapy?
Is it indeed possible for useful communication
to take place between experts on, say, molecular
quantum dynamical modelling and clinical radiobiologists or medical physicists?
This was one of the challenging questions to be
met by the TRIBCT workshop (Translational Research in Ion Beam Cancer Therapy). The meeting
took place from 30 September to 2 October 2014
in Aarhus, Denmark and was organised jointly by
Aarhus University and Aarhus University Hospital [*].
The workshop was staged at the new university
hospital site in Skejby and represents one of the
final phases of a recent European Cooperation
in Science and Technology (COST) action, nano-IBCT (nanoscale insights in ion beam cancer
therapy - http://fias.uni-frankfurt.de/nano-ibct/
overview/). This COST action was dedicated to
the detailed exploration of the mechanisms, from
PHYSICS MEMBERS SURVEY
nanoscale physics to chemical and radiobiological level, which underpin the ion therapy process.
The action was originally motivated by a growing
interest in the fundamental atomic and molecular
physics community in the physics of ion beam
therapy, where this interest was to a great extent
stimulated by the discovery that low energy electrons can be very effective in the destruction of biomolecules [1]. For example, it was very clear that
the energy spectra of secondary electrons, from
heavy ion collisions at Bragg peak energies, are
peaked at sub kiloelectronvolt (keV) energies, indeed typically as low as tens of electronvolts (eV)
and thus in a region where low energy molecular
and atomic physics plays an important role. The
aim of the nano-ICBT programme was to provide a better understanding of the complex multi-scale scenario of radiation damage induced by
ion beams. The ultimate goal was to allow a more
informed and better control of the irradiation parameters in clinical treatment. Thus the potential
outcome of nano-ICBT should be enhanced treatment programmes, fully exploiting the physical
and radiobiological advantages of ion beams.
The essential purpose of the TRIBCT meeting was
to explore the path between clinical practice and
fundamental research in proton and heavy ion
therapy. The primary aim was that those performing basic physics, chemistry and biology research
should be aided in their appreciation of the place
of their work with respect to actual treatment
and the relation that their results could have to
clinical practice. An additional and related aim
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EDITORS’ PICKS
followed, emphasising the special role of dosimetry. The problem of quenching of detectors under
high LET (linear energy transfer) irradiation was
pointed out. In connection with this, in his talk
Niels Bassler presented something of a challenge
to the nanoscale community. He underlined
the analogy between the relative response of a
dosimeter at different radiation qualities and
the relative biological effectiveness (RBE), and
then suggested a focus on the description of the
quenching of a simple radiation detector, rather
than struggling with complex cellular systems.
This, he suggested, was the best way forward to
elucidate the characteristics of high LET radiation and its associated radiobiology.
The participants of the meeting at the Aarhus University Hospital, Skejby
was to present new concepts and paradigms for
ion beam-induced radiation damage, emerging
from research at physical, chemical and biological levels, as always looking for clinical impact.
The meeting was especially timely, since a proton
therapy centre, the Danish Centre for Particle
Therapy, is to be built in Aarhus by the Aarhus
University Hospital, Aarhus University and the
local Health Authority (opening 2018).
The organisers of the meeting, lead by David
Field for atomic and molecular physics and Kevin
Prise, Niels Bassler, Jørgen Petersen and Cai Grau
for the clinical-oriented research, crafted an excellent programme in a top-down fashion, start-
INTRODUCTION
ing from the very basic definition of the medical
issues and progressing step by step towards the
fundamental physics of IBCT. The first part of the
meeting was in the form of a tutorial, where selected experts in the various disciplines of radiotherapy and oncology placed the clinical problem
in the proper context. Following some basic talks
on cancer radiotherapy from leading practitioners, Jan Alsner illustrated aspects at the cellular
and molecular biology scale and Ludvig Muren
and Per Poulsen overviewed modern medical radiation physics techniques, focusing on adaptive
radiotherapy and motion management.
A comprehensive talk by Claus Andersen then
PHYSICS MEMBERS SURVEY
The stage was then set for Jens Overgaard, who
warned about the possible risks of models, even
on a very macroscopic, phenomenological scale
and stressed the importance of extending experimental campaigns for in vivo measurements.
Immediately afterwards, Cai Grau showed how
the evidence-based medicine requirements are
still lacking in proton therapy, despite obvious
demonstrations of success. It is evident that a
great deal more clinical work is required to work
out, on a purely observational basis, for example
what is the optimal fractionation schedule and,
further, to establish the answer to this fundamental clinical question for different types of cancer.
Brita Sørensen then presented the latest results of
the first follow-up of a large-scale in vivo experiment performed at GSI (Helmoholtz center for
WORKSHOP ON TRANSLATIONAL RESEARCH
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EDITORS’ PICKS
Heavy Ion Research) in July; that is, the initial,
normal tissue complication probability (NTCP)
data for early effects with photon and carbon
ions, extracting from them an RBE value. Kevin
Prise went on to show, with his recent measurements, the importance of a correct radiobiological description all along a spread-out Bragg peak
irradiation, contrasting this with the commonly
used over-simplification to a constant RBE value.
Michael Krämer showed how RBE is implemented in active scanned particle therapy, fully accounting for the mixed radiation field, through
the treatment planning system TRiP98. He also
mentioned recent studies using novel ion beams,
such as helium, which presents potential specific
indications for paediatric cases, or oxygen, whose
high LET offers selective advantages for irradiation of hypoxic regions. For all these ion beams,
Paola Maria Frallicciardi presented a novel monitoring technique based on simultaneous detection of prompt photons and secondary particle
emission. This will be implemented, she reported,
in the Italian National Centre of Hadrontherapy
for Cancer Treatment (CNAO) beamline in Pavia.
During the track simulation session, macroscopic
radiation transport codes (FLUKA and SHIELDHIT) were presented as well as nanoscale 3D
track structure models (PARTRAC, LEPTS,
TRAX, EPOTRAN) and so called amorphous
track models, in which the radial dose deposition
along the track is considered (LEM). Christophe
Champion showed the advances in quantum me-
INTRODUCTION
From left to right: Cai Grau, giving his tutorial lecture on cancer radiotherapy; Michael Krämer, discussing the biological effect based optimisation in treatment planning for particle therapy; Brita Singers Sørensen, stressing the importance
of new in vitro/in vivo data for relative biological effectivess (RBE) assessment. (Pictures by Niels Bassler)
chanical calculations of electron induced ionisation processes. These are basic input for radiation
track structure simulations, as well as for positron transport, the nature of which has an important role in assessing the resolution of positron
emission tomography (PET).
Jorge Kohanoff described the ability of ab initio
modelling to aid in understanding radiation
damage mechanisms at the molecular level,
specifically with reference to the breaking of
bonds in DNA and other biomolecules. Andrey
Solov’yov mentioned the role of shock waves
generated in the medium by the passage of fast
ions, resulting in sudden intense local heating in
PHYSICS MEMBERS SURVEY
the Bragg peak region, as a possible contribution
to the overall damage. Pavel Kundrat showed
the accurate description available in PARTRAC
code of the physico-chemical and chemical stages
involved in IBCT. PARTRAC allows the prediction of the nature and concentration of chemically-active species produced (radicals, solvated
electrons) as a function of the LET of the incident
particle. The studies introduced in this part of
the meeting could provide important insights, for
example, in modelling the oxygen enhancement
ratio in IBCT.
The hypoxia issue, “adored and ignored” [2], was
identified as a major topic of research,
WORKSHOP ON TRANSLATIONAL RESEARCH
IN ION BEAM CANCER THERAPY
EDITORS’ PICKS
following a couple of instructive talks from Michael Horsman and Jens Overgaard. The need to
consider the microenvironment as an additional
parameter for the biological optimisation was
quite evident. Particle therapy promises a valuable contribution in specifically targeting this issue, especially thanks to the high flexibility of the
full active scanning dose delivery and through
different approaches such as LET painting (Aarhus) and killing painting (GSI).
In the final part of the meeting, dedicated to new
insights, nanoparticle-aided therapy became one
of the focus of discussion. Fred Currell showed
a brilliant example of successful translational
research in this topic, starting from a track structure analysis of the Auger electrons emitted in
gold nanoparticles under photon irradiation, and
reproducing the observed cell-killing enhancement. But, as he mentioned, while the use of
metallic nanoparticles as radio-sensitisers with
photon therapy has been suggested for more than
a decade, it is not obvious if an additional sensitisation effect could be achieved in particle therapy
as well. This is despite recent positive in vitro and
in vivo results. In this connection the birth of a
new Marie Curie international training network,
ARGENT (Advanced radiotherapies generated
by exploiting nanoprocesses and technologies http://itn-argent.eu/) has been announced, dedicated to the investigation of possible combination
of ion beam irradiation with metallic nanoparticles.
INTRODUCTION
The poster session was also very stimulating, with
several outstanding contributions. For example,
Ivana Dokic presented a systematic in vitro analysis with the four ion beams available at HIT,
Heidelberg Ion Therapy centre (protons, helium,
carbon, oxygen), pointing out how in vitro research is still needed fully to characterise these
“new” beams and fully to exploit their selective
advantages.
Over 40 delegates from all over the world participated in the conference, bringing together
their view on the basic challenges in particle
therapy and pointing out where research directions should be concentrated. The participant list
included representatives from the facilities for
active scanned carbon therapy, which are currently operating (CNAO and HIT), or completed
the pilot project (GSI), as well as from the major
European laboratories in the area of fundamental
physics, chemistry and biology. The meeting was
really successful, with many stimulating discussions, sometimes quite animated, both during the
talks and the breaks, frequently among scientists
who have never had the opportunity to interact
before.
In conclusion, it is clear that particle therapy
is a growing reality that can offer a significant
contribution to the palette of treatments in European radio-oncology and worldwide. It is clear
that much research in many diverse topics is still
needed to provide a solid evidence-based treatment, and to enhance the range of cancers that
PHYSICS MEMBERS SURVEY
can be treated [3]. The meeting underlined that
fundamental research can definitely provide useful insights and suggest treatment enhancement,
but the complexity of the field requires a close
collaboration between radiation oncology professions, to design optimal clinical trials. TRIBCT
2014 then emphasised to those involved in basic
physics, chemistry and biology the necessary
spirit of caution with which promising experimental and theoretical results must be viewed in
relation to cancer treatment [#].
We look forward to a TRIBCT 2015!
Emanuele Scifoni
Biophysics Department
GSI Helmholtz centre for Heavy Ion Research,
Darmstadt, Germany
e.scifoni@gsi.de
REFERENCES
* More information, Book of Abstract and references
therein on http://tribct2014.au.dk/
1. B. Boudaïffa et al., Science (2000) 287, 1658.
2. J. Overgaard, J. Clin. Oncol. (2007) 25, 4066.
3. J.S. Loeffler and M. Durante, Nature Rev. Clin. Oncol.
(2013) 10, 411.
# Thanks to David Field, Niels Bassler and Ludvig Muren
for precious assistance in summarising this event.
WORKSHOP ON TRANSLATIONAL RESEARCH
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EDITORS’ PICKS
EDITORS’ PICKS
PHYSICS
Highlight Radiotherapy Physics Papers
Detector to detector corrections: a
comprehensive experimental study of detector
specific correction factors for beam output
measurements for small radiotherapy beams
Godfrey Azangwe
Medical Physics 41, 072103 (16pp.) (2014), online: http://dx.doi.
org/10.1118/1.4883795
Institutional patient-specific IMRT QA does not
predict unacceptable plan delivery
Stephen F. Kry
International Journal of Radiation Oncology Biology Physics
(in Press)
INTRODUCTION
PHYSICS MEMBERS SURVEY
Proton range verification through prompt
gamma-ray spectroscopy
Joost Verburg
Physics in Medicine and Biology 59 (2014) 7089–7106
Direct use of multivariable normal tissue
complication probability models in treatment
plan optimisation for individualised head and
neck cancer radiotherapy produces clinically
acceptable treatment plans
Roel G.J. Kierkels
Radiotherapy & Oncology, in press accepted September 2014
WORKSHOP ON TRANSLATIONAL RESEARCH
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EDITORS’ PICKS
EDITORS’ PICKS
Highlight Radiotherapy Physics Papers
PHYSICS
DETECTOR TO DETECTOR
CORRECTIONS: A COMPREHENSIVE
EXPERIMENTAL STUDY OF
DETECTOR SPECIFIC CORRECTION
FACTORS FOR BEAM OUTPUT
MEASUREMENTS FOR SMALL
RADIOTHERAPY BEAMS
Godfrey Azangwe, Paulina Grochowska, Dietmar Georg, Joanna
Izewska, Johannes Hopfgartner, Wolfgang Lechner, Claus E.
Andersen, Anders R. Beierholm, Jakob Helt-Hansen, Hideyuki
Mizuno, Akifumi Fukumura, Kaori Yajima, Clare Gouldstone,
Peter Sharpe, Ahmed Meghzifene, and Hugo Palmans.
Medical Physics 41, 072103 (16pp.) (2014),
online: http://dx.doi.org/10.1118/1.4883795
CORRESPONDING AUTHOR:
Godfrey Azangwe
National University of Science and Technology
Bulawayo, Zimbabwe
What was your motivation for initiating
this study?
The study provides a comprehensive set of detector-specific correction factors for dosimetry of
small photon fields using a wide range of real time
and passive detectors.
The motivation for the study was the lack of data
in this area, which has reportedly led to radiation
accidents in the past. It also addresses the needs of
a code of practice for small field photon beam dosimetry under development by an IAEA-AAPM
working group to arrive at a dosimetry approach
consistent with protocols for broad beam dosimetry such as the IAEA TRS 398 and AAPM TG 51.
Such a link is critical as some high precision treatment units do not allow set up in reference conditions (i.e. 10 × 10 cm2 field size at a distance from
the source of 100 cm).
What where the challenges during the
work?
The study encountered the challenges of gathering
a wide range of detectors (operated by different
research groups) and of accurate positioning of
detectors especially for the passive detectors in a
solid phantom in the smallest field sizes.
What is the most important finding of
your study?
The results from the study demonstrate how ignoring effects such as volume averaging, perturbation and differences in material properties of
detectors can potentially lead to large errors in
dose determination. It also provides data that will
be incorporated in the new IAEA-AAPM code of
practice.
What are the implications of this research?
Based on the results from this study, the authors
recommend the use of detectors that require
relatively little correction, such as unshielded
diodes, diamonds, micro-chambers and organic
scintillators, as well as passive detectors such as
alanine, TLDs, and fibre coupled OSL detectors
such as Al2O3:C. Some larger volume ionisation
chambers required unacceptably high corrections
due to the larger volume averaging correction
required and non-water equivalence and,
therefore, are not recommended for small beam
dosimetry.
GODFREY AZANGWE
INTRODUCTION
PHYSICS MEMBERS SURVEY
WORKSHOP ON TRANSLATIONAL RESEARCH
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EDITORS’ PICKS
EDITORS’ PICKS
Highlight Radiotherapy Physics Papers
PHYSICS
INSTITUTIONAL PATIENT-SPECIFIC
IMRT QA DOES NOT PREDICT
UNACCEPTABLE PLAN DELIVERY
Stephen F. Kry, Andrea Molineu, James R. Kerns, Austin M.
Faught, Jessie Y. Huang, Kiley B. Pulliam, Jackie Tonigan, Paola
Alvarez, Francesco Stingo, David S. Followill.
International Journal of Radiation Oncology Biology Physics
(in Press)
CORRESPONDING AUTHOR:
Stephen F. Kry
Assistant Professor
IROC Houston QA Center
Department of Radiation Physics
The University of Texas MD Anderson Cancer Center
Houston, USA
sfkry@mdanderson.org
What was your motivation for initiating
this study?
The Imaging and Radiation Oncology Core at Houston (IROC Houston) intensity-modulated radiation
therapy (IMRT) credentialing phantoms are managed like a patient by the hospital, including simulation, planning, and treatment delivery. Dosimeters
measure the dose throughout the target volume from
the clinical delivery of the plan. Thus, the IROC
Houston phantoms evaluate the overall accuracy
of the hospital’s IMRT treatments. In-house IMRT
quality assurance (QA) aims to evaluate much the
same thing: was the delivered dose distribution that
which was intended? Although there are differences
for IMRT QA, the expectation is that both IMRT QA
and credentialing phantoms should provide the same
result: they should detect the error if the planned
dose is not delivered to the target. However, credentialing phantoms show approximately 20% of plans
have problems, whereas IMRT QA typically reports
this number to be 1-3%. This surprising disparity
motivated us to directly compare in-house IMRT QA
results to credentialing phantom results based on the
IROC Houston phantom programme.
What where the challenges during the
work?
STEPHEN F. KRY
INTRODUCTION
One major challenge of this work was that the inhouse IMRT QA data submitted by each institution
PHYSICS MEMBERS SURVEY
for their phantom irradiation showed the heterogeneity present in the community. Different devices,
delivery methods, analysis methods, and acceptance criteria were all used and needed to be meaningfully sorted to understand the data.
What is the most important finding of
your study?
Current IMRT QA techniques had poor sensitivity
for detecting a plan that would fail an IROC Houston credentialing phantom. This was particularly
true at commonly used acceptability criteria for
IMRT QA, where three percent agreement or 90%
of pixels passing a 3%/3mm gamma agreement
showed extremely poor sensitivity. However, across
all criteria (evaluated with ROC analysis) current
IMRT QA methods showed no good criteria that
provided reasonable sensitivity and specificity.
In short, two systems that the radiation oncology
community largely believes should yield the same
result, do not actually agree.
What are the implications of this research?
This work highlights that we, as a field, must better
understand how we are evaluating IMRT treatments. We must identify methods that are shown to
work, and these should be broadly and consistently
implemented throughout the community.
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EDITORS’ PICKS
Highlight Radiotherapy Physics Papers
PHYSICS
What was your motivation for initiating
this study?
PROTON RANGE VERIFICATION
THROUGH PROMPT GAMMARAY SPECTROSCOPY
Joost M. Verburg and Joao Seco.
Physics in Medicine and Biology 59 (2014) 7089–7106
http://iopscience.iop.org/0031-9155/59/23/7089/article
CORRESPONDING AUTHOR:
Joost Verburg
Harvard Medical School and Massachusetts General Hospital,
Department of Radiation Oncology
Boston, USA
jverburg@fas.harvard.edu
Proton radiotherapy uses the Bragg peak and the
finite range of protons to deliver a highly conformal dose distribution to the target, while reducing the integral dose to the patient by a factor of
two to three as compared to x-ray radiotherapy.
The advantage of the sharp distal dose gradient,
however, cannot yet be fully exploited, because
of uncertainty in the end-of-range of the beam
when delivered to the patient. To further improve
treatments, it would be highly desirable, therefore,
to verify the range of proton beams in real-time.
For this reason, we are developing a system to
perform in vivo range verification by detecting
prompt gamma-rays induced by proton-nuclear
reactions.
What where the challenges during the
work?
JOOST VERBURG
INTRODUCTION
The proton range verification method we propose
is based on measurements of prompt gamma-rays
with discrete energies resulting from specific
nuclear reactions, which we related to gamma-ray
emission cross sections to determine the absolute range of the proton beam. The method relies
on quantitative measurements of prompt gamma-rays, which are challenging to perform during proton irradiation. The detector, electronics,
PHYSICS MEMBERS SURVEY
algorithms and software were designed to handle high radiation levels, to automatically adapt
calibrations, and to separate the proton-induced
gamma-rays from neutron-induced background.
Previous data on the relevant nuclear reactions
were limited, so we also measured cross sections
required by our models.
What is the most important finding of
your study?
The experiments with our prototype detector
showed that the method accurately verifies the
absolute range of proton beams. A unique feature
of the method is the simultaneous determination
of elemental composition of the irradiated tissue,
which provides robust range verification in any
type of tissue.
What are the implications of this research?
We believe that prompt gamma-ray spectroscopy
combined with quantitative modelling of protonnuclear interactions is a very promising approach
to in vivo range verification of proton beams.
The next step is to develop a full scale system for
clinical trials.
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EDITORS’ PICKS
EDITORS’ PICKS
Highlight Radiotherapy Physics Papers
PHYSICS
DIRECT USE OF MULTIVARIABLE
NORMAL TISSUE COMPLICATION
PROBABILITY MODELS IN TREATMENT PLAN OPTIMISATION FOR
INDIVIDUALISED HEAD AND NECK
CANCER RADIOTHERAPY PRODUCES CLINICALLY ACCEPTABLE TREATMENT PLANS.
Kierkels R.G.J., Korevaar E.W., Steenbakkers R.J.H.M., Janssen T.,
van ’t Veld A.A., Langendijk J.A., Schilstra C, van der Schaaf A.
Radiotherapy & Oncology, in press accepted September 2014
CORRESPONDING AUTHOR:
Roel G.J. Kierkels
Medical physicist
Department of Radiation Oncology, University of Groningen,
University Medical Center Groningen
Groningen, The Netherlands
ROEL G.J. KIERKELS
INTRODUCTION
What was your motivation for initiating
this study?
Generally, IMRT dose distributions are created by
optimising a composite objective function (OF),
which relies on dose-volume objectives and often
also on biologically motivated indices such as
the generalised equivalent uniform dose (gEUD)
formalism. However, these OFs are not directly
linearly correlated with clinical response. Therefore, application of more sophisticated multivariable NTCP models, comprising dose parameters
of multiple organs at risk and additional prognostic clinical factors (e.g. age and baseline toxicity
scores), would be more clinically meaningful. We
investigated the feasibility of incorporating these
multivariable NTCP models directly in the optimiser for inverse treatment planning of head and
neck cancer radiotherapy.
What where the challenges during the
work?
During conventional IMRT planning, trade-off
objectives are iteratively changed by the planner,
which means that IMRT plan quality is highly dependent on the expertise of the dosimetry
planner. To objectively compare two optimisation
techniques (i.e. inverse planning optimisation
using OFs based on multivariable NTCP models
or the gEUD), we used so-called “pseudo” Pare-
PHYSICS MEMBERS SURVEY
to front comparisons. Therefore, per patient and
per technique, a database of treatment plans was
automatically created in the Pinnacle treatment
planning system. The calculation of the required
databases of treatment plans was, however, very
time-consuming.
What is the most important finding of
your study?
We demonstrated that inverse planning optimisation with direct use of multivariable NTCP
models in the optimisation process is feasible
and led to clinically realistic treatment plans for
head and neck cancer patients. The optimisation
techniques resulted in treatment plans with only
small differences. However, the use of an NTCPbased OF resulted in dose distributions which
would lead to slightly lower NTCP estimates.
What are the implications of this research?
The objective functions based on multivariable
NTCP models have the advantage of fewer
unknown optimisation parameters. Additionally,
the prognostic clinical factors will facilitate
personalised optimisation. It is believed that
these properties reduce the effort of finding
optimal planning objective settings. In clinical
practice, this could lead to a more efficient search
of the optimal treatment plan per patient.
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EDITORS’ PICKS
RTT
INTRODUCTION
THE BELGIAN
NATIONAL SOCIETIES
PAPER REVIEWS
3RD ESTRO FORUM
Welcome to the January/February edition of the ESTRO newsletter. I hope
you had a merry Christmas and are enjoying winter, maybe with some
days out of the office for a small winter holiday. I would like to wish you a
happy and prosperous new year.
RTT
“We would like to wish
you a happy and
prosperous new year”
The first RTT Corner of this year consists of three interesting articles. In
the first article, Paul Bijdekerke (VVRO) and Aude Vaandering (AFITER.
be) give us an insight into the national societies of Belgium, by describing
their current situation, as well as the composition and aims of these societies.
PHILIPP SCHERER
In the second part of this Corner, Andreas Osztavics reviews two current
articles on hot topics that shouldn't be missed. Read them before you get
the information from your colleagues or patients.
Last but not least, Martijn Kamphuis, chair of the scientific advisory
group, and Filipe de Moura, chair of the pre-meeting course, present a
sneak preview of the scientific programme of the 3rd ESTRO Forum,
which will be held from 24-28 April 2015 in Barcelona. A teaser that, in
addition to the city of Barcelona itself, should convince you to join us for
an enjoyable and fruitful meeting.
MARTIJN KAMPHUIS
We hope you'll enjoy reading our RTT Corner. If you want to contribute
or have ideas for future inclusions in this Corner or the ESTRO newsletter,
please don't hesitate to contact us at m.kamphuis@amc.nl or
p.scherer@salk.at – every input is welcomed.
Philipp Scherer and Martijn Kamphuis
INTRODUCTION
THE BELGIAN
NATIONAL SOCIETIES
PAPER REVIEWS
3RD ESTRO FORUM
RTT
THE BELGIAN
NATIONAL
SOCIETIES
Even though Belgium is a small country, like
many small countries it is subdivided into different regions, languages, entities and legislative
bodies. However, through this complex network,
two associations have been created and have
collaborated in order to represent the 25 radiotherapy departments of Belgium (six in Brussels,
seven in Wallonia and 12 in Flanders): the VVRO
(Vereniging voor Verpleegkundigen Radiotherapie en Oncologie ) and AFITER.be (Association
Francophone des Infirmiers et Technologues
Exerçant en Radiothérapie Belge).
Most professionals who perform treatments in
the Belgian radiotherapy centres are nurses. Legally, in Belgium, the only profession allowed
to work in radiotherapy is a nurse (law dating
from 1991). However, Belgian law is no longer
in line with the reality of radiotherapy department needs. Nurses are not the only professionals found at the treatment workstation, or in
simulation or treatment planning. Throughout
the years, other professions such as laboratory
technicians, physiotherapists and midwives have
also been hired in the different departments. And
more recently, the radiographers have found a
new place in radiotherapy and are appreciated
for their skill in manipulating this fast evolving
technology.
AUDE VAANDERING
INTRODUCTION
PAUL BIJDEKERKE
have an excellent level of quality. However, the
educational background of the nurses and radiographers working as radiation therapists (RTTs)
is insufficient, especially when comparing it to
European standards such as the ESTRO RTT core
curriculum. They do benefit from on-site training
as well as specific modules set up by education
institutions or private initiatives. However, it is
essential that the proper training in accordance
with internal recommendations has to be encouraged and subsidised by governmental entities. In
parallel, the Belgian professional recognition of
RTTs needs to be legally established.
The VVRO and AFITER.be have become active
partners in the quest to obtain the proper training and professional recognition of Belgian RTTs.
aul Bijdekerke (VVRO) and Aude Vaandering
(AFITER.be) present the two societies, their composition and aims.
The recent Belgian clinical audits (QUATRO),
which have been carried out in the majority of
the Belgian radiotherapy departments, have been
able to demonstrate that the Belgian departments
THE BELGIAN
NATIONAL SOCIETIES
PAPER REVIEWS
3RD ESTRO FORUM
VVRO
(Vereniging voor Verpleegkundigen Radiotherapie en Oncologie)
AFITER.BE
(Association Francophone des Infirmier et Technologues Exerçant en Radiothérapie Belge)
By Paul Bijdekerke, chair of the radiotherapy
workgroup in the VVRO
www.vvro.be >
Most of the RTTs are nurses (approximately 90%),
although the number of nurses varies among
the different centres. Flanders has an umbrella
organisation, the VVRO, that represents nurses
who administer chemotherapy as well as nurses
working in the radiotherapy centres. This association includes multiple workgroups such as the
radiotherapy workgroup, chemotherapy workgroup, child oncology workgroup, breast nurses
workgroup and others.
The 16 members of the radiotherapy workgroup
represent ten of the Dutch-speaking departments.
During our meetings we share experiences, but
our main goal is to organise several training sessions a year, such as interactive workshops where
colleagues from the different departments can
discuss protocols, methods and problems they
encounter while working. During the conference,
RTTs can be trained on the latest developments
in radiotherapy. We also make arrangements to
enable colleagues to visit another centre for a day.
INTRODUCTION
Along with physicists and physicians, we perform clinical audits using the Quatro (Quality
Assurance Team for Radiation Oncology) IAEA
(International Atomic Energy Agency) methodology. This initiative of the College of Physicians
for radiotherapy departments is carried out in
the five Belgian radiotherapy centres each year.
The College is an advisory body to our Minister
of Health. An annual report is sent to the Minister of Health and the Federal Agency for Nuclear
Control.
We also participate in different projects, such as
writing a reference book on oncology for student
nurses, writing skin care protocols and cooperating with the representatives of the Dutch-speaking colleges in relation to the training of oncology
nurses.
THE BELGIAN
NATIONAL SOCIETIES
By Aude Vaandering
vice president of AFITER.BE
www.after.be >
The project to create the association AFITER.BE
was born about a year and a half ago. The founding members met for the first time on 22 February 2013. In fact, the French-speaking region
of Belgium did not have a structure to represent
nurses and radiation therapists practicing in radiotherapy. Therefore, the founding members of the
AFITER.BE met and reflected on the professional
profile of RTTs, which had substantially evolved
with the technological developments in the past
decade. The fledgling organisation then formulated specific objectives and the association was
legally recognised on 3 May 2014.
AFITER.BE is an association that represents and
promotes the RTT profession. At the centre of its
concerns are the patient and the quality of care in
a modern and constantly evolving radiotherapy
world. The objective of the association are thus to:
• Facilitate the creation of networks between
the Belgian RTTs in the different radiotherapy
PAPER REVIEWS
3RD ESTRO FORUM
departments (nurses, radiographers, technicians,…)
• Define and delimit the Belgian RTTs’ scope of
practice
• Participate in the continuous improvement of
RTT patient care and technical related procedures through the exchange of experiences,
technical procedures and training between the
different radiotherapy departments
• Provide objective advice and recommendations
to the competent authorities concerning RTT
professional recognition, qualifications and
training
• Organise seminars, training and workshops
• Create and maintain international contacts and
synergies with other professional associations
directly or indirectly connected with radiation
therapy
• Support and help in the fight against cancer.
tient quality of care by endorsing the professional
recognition of RTTs. We hope to achieve this in
the coming years.
Read the National societies Corner of this
newsletter on p 123>
AFITER.be has organised its first, very successful
conference (22 November 2014). Furthermore, its
founding members have already been involved
in the creation of a six European Credit Transfer
and Accumulation System (ECTS) radiotherapy
course, open mostly to nurses and radiographers
already working in radiotherapy departments
and wanting to solidify their competences. The
association is also involved in an educational
working group aiming to create a 60 ECTS radiotherapy specialisation course accessible to nurses
and radiographers.
Along with the VVRO, AFITER.be promotes pa-
INTRODUCTION
THE BELGIAN
NATIONAL SOCIETIES
PAPER REVIEWS
3RD ESTRO FORUM
PAPER REVIEWS
RTT
by Andreas Osztavics
Paper review by
Andreas Osztavics
Radiation Therapist
Medical University of Vienna (AT)
The impact of stool and gas volume on
intrafraction prostate motion in patients
undergoing radiotherapy with daily endorectal
balloon
Evaluation of treatment plan quality of IMRT and
VMAT with and without flattening filter using
Pareto optimal fronts
Wang KK, Vapiwala N, Bui V, Deville C, Plastaras JP, Bar-Ad V, Tochner Z,
Both S.et al.
Radiotherapy and Oncology, Volume 109, Issue 3, Dec. 2013, pages 437–441
Wolfgang Lechner, Gabriele Kragl, Dietmar Georg
Radiotherapy and Oncolgy, Volume 112, Issue 1, July 2014, Pages 89–94
INTRODUCTION
THE BELGIAN
NATIONAL SOCIETIES
PAPER REVIEWS
3RD ESTRO FORUM
PAPER REVIEWS
by Andreas Osztavics
RTT
BACKGROUND
THE IMPACT OF STOOL
AND GAS VOLUME
ON INTRAFRACTION
PROSTATE MOTION IN
PATIENTS UNDERGOING
RADIOTHERAPY WITH DAILY
ENDORECTAL BALLOON
Wang KK, Vapiwala N, Bui V, Deville C, Plastaras JP, Bar-Ad V,
Tochner Z, Both S.et al.
Radiotherapy and Oncolgy, Volume 112, Issue 1, July 2014, Pages
89–94
The effect of an endorectal balloon (ERB) on
prostate intrafraction motion has been assessed.
No studies have addressed the impact of variable
rectal stool/gas volume, when a daily ERB is used.
In this study the aim was to assess the impact
of rectal stool/gas volume on intrafraction 3D
prostate displacements, analysed as a function of
treatment time. Therefore, a group of 30 prostate
cancer patients treated with daily ERB were followed prospectively using cone-beam computed
tomography (CBCT) and Calypso-based localisation and tracking.
METHODS
Patients were provided with bladder-filling protocols and dietary guidelines. A daily regimen
for emptying the rectum prior to each treatment
was reinforced for all study subjects. Patients
were immobilised in a supine position using an
indexed knee wedge and foot lock device and an
indexed-lumen, 100 ml water-filled ERB.
A total of 494 datasets with CBCT and tracking
information were available for analysis. Motion
in LR, CC, and AP directions was evaluated. The
average radiation delivery time was four minutes,
and the maximum time was six minutes. The
INTRODUCTION
THE BELGIAN
NATIONAL SOCIETIES
rectum and stool/gas volumes were contoured,
along with the dimension of the ERB. The total
stool/gas volume was defined as the volume difference between rectum and ERB contoured on
the CBCT.
FINDINGS
The time-dependent distributions of 3D prostate
displacement are remarkably different between
the small and large stool/gas volume groups. The
volume and location of the rectum stool/gas can
impact the effectiveness of ERB in immobilising
the prostate.
RELEVANCE TO RADIATION THERAPISTS (RTTS)
Modern equipment and treatment techniques
for prostate patients have their limits, and they
are reflected in the safety margins. Patient management and more individualised immobilisation devices for high-precision treatment will be
crucial in radiotherapy in the near future. In all
these working fields RTTs will have an important
role. Patient management will be more important
and also the evaluation of the data sets from the
verification systems to adapted immobilisation
strategies for the individualised tailored treatment.
PAPER REVIEWS
3RD ESTRO FORUM
PAPER REVIEWS
by Andreas Osztavics
RTT
INTRODUCTION
EVALUATION OF TREATMENT
PLAN QUALITY OF IMRT AND
VMAT WITH AND WITHOUT
FLATTENING FILTER USING
PARETO OPTIMAL FRONTS
With flattening filter-free photon beams being
available in clinical practice, the differences in
treatment plan quality of IMRT and VMAT
treatment plans applied with flattening filter (FF)
and without flattening filter (FFF) are of interest.
Besides the dosimetric treatment plan quality,
this study focused on the differences in delivery
time between all investigated modalities.
Wolfgang Lechner, Gabriele Kragl, Dietmar Georg
MATERIALS AND METHODS
Radiotherapy and Oncology, Volume 109, Issue 3, Dec. 2013,
pages 437–441
INTRODUCTION
Pareto optimal fronts were generated for six
prostate and head and neck cancer patients using
9-field static IMRT and 360° single arc VMAT
with and without flattening filter, respectively.
The Pareto optimal fronts described the relationship between target coverage and the capability
of sparing the primary organ at risk. For these
calculations, the beam model of an Elekta Precise
(Elekta AB, Crawley, UK) capable of delivering
FFF-beams was used. Additionally, the efficiency and low dose exposure of the treatment plans
was assessed by estimating the delivery times
and the volume that received five Gy or more for
each treatment technique. Statistical analysis of
the Pareto optimal fronts was performed using
the sign-test; the analysis of the delivery time was
performed using student's t-test.
THE BELGIAN
NATIONAL SOCIETIES
RESULTS
No significant difference between the treatment
plan quality of treatment plans calculated with
flatting filter compared to treatment plans calculated without flattening filter was found. These
results were independent of the investigated treatment site. However, with respect to treatment
plan efficiency, a significant decrease of delivery
time of IMRT treatment plans without flattening
filter compared to those with filter was found. On
average, the delivery time decreased by 18% and
4% for prostate and head-and-neck cases, respectively. This could be attributed to the higher dose
rate in the flattening filter-free mode. In contrast
to that, the delivery time of VMAT treatment
plans without flattening filter was significantly
increased by 22% and 16% for prostate and headand-neck cases, respectively. A reason for this was
that the maximum leaf velocity of the standard
multi-leaf-collimator limited the dose rate of the
flattening filter free mode substantially.
RELEVANCE TO RADIATION THERAPISTS (RTTS)
One of the interesting factors for RTTs is that the
potentially higher dose rate available for FFFbeams does not necessarily translate into a reduction of delivery time. In particular, for complex
PAPER REVIEWS
3RD ESTRO FORUM
PAPER REVIEWS
by Andreas Osztavics
dynamic treatments, such as VMAT for head
and neck cancer patients, this effect was greater.
Therefore, the impact for the management of the
schedule for the daily treatments on the Linacs
should be analysed carefully at the beginning of
implementation of FFF-beams in each department.
INTRODUCTION
THE BELGIAN
NATIONAL SOCIETIES
PAPER REVIEWS
3RD ESTRO FORUM
3RD ESTRO FORUM
RTT
RTT Meeting - Scientific programme
3rd ESTRO Forum
24-28 April, 2015
Barcelona, Spain
Martijn Kamphuis
Filipe Moura
INTRODUCTION
THE BELGIAN
NATIONAL SOCIETIES
PAPER REVIEWS
3RD ESTRO FORUM
3RD ESTRO FORUM
RTT Meeting - Scientific programme
RTT
"The main subjects in our
programme deal with topics
that are applicable to the
everyday practice of modern
radiotherapy"
The 3rd ESTRO Forum, which will be held from
24-28 April 2015, is approaching. I’m proud to say
that within this Forum the Radiation TherapisTs
(RTTs) have a clear programme of their own. The
main subjects in our programme deal with topics that are applicable to the everyday practice of
modern radiotherapy. Besides that, there will also
be sufficient time spent on developments that will
affect our practice in the near future.
The meeting will be preceded by a course on the
implementation of SBRT. Course director Filipe
Moura gives you more information on the
pre-meeting course in this very Corner. The main
programme of the RTT track will deal with the
following topics:
vision on what should be done to improve the
RTT world.
The meeting will end with an attractive debate
on online versus offline position verification. We
look forward to your participation in this debate and in the whole conference to enhance this
scientific programme and to share and develop
knowledge, know-how and experience.
Martijn Kamphuis
Chair, scientific advisory group for the RTT
meeting
• IGRT, margin calculation and minimising treatment volumes
• Advanced treatment planning techniques
• A site-specific symposium on breast cancer
• Proton therapy
• MRI imaging throughout the treatment chain
MARTIJN KAMPHUIS
INTRODUCTION
The last day of the conference is a day of reflection. We will spend time looking at the future of
the RTT discipline. After an extensive overview
of the current situation by Mary Coffey, speakers
from different parts of the globe will share their
THE BELGIAN
NATIONAL SOCIETIES
PAPER REVIEWS
3RD ESTRO FORUM
3RD ESTRO FORUM
RTT Meeting - Scientific programme
RTT
IMPLEMENTING OF SBRT
AND SRS: A REVIEW OF
CURRENT PRACTICE
RTT pre-meeting course
24 April 2015
Highly conformal techniques have been developed over the past couple of years. At the same
time a revolution in image guided radiotherapy
has taken place which makes stereotactic body
radiotherapy feasible and a reality in many clinical institutions.
Increased levels of confidence and implementation
over planning and delivering hypofractionation
and single dose regimens have led to an even safer
radiotherapy environment, helped by the experience gained by departments from across Europe
and the rest of the world during the last decade.
The course on the review of clinical practice in
the implementation of SBRT and stereotatic radiosurgery (SRS) will join synergies from several
institutes. This will provide participants with the
theoretical background to implement SBRT in a
safe environment, which will enable the development of new skills and competences for advanced
treatment strategies.
FILIPE MOURA
INTRODUCTION
for the implementation of new techniques. An
equipment-oriented session will provide a global
understanding of new features, and the pros and
cons of each method.
To complete the course, participants will have the
opportunity to assist in an online (live) practical
planning session coupled with video streaming
on treatment verification and delivery.
For the grand finale, attendees will make use of
the digital turning point system, which will help
with each person’s level of understanding of the
knowledge gained during the course.
The final debate and concluding remarks with
the faculty will complete the educational loop to
ensure maximum understanding of the common
practices from each specialised institution.
We are expecting a very productive course, full of
new insights and up-to-date information ready to
be taken home.
Teaching lectures will give the attendees basic
and advanced concepts for their clinical daily
routine, coupled with site-specific sessions for a
more practically-oriented approach.
On behalf of the faculty and the RTT committee, I welcome you to this course and I hope you
enjoy the wonderful city… Visca Barça!
Software and hardware technology is spreading
and evolving quickly, and is becoming crucial
Filipe Moura
Course Director
THE BELGIAN
NATIONAL SOCIETIES
PAPER REVIEWS
3RD ESTRO FORUM
RADIOBIOLOGY
INTRODUCTION
SYMPOSIUM ON SMALL ANIMAL
PRECISION IMAGE-GUIDED RADIOTHERAPY
REVERSE THE ODDS
PAPERS YOU MAY WANT TO READ
RADIOBIOLOGY
“We present two
innovations that could
have a strong impact
on our research in the
coming years”
Dear Radiobiology Corner reader,
This month there is no specific focus to this Radiobiology Corner.
However we present two innovations that could have a strong impact on our research in the coming years. We report on a meeting
on Small Animal Precision Image-Guided Radiotherapy, which
was held this summer in Vancouver, Canada. Furthermore we will
introduce you – via an interview – to an exciting novel Citizen
Science approach to immunohistochemistry scoring, incorporated
into a downloadable game app.
Finally, three PhD students from Martin’s group present recent papers on different topics, which are of interest to them and perhaps
to you too. We would also draw your attention to a further paper
in the “Read it before your patients” section on p 25, namely “p16
protein expression and human papillomavirus status as prognostic
biomarkers of non-oropharyngeal head and neck squamous cell
carcinoma” by Christine H. Chung et al, published in J Clin Oncol.
2014 Sep 29. The authors investigated the prevalence and significance of p16 protein expression in the oral cavity, hypopharynx, or
larynx, collectively referred as non-OPSCC, where HPV infection
is less common than in the oropharynx.
MARTIN PRUSCHY
ANNE KILTIE
We hope you enjoy reading this section.
Anne Kiltie, Conchita Vens, Martin Pruschy
CONCHITA VENS
As usual we encourage you to contact
Conchita Vens, Anne Kiltie and Martin
Pruschy with comments (good or bad)
at our “electronic” mail address
radiobiology_corner@estro.org
INTRODUCTION
SYMPOSIUM ON SMALL ANIMAL
PRECISION IMAGE-GUIDED RADIOTHERAPY
REVERSE THE ODDS
PAPERS YOU MAY WANT TO READ
RADIOBIOLOGY
SYMPOSIUM ON
SMALL ANIMAL
PRECISION
IMAGE-GUIDED
RADIOTHERAPY
11 - 13 August 2014
Vancouver, BC, Canada
ESTRO recommended event
The second Symposium on Small Animal Precision Image-Guided Radiotherapy was held this
summer in Vancouver, Canada. This exciting
meeting brought together biologists, physicists
and physicians working on precision irradiation of small animals for preclinical studies.
Presentations covered a wide range of themes, from
irradiation and imaging technologies that enable
precision radiotherapy studies, to the development
and assessment of tumour models, as well as contributions from the field of curative radiotherapy for
larger animals such as dogs. Other topics included preclinical trials, immunological and abscopal
INTRODUCTION
SYMPOSIUM ON SMALL ANIMAL
PRECISION IMAGE-GUIDED RADIOTHERAPY
REVERSE THE ODDS
effects, radio-modifiers and experimental animal
facilities with proton beams. There was also a discussion on the need for standardisation, common
protocols and networking in this new field, to optimally exploit its mix of specialities. The meeting
opened with a keynote address from Albert van der
Kogel (University of Wisconsin, Madison). Relating
to earlier animal irradiation studies, he discussed
the higher dose tolerances reported when small
targets are irradiated and covered many research
areas that were revisited in subsequent conference
talks, including the validity of the linear-quadratic
(LQ) model, effects of the very high doses used in
stereotactic body radiotherapy, optimisation of
PAPERS YOU MAY WANT TO READ
heterogeneous dose distributions and the effects of
low dose baths in modern radiotherapy.
The symposium saw young researchers lauded for
their work. Sarah Krueger (Beaumont Health System) won the Best Young Speaker award, for her
presentation “Use of a small animal image-guided
irradiator in the development of a rat model of
radiation cystitis”. Although haemorrhagic cystitis
is a major long-term chronic side effect of pelvic
irradiation that is seen in 5-10% of patients, no
high-quality clinical trials have been performed
in this area and treatment options are not well established. It is, therefore, an ideal candidate for a
well-controlled preclinical investigation. Krueger
and colleagues used a combination of a precision
irradiator, CT-guidance and an automated system
to show that, compared to older studies using
larger radiation fields, high doses from CT-guided small tailored fields were far better tolerated.
The model will now be utilised to evaluate agents
(such as immunosuppressants, for example) that
could mitigate radiotherapy side effects.
Robert Weersink (Princess Margaret Hospital)
was the winner of the award for Second Best
Young Speaker. In his presentation, “Targeting accuracy tests of bioluminescence imaging integrated
INTRODUCTION
with cone-beam CT for image-guided small animal irradiation”, he discussed the need for bioluminescence imaging, integrated with modern
animal irradiation cabinets equipped with precision irradiation and CT, to image and precisely
target early-stage tumours. Weersink described
his work on various optical source reconstruction
algorithms, noting the high complexity of the
problem, due to the dependence of optical photon
scatter and absorption on the wavelength, depth
and distribution of the optical source. Studies in
homogenous phantoms showed good targeting
capabilities for parallel-opposed radiation beams
and more complex beam arrangements. He noted
that source reconstruction is hampered by heterogeneous mouse geometries, but that more sophisticated reconstruction techniques may help.
One of the meeting’s youngest speakers, Hwan
Lee (British Columbia Cancer Center), delivered a
presentation that provoked much discussion. Lee
described experiments investigating the abscopal
effect, a purportedly immune-mediated inhibition of distant tumours upon primary tumour
irradiation. The studies used mouse models with
subcutaneously implanted breast cancer cells at
each shoulder, one of which was treated with a
hypofractionation scheme of 4 x 12 Gy. Lee and
SYMPOSIUM ON SMALL ANIMAL
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colleagues assessed tumour response using FDG
PET/CT scans and calliper measurements and
saw that both irradiated and non-irradiated tumours on the same animal showed significant
growth inhibition, as well as increased FDG uptake, compared with a control group.
Orthotopic tumours
One recurrent theme during the symposium
was the use of orthotopic tumour models for
image-guided radiotherapy, preferably based on
bioluminescent imaging, to better mirror clinical
situations and ease translation of study results
into clinical trials. Rebecca Bütof (OncoRay),
who was also awarded Third Best Young Speaker, and colleagues have studied the implantation
of orthotopic tumours (those situated in their
naturally occurring site) in the lung and brain of
mice. Such models are hypothesised to represent
human tumours better than the commonly used
human xenograft tumours implanted subcutaneously in mice. The research revealed many details
regarding the practicality of cone-beam CT and
optical bioluminescence imaging of orthotopic
tumours and should help pave the way towards
more realistic tumour preclinical studies.
PAPERS YOU MAY WANT TO READ
Frank Giordano (University Hospital Mannheim)
used a similar tumour model to demonstrate
proof-of-principle of high-precision irradiation
using three beams and a fractionated treatment
schedule to spare oesophageal and tracheal structures. Jay Dorsey (University of Pennsylvania)
combined gold nanoparticles with high-precision
irradiation of orthotopic glioblastoma tumours
and observed improved survival. He noted that
the combination of gold and superparamagnetic
iron oxide nanoparticle (SPION)-loaded micelles
could provide an MRI contrast agent with sufficient sensitivity to detect and delineate tumours
for treatment planning. Sanaz Yahyanejad (Maastricht University) demonstrated good correlation
between contrast-enhanced CT and luminescence
imaging and observed a dose-dependent irradiation effect on orthotopic glioblastoma growth.
The second model examined was the orthotopic
lung tumour, originating from cells or tumour piece
implantation, or from spontaneous genetic models.
Rebecca Bütof showed that tumour piece implantation is preferable to cell injections to prevent growth
in the injection channel and early metastatic spread.
Using mice that spontaneously develop lung tumours and integrated breath-hold techniques, Ashley Rubinstein examined whether the cone-beam
CT of a small-animal irradiator can be used to
investigate the relationship between tumour image
features and characteristics such as aggressiveness
(a study by MD Anderson’s Laurence Court).
INTRODUCTION
The final model presented was the metastasising
cervix tumour model established by the group of
Richard Hill (University of Toronto). The team used
an eight-beam protocol with daily target imaging
prior to fractionated irradiation combined with
various other therapeutic agents. All treatment
modalities demonstrated enhanced primary tumour response and reduced growth of lymph nodal
metastases when combined with radiation, without
significant short-term gastro-intestinal toxicities.
All of these studies provide evidence that new,
clinically relevant tumour models are available to
fully exploit the capabilities of novel small-animal
irradiators combined with imaging technology.
Such developments will enable researchers to better
mimic clinical radiotherapy practice using complex
preclinical radiation delivery strategies.
tion for small animals. They can also be assessed
by http://www.sciencedirect.com/science/journal/
aip/09393889
This is an abstract of a full report authored by
four workers from Maastro Clinic and Maastro
Lab in Maastricht, The Netherlands, who also
co-organised the meeting. Frank Verhaegen is
Head of Clinical Radiotherapy Physics Research,
Ludwig Dubois is Assistant Professor in Molecular Biology, Patrick Granton is a recent PhD graduate from the Physics Research group and Stefan
van Hoof is a PhD student in the same group.
The full report can be found at: http://medicalphysicsweb.org/cws/article/opinion/58887
Of note, there will soon appear a special issue of
the journal Zeitschrift fuer Medizinische Physik,
with several invited papers on precision irradia-
SYMPOSIUM ON SMALL ANIMAL
PRECISION IMAGE-GUIDED RADIOTHERAPY
REVERSE THE ODDS
PAPERS YOU MAY WANT TO READ
RADIOBIOLOGY
“REVERSE THE
ODDS”: THE NEW
EXCITING GAME
APP ON IMMUNOHISTOCHEMISTRY
Interview with Anne Kiltie
Contributor to “Reverse the Odds” game
ANNE KILTIE
INTRODUCTION
Anne Kiltie at the University of Oxford has been
involved in the development of an exciting new
game app, which gets members of the public to
score images from immunohistochemistry slides.
In the interview below you can learn more about
it and find out how you can get involved:
Martin Pruschy: Hi Anne, could you quickly
summarise what this game is all about?
Anne Kiltie: Well, Martin, “Reverse the Odds” is
a fun and unique puzzle mobile game for Apple,
Android and Amazon phones and tablets aimed
at casual gamers of all ages. Every player is helping Cancer Research UK scientists by analysing
real cancer slides as they progress through the
game. The story revolves around the world of the
SYMPOSIUM ON SMALL ANIMAL
PRECISION IMAGE-GUIDED RADIOTHERAPY
REVERSE THE ODDS
“Odds”, cute creatures whose world has become
a desolate wasteland. Gamers need to help revive
the Odd-world back to its glory using special potions. Players earn potions through a puzzle game
of “reversi” and by analysing cancer data. The
potions are then used to revitalise the desolate
wasteland the Odds live in, into an amazing wonderland. The more people who play the game, and
the longer they play for, the more the scientists
are helped. The cancer analysis itself takes seconds and is one part of a highly engaging game.
There are over 350 levels and is easy to learn with
increasing challenge and difficulty.
MP: But how does it work exactly?
AK: The principle behind this is that we take
PAPERS YOU MAY WANT TO READ
tissue images they see contain a particular molecule (represented as colour) and how much of
that molecule there is (the intensity of the colour)
or to count how many of a particular type cell
they see (percentage of coloured cells).
The samples were taken from patients’ tumours
before they had their treatment so they contain
cancer cells. The actual cores are 0.6 mm diameter but for the purposes of the game these are
split into thirty six square segments, each 0.1 mm
x 0.1 mm, so that the cells are a good size when
seen on a mobile phone (looking at the whole
core would mean that the cells would be too
small). Each square is then analysed 25 times.
lots of samples of patients’ tumours. Each tumour
sample is split into hundreds of smaller cores of
tissue, which we give a score depending on the
cells we see. This can generate a huge amount of
data. And buried in all these data are important
answers that could transform cancer treatments.
But it takes a long time to analyse, meaning researchers end up with data bottlenecks. Citizen
science has the power to speed up this process
by using the power of the crowd. “Reverse the
Odds” accelerates data analysis with the aim of
unveiling clues about cancer sooner, thus saving
researchers valuable time.
In order to progress through levels in the game,
members of the public are asked to judge if the
INTRODUCTION
The data are processed by Zooniverse (www.zooniverse.org) to collate all the squares and scores
for each sample, to give a result similar to that
generated by scientists. These can then be compared with a subset of the images that have been
scored in the lab by “experts”.
Our lab is interested in muscle-invasive bladder
cancer and we have approximately 850 images
per tissue microarray set and will have 18 stained
sets, some of which can be scored for nuclear, cytoplasmic and membranous proteins, so around
25 sets in total. On a rough calculation that
makes 19 million classifications, but we had already achieved one million classifications within
three weeks of going live. Colleagues from Southampton are interested in how the immune system
can be harnessed to help treat cancer and have
SYMPOSIUM ON SMALL ANIMAL
PRECISION IMAGE-GUIDED RADIOTHERAPY
REVERSE THE ODDS
images that are being scored from other tumour
types, including lung cancer. The idea is that other people can add their data sets in future.
MP: Is it only a game or will you use these data?
AK: This is certainly not “only a game”. We will
use the scores generated by the citizen scientists
to compare with clinical outcome data from radiotherapy and surgical patients to try to identify
biomarkers that are prognostic in bladder cancer
and also those that are predictive of outcome
after specific treatment modalities. Promising
markers will then need to be validated in independent data sets.
MP: How does the game as a game work? Does it
get more difficult?
AK: The game is comprised of two elements,
playing “reversi” and scoring the images. The
images alternate between the bladder cancer and
immunology sets, which give variety in the images people are scoring. The analysis itself takes seconds and doesn’t get progressively more difficult,
although some images are trickier to score than
others. The reversi puzzle game starts off as quite
easy to play and then gets more challenging, but
never impossible because you can win “potions”
when you score images well, which can be used
to help win a game. On each round of the game
you go into the lab to score images before going
back to the reversi puzzle game. That way you are
always contributing to the science part and are
rewarded with potions when your answers match
others.
PAPERS YOU MAY WANT TO READ
Screenshot of app page asking players to decide
whether there are tumour cells present on the images or not. The ‘Not Sure’ button takes them to a
tutorial with further images, to help them decide.
Screenshot of app page asking players to decide
what proportion of the cells are positively stained
(blue). The player can select from a range of percentages, and if unsure, they can press the ‘Not
Sure’ button first to be taken to a tutorial with
further images, to help them decide.
Screenshot of app page asking players to decide
how intensely stained the cells on the image are,
from weak, through medium, to strongly stained.
The ‘Not Sure’ button takes them to a tutorial with
further images, to help them decide.
MP: Who is the target audience? And how could
you use the data? Any experience on quality?
Comparisons with scoring by experts?
AK: The game is aimed at casual gamers of all
ages but we know many people who don’t usually play mobile games are playing “Reverse the
Odds” because they want to help in the fight
against cancer and are enjoying it!
We would never have been able to do this whole
project on our own, so the additional manpower
through the public getting involved is key. Now
we only have to score 10% of the images for comparison with the scores of the citizen scientists.
Also, having multiple opinions on each image
should make the results more robust than taking
the opinions of only a small number of research-
ers. Zooniverse does all the processing of the
data, so we get something that can be directly
compared with our results in the lab, from three
trained scientists reaching a consensus score. We
plan to look at 10% of each dataset for comparison with the data generated by citizen scientists.
When the game was being tested during development, the results being generated were very
INTRODUCTION
SYMPOSIUM ON SMALL ANIMAL
PRECISION IMAGE-GUIDED RADIOTHERAPY
REVERSE THE ODDS
PAPERS YOU MAY WANT TO READ
similar to the lab data, so we’re excited to see the
results of this.
MP: Are you planning to publish these data?
AK: Yes, we are hoping to publish the data in
terms of the pathology, but it would also be good
to publish on this approach and what we have
learnt from it.
MP: What is the major purpose of the app? Public awareness? Fund-raising?
AK: The major purpose of the app is to accelerate
our research and allow scope for analysis of many
more markers, cells and molecules in our tumour
samples than we would have ever been able to do
ourselves. However, it is a great opportunity for
the lab to get involved with public engagement
in science. We also hope that the game will raise
public awareness of cancer research and be fun
for the gamers.
“Reverse the Odds” is not about fundraising.
Channel 4 TV and Stand up to Cancer have been
careful to separate promotion of the game from
their fundraising efforts. People playing the game
are already making a huge contribution to cancer
research by carrying out the scoring for us.
MP: How did you get involved with this whole
endeavour?
AK: I was approached by Cancer Research UK
in January 2014 for my opinion on current and
future demand for pathology analysis in research.
INTRODUCTION
They contacted me again in March to see if I
would be interested in getting involved in a game
that was being developed by Cancer Research
UK, Channel 4 TV as part of Stand up to Cancer,
Maverick, Chunk and Zooniverse, to score our
tissue microarrays.
through the employee ranks by mapping your
route through the densest areas of Element Alpha, collecting as much of it as possible, while
destroying asteroids along the way. You can find
links to the science behind the game here: genesin-space.org
We sent in some example images and the game
developers felt they could work with these, and
over the following few months we had to get
the various regulatory and ethical approvals in
place in order to be able to send our images for
inclusion in the game. We also had to work on
questions to include in the tutorials, which are
embedded in the game, to ensure that people were
scoring the slides correctly. Meanwhile the game
developers were busy at their end and, in a very
exciting and productive face-to-face meeting of
the project team in London in July, we got to see
the prototype game and ironed out a few technical
issues. Things then moved very quickly from there
with the launch of the game on 3 October 2014.
MP: In general, what is the benefit of involving
the public in the mass-analysis of such data? Are
members of the public better than computers?
AK: One of the key attributes of the project is
the inherent ability of humans to recognise patterns. Computer algorithms on image analysis
programs don’t always work very well, or the
‘tweaking’ required is so time-consuming that it
is quicker to do the scoring yourself.
MP: I realise that this is not the only game produced by Cancer Research UK. What does the
other one involve?
AK: The other game is called “Play to Cure:
Genes in Space” and it lets the public rapidly
analyse significant amounts of microarray data
which would have taken scientists hours to do.
The mission of “Genes in Space” is to collect a
fictional substance dubbed “Element Alpha”.
This represents genetic cancer data, which might
underpin certain types of cancer. You get to rise
SYMPOSIUM ON SMALL ANIMAL
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By transforming our research data into exciting
and engaging formats we can get the general
public involved in this analysis, so they can stand
with us in our fight against cancer. With thousands more eyes on the data, we can greatly accelerate the time it takes to clear the data backlogs,
and answer more questions that will help to on
develop new ways to beat cancer sooner.
MP: Does the app cost anything and how much
does CRUK support this approach?
AK: No, the app is free to download. The game
has been commissioned by Channel 4 as part of
Stand Up To Cancer, and was produced by Maverick TV’s Multiplatform team and developed by
Chunk. Cancer Research UK is showing great innovation in using the public to help accelerate
PAPERS YOU MAY WANT TO READ
research. The pioneering approach is now embedded into the charity, where they want to continue
working with more scientists on more products
in the future to help speed up accurate research
to help bring forward the day when all cancers
are cured.
The mobile app has already seen more than
two million images analysed by citizen scientists and has been translated into French,
German, Spanish and Italian.
TO DOWNLOAD THE APP:
You can download it for free, and join the
fight against cancer from your mobile at
cruk.org/reversetheodds:
· Download from the Apple App Store:
itunes.apple.com/gb/app/id915440727?mt=8 >
MP: Did I forget something?
AK: Yes, you forgot to ask how to access the
game! Please download the game and give it a try.
You can download it for free to your smartphone
or tablet from the Apple App Store, Google Play
and the Amazon AppStore – just search “Reverse
the Odds”. Also, please share the app with your
colleagues, friends and family online. Whether
it’s on Twitter, Facebook or LinkedIn, every share
will help Cancer Research UK to recruit new
players and increase the impact of “Reverse the
Odds”. You can find out more here: cruk.org/reversetheodds
· Download from Google Play
play.google.com/store/apps/details?id=com.
channel4.hardcell >
· Download from Kindle AppStore:
www.amazon.com/gp/mas/dl/android?p=com.channel4.hardcell >
· Visit the Reverse The Odds website:
www.cancerresearchuk.org/support-us/citizen-science-apps-and-games-from-cancerresearch-uk/reverse-the-odds >
Lastly, if anyone is interested in finding out more
about the programme or wants to work with
them in the future, you can contact them on citizenscience@cancer.org.uk
MP: Thanks, Anne, for this interview, I am actually interested to get some feedback from the
ESTRO community about this very innovative approach. Why don’t you all download this
“game”, get some experience with this citizen science/crowd sourcing approach and send us your
feedback to radiobiology_corner@estro.org.
INTRODUCTION
SYMPOSIUM ON SMALL ANIMAL
PRECISION IMAGE-GUIDED RADIOTHERAPY
REVERSE THE ODDS
PAPERS YOU MAY WANT TO READ
RADIOBIOLOGY
PAPERS YOU MAY WANT TO READ
PAK1 tyrosine phosphorylation is required to
induce epithelial–mesenchymal transition and
radioresistance in lung cancer cells
Cisplatin-mediated radiosensitisation of nonsmall cell lung cancer cells is stimulated by ATM
inhibition
Cancer Res. 2014 Oct 1;74(19):5520-31
EunGi Kim, HyeSook Youn, TaeWoo Kwon, et al.
Radiother Oncol. 2014; 111:228-36
Toulany M, Mihatsch J, Holler M, Chaachouay H, Rodemann HP
The retinoblastoma tumour suppressor modulates DNA repair and radioresponsiveness
Clin Cancer Res. 2014 Nov 1;20(21):5468-82
Chellappagounder Thangavel, Ettickan Boopathi, Steve Ciment,
et al.
INTRODUCTION
SYMPOSIUM ON SMALL ANIMAL
PRECISION IMAGE-GUIDED RADIOTHERAPY
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PAPERS YOU MAY WANT TO READ
PAPERS YOU MAY WANT TO READ
RADIOBIOLOGY
PAK1 TYROSINE PHOSPHORYLATION IS REQUIRED TO
INDUCE EPITHELIALMESENCHYMAL TRANSITION
AND RADIORESISTANCE IN
LUNG CANCER CELLS
EunGi Kim, HyeSook Youn, TaeWoo Kwon,
et al.
Cancer Res. 2014 Oct 1;74(19):5520-31
Paper review by
Ashish Sharma
PhD-student
Dept. Radiation Oncology
University Hospital Zürich
Switzerland
INTRODUCTION
As I am a PhD student working on resistance
mechanisms triggered by irradiation, this current study is of great interest as it demonstrates
the role of a novel pathway i.e. JAK2, PAK1 and
Snail in conferring radioresistance in non-small
cell lung cancer. This study deals with the critical and urgent therapeutic need to identify new
targets in order to overcome treatment resistance and improve treatment outcome.
Radiotherapy, along with surgery and chemotherapy, is the primary treatment approach for
locally advanced non-small cell lung cancer
(NSCLC). However, the clinical outcomes are
still disappointing with the five-year survival rate
being only approximately 20%. Improvement
in treatment outcomes requires development of
novel treatment modalities, which can overcome
radio-resistance and enhance the IR-induced cell
cytotoxicity. In this recent study published in
Cancer Research, EunGi Kim and colleagues revealed that p21-activated Ser/Thr kinase 1 (PAK1)
and JAK2 are the key molecules that confer radio-resistance in NSCLC. They demonstrate that
ionising radiation (IR)-induced phosphorylation
of PAK1 on Tyr residues by JAK2 and its subsequently increased stability play important roles
in survival signal transduction in NSCLC cells.
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Previously, they evaluated whole-transcriptome
alteration in radio-resistant A549 cells in response
to irradiation and identified PAK1, which was
significantly up-regulated. They hypothesised that
IR-dependent up-regulation of PAK1 might lead
to epithelial to mesenchymal transition (EMT),
migration and inflammatory processes [1].
In the current study, they demonstrate that PAK1
is differentially up-regulated, tyrosine phosphorylated, and translocated to the nucleus. JAK2
controls the tyrosine phosphorylation of PAK1
and was essential for protein stability and binding to Snail. PAK1-Snail binding was validated
using peptide fingerprinting, and functional
interactions were determined using curated databases. Snail actively regulates epithelial to mesenchymal transition (EMT) through promotion of
transcriptional repression of several genes, including epithelial marker proteins (E-cadherin).
Inhibition of Tyr phosphorylation of PAK1 can
reduce IR-dependent EMT. JAK2 inhibitors can
also counteract the tyrosine phosphorylation of
PAK1 leading to radiosensitisation and reduced
in vivo EMT in a lung carcinoma-derived xenograft mouse model.
In a nutshell, the authors demonstrate that Tyr
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phosphorylation of PAK1 confers radioresistance
to lung carcinoma cells. This novel regulatory
mechanism of radioresistance includes functional
involvement of JAK2, PAK1 and Snail in response
to irradiation. JAK2 inhibitors could be used as
potent radiosensitisers and promising agents to
counteract IR-induced EMT.
1. Yang HJ, Kim N, Seong KM, Youn H, Youn B. Investigation of radiation-induced transcriptome profile of radioresistant non–small cell lung cancer A549 cells using
RNA-seq. PLoS ONE 2013;8: e59319.
INTRODUCTION
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RADIOBIOLOGY
THE RETINOBLASTOMA
TUMOUR SUPPRESSOR
MODULATES DNA
REPAIR AND RADIORESPONSIVENESS
Chellappagounder Thangavel, Ettickan
Boopathi, Steve Ciment, et al.
Clin Cancer Res. 2014 Nov 1;20(21):5468-82
Paper review by
Sabine Bender
PhD-student
Dept. Radiation Oncology
University Hospital Zürich
Switzerland
INTRODUCTION
Molecular characterisation of tumours is crucial
to individualise cancer therapy and is becoming increasingly more important for radiation
therapy. By targeting the driving force, the tumour can be sensitised to radiation treatment
and normal tissue toxicity can be lowered. The
retinoblastoma protein is one of the best-studied
tumour-suppressor genes and it is inactivated
in various types of cancer. Therefore, there is a
clear imperative to investigate the impact of the
retinoblastoma status on radiation sensitivity.
The retinoblastoma protein (RB1) is a tumour
suppressor protein that regulates G1-S cell cycle
progression. In a dephosphorylated state, RB1
binds and inhibits E2F-regulated gene promoters. Phosphorylation inactivates RB1 and allows
transcription of E2F-regulated genes, which are
required for cell cycle progression. Retinoblastoma is functionally inactivated in several tumour
types. In prostate cancer, it occurs during progression of the disease in only five percent of primary
tumours, but approximately 30-40% of metastatic
and castration-resistant prostate cancers show retinoblastoma inactivation. Although the retinoblastoma inactivation rate is relatively high in prostate
cancer, so far only a few studies have investigated
its role in radiation responsiveness.
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The study by Thangavel et al. shows for the first
time that loss of the retinoblastoma function
results in increased radiosensitisation of human
prostate cancer cells. The authors demonstrate
increased radiosensitivity of retinoblastoma-deficient prostate cancer cell lines compared to their
retinoblastoma proficient pairs, in both hormone-sensitive and castrate-resistant cancer cells.
No differential response in cell cycle distribution
was observed after radiation of the cell lines, regardless of their retinoblastoma status. However,
the amount of IR-induced double-strand breaks
was significantly higher in retinoblastoma-deficient cells suggesting that retinoblastoma loss
alters DNA damage and repair capacity in response to radiation. As retinoblastoma is involved
in anti-apoptotic signalling, the effect of retinoblastoma loss on apoptosis was investigated. In
response to radiation, retinoblastoma-deficient
cells show increased levels of NF-κB and elevated
transport to the nucleus where it acts as a transcription factor. It binds to the promoter region of
the polo-kinase 3 (PLK) and mediates apoptosis
via PLK3 transcripts. Differential radiosensitivity
was further demonstrated in xenograft models,
where retinoblastoma depletion showed a tumour
growth delay. Additionally, prostate specific antigen (PSA) levels were significantly lower in
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animals carrying retinoblastoma-deficient xenografts.
In a retrospective study, a set of biopsies was
analysed retrospectively where patients developed
local recurrence after radiation treatment. All
samples were stained positive for retinoblastoma,
strengthening the hypothesis that these cells are
more radiation resistant.
This raises the question as to whether the retinoblastoma status could be considered as a biomarker upon which to base therapeutic decisions.
Cyclin-dependent kinase (CDK) inhibitors could
provide an approach to halt cellular proliferation
in retinoblastoma-proficient tumours, whereas
retinoblastoma-deficient tumours could be treated with DNA-damaging agents to hypersensitise
them to genotoxic stress.
INTRODUCTION
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RADIOBIOLOGY
CISPLATIN-MEDIATED RADIOSENSITISATION OF NONSMALL CELL LUNG CANCER
CELLS IS STIMULATED BY
ATM INHIBITION
Toulany M, Mihatsch J, Holler M,
Chaachouay H, Rodemann HP
Radiother Oncol. 2014; 111:228-36
Paper review by
Andrea Orlando Fontana
PhD-student
Dept. Radiation Oncology
University Hospital Zürich
Switzerland
INTRODUCTION
As I work on cancer and DNA repair, this paper
has offered me interesting insights into how specific molecular mechanisms, which are linked to
the DNA repair machinery, are also responsible
for treatment resistance to classic clinically-relevant chemotherapeutical compounds such as
cisplatin.
Cisplatin (cis-diamminedichloroplatinum(II),
CDDP) is a widely used chemotherapeutic agent
for sarcoma and carcinoma, especially for lung
and ovarian carcinoma. CDDP primarily acts as
a cross-linking agent, forming intrastrand DNA
adducts, which are mainly repaired by the nucleotide excision repair pathway. Indeed, cells
defective in this pathway are hypersensitive to
cisplatin. Following NER activation, a cascade of
downstream proteins are activated, which bind
to the cisplatin-induced distortions in the DNA,
leading to delayed DNA damage repair, cell cycle
arrest and induction of apoptosis. Among these
proteins, recruitment of ATM (ataxia telangiectasia mutated protein) kinase leads to repair of the
damaged DNA by promoting DNA-PKcs transphosphorylation and BRCA1 activation through
its BRCT domain. ATM activation also induces
cell cycle checkpoint activation, cell cycle arrest
and autophagy, ensuring that the cell can survive
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DNA damage. Resistance to cisplatin can be multifactorial. Reduced drug uptake, increased drug
inactivation and increased DNA adduct repair all
contribute to resistance. Interestingly, over-expression or activation of specific DNA repair proteins, including ATM, has recently been shown to
be a serious candidate mechanism for clinically
observed cisplatin-resistance.
In this study Mahmoud Toulany investigated the
radiosensitising effect of cisplatin and its molecular background in the non-small cell lung cancer
cell line A549 and H460. Interestingly, cisplatin
sensitised H460 cells but not A549 cells to ionising radiation. Lack of radiosensitisation in A549
cells was associated with increased cytoplasmic
ATM phosphorylation at serine-1981, which
exerts several pro-survival effects thereby counteracting the cytotoxic effects of ionising radiation. Indeed, combined treatment with cisplatin
and the potent ATM inhibitor KU-55933 strongly
sensitised both H460 and A549 cells, indicating
a pro-survival effect of cisplatin-mediated activation of ATM. Toulany et al. also demonstrated a
strong involvement of the ATM/AMPK-pathway,
which is part of the cellular metabolic and energy
regulation machinery, in the observed cisplatin-resistance in the A549 cells.
PAPERS YOU MAY WANT TO READ
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The role of ATM kinase in DNA damage recognition after cisplatin treatment was further
investigated. Surprisingly, a strong reduction in
residual γH2AX foci was observed in response to
treatment with cisplatin and the ATM inhibitor
despite the synergistic effect of KU-55933 and
cisplatin at the level of clonogenic survival. These
results suggest a limited recognition of radiation-induced DNA breaks rather than a lower frequency of initial radiation-induced DNA double
strand breaks in cells pre-treated with the ATM
inhibitor alone or in combination with cisplatin.
According to the model proposed by the authors,
ATM activation following cisplatin-treatment
leads to the activation of several pro-survival
mechanisms including reduction of apoptosis,
autophagy and improved energetic metabolism
through the AMPK pathway. Therefore, selective
blockage of the ATM kinase in combination with
cisplatin could improve the radiation response
especially in tumour cells with reduced treatment
responses to platinum compounds alone.
INTRODUCTION
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ESTRO SCHOOL
INTRODUCTION
E-LEARNING
COURSE REPORTS
E-ESO
ESTRO SCHOOL
“The course directors
and teaching staff have
been chosen because
they are international
experts in their fields”
Education has always been a central theme for ESTRO and the remit of
the Education and Training Committee (ETC) has now expanded to the
extent that the Board agreed that it would be appropriate for the Core Education Committee to become a full ESTRO Council in 2015. The structure and composition of this new Council is being drafted currently and
more details will be presented to the Education and Training Committee
in February.
The education courses on offer for 2015 are designed to cover comprehensively the core curricula for radiation oncologists, radiation physicists and
RTTs. As always, the course directors and teaching staff have been chosen
because they are international experts in their fields who also have a track
record of excellent teaching. Participation in live ESTRO courses supplements teaching at national levels and allows participants to interact with
their peers from other countries, to harmonise their training to European
standards and to achieve the knowledge and skills required for tomorrow’s practices.
Of course, it is not always possible to attend all of the four-day live courses that you would like to during the year. Alternative ways to benefit from
the high quality ESTRO teaching on offer are to sign up for one of the
online courses or one of the one-day pre-meeting courses. Check out the
exciting possibilities listed on the programme for 2015.
FIONA STEWART
Core member, Education
and Training Committee
CHRISTINE VERFAILLIE
ESTRO Chief Operating
Officer
Finally, we are happy to welcome Fiona Stewart to the editorial team of
the School Corner. Fiona has been involved with ESTRO for many years,
specifically in the School activities. She is a core member of the current
ETC and she will now contribute to developing this Corner to best reflect
how stimulating our educational activities are.
Richard Pötter, Christine Verfaillie and Fiona Stewart
INTRODUCTION
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RICHARD PÖTTER
Chairman, Education
and Training Committee
E-ESO
ESTRO SCHOOL
E-LEARNING
Future horizons for Online
FALCON workshops
It was almost two and a half years ago that I was
invited to participate in the first “pilot” Online
FALCON (Fellowship in Anatomic deLineation
and CONtouring) contouring workshop in breast
cancer. I still remember perfectly that first online
meeting. The whole idea seemed so innovative
and exciting.
Since then, I have participated as a tutor and have
been able to witness at first hand how certain
aspects have evolved slightly, while always maintaining the spirit of a very interactive, close and
personal teaching experience, even though we are
all many kilometres apart. This is what I find the
most outstanding feature of these workshops, and
I believe that this is the reason for their success.
Thanks to the small size of the groups (maximum
20-25), the faculty and tutors establish a special
connection with the participants, and the participants also have the opportunity to get acquainted
with each other.
How FALCON workshops began
ELEONOR RIVIN
DEL CAMPO
INTRODUCTION
The background of the FALCON project comes
from the well-known importance of contouring
definition of target volumes in radiation oncology. There is a continuous evolution of the definitions of Gross and Clinical Target Volumes
(GTVs and CTVs), as well as for Organs At Risk
(OARs). Therefore, even though specifications are
available in ICRU reports, and guidelines/recommendations have been published by international
societies like ESTRO and the Radiation Thera-
E-LEARNING
py Oncology Group (RTOG), many single and
multi-institutional trials have also contributed to
this body of literature. This led ESTRO to focus
on this subject in order to reduce contouring
uncertainties (both the intra- and inter-observer variability), aiming to gain in tumour control
while minimising morbidity. Initially, FALCON
was used for onsite, interactive delineation workshops performed at annual ESTRO meetings and
live ESTRO teaching courses (Eriksen et al. Four
years with FALCON – An ESTRO educational
project: Achievements and perspectives. Radiother Oncol; Jul 2014).
The first Online FALCON contouring workshop was held in October 2012, in breast cancer.
The experts were Birgitte Offersen and Philip
Poortmans, and the tutors were Sofia Rivera and
Arturo Navarro. The next topic to be taught in
this format was head and neck cancer. And, just
recently, two workshops have been held in gynaecological cancer (the first one in external beam
radiotherapy and the second in brachytherapy).
All of these workshops were fully booked, and
in the last one there was outstanding interaction
between the faculty, tutors and participants.
Dynamics of the Online FALCON
workshop
The structure of Online FALCON workshops is
identical. The live sessions are held through an
online platform for interactive presentations, the
WebExTM system. During the first session the
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Screenshots of the breast cancer Online FALCON contouring workshop, showing the teacher, Birgitte Offersen (left) and one of the tutors, Eleanor Rivin del Campo (right).
case is presented, as well as the FALCON contouring system (EduCaseTM software, http://estro.
educase.com/), the teachers, the tutors and the
participants. Each interactive live online session
is between 1-1.5 hours long. The participants are
invited to contour certain Regions Of Interest
(ROIs) during the first week. The second session
is when the guidelines for the specific tumour
site are presented and the contours from the
first week are reviewed. Contours may be shown
anonymously, which improves the quality of the
discussions, since the participants feel comfortable commenting on the strengths and weaknesses
of the anonymous contours. During the second
week they are asked to re-contour the case. The
INTRODUCTION
third and final live WebEx meeting consists in
presenting the contours from the first and second
week, compared with those from the teacher, as
well as between weeks, and there is a question
and answer session.
Looking ahead
The Online FALCON contouring workshop family has steadily grown, with new incorporations
of faculty and tutors, allowing them to broaden
the scope of tumour sites within the frame of
the ESTRO School. The enthusiasm of all of the
components of each Online FALCON contouring
workshop team seems to be contagious, attract-
E-LEARNING
ing more and more experts and tutors to this new
teaching method.
All of this has allowed the Online FALCON
workshop team to begin planning for the future.
Their goal is to establish an annual programme of
workshops, as already exists, and in parallel, with
the ESTRO live courses.
The initial tumour sites under discussion are
gynaecology (brachytherapy as well as external
beam radiotherapy, in separate workshops), head
and neck, prostate, accelerated partial breast irradiation, organs at risk and paediatric. However, if
more experts come forward in other fields,
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the more the merrier! Ideally, approximately
seven to ten Online FALCON workshops may
be held in total, per year. This would allow more
participants to enrol in these workshops, as the
demand is quite high.
And finally, an even more ambitious project is
the possibility of trying to integrate ESTRO live
courses with the Online FALCON workshops.
This will take careful thought and planning, but
may give very interesting results.
Eleonor Rivin del Campo
Specialist in radiation oncology
Gustave Roussy Cancer Campus
Villejuif, France
eleonorrivin@gmail.com
INTRODUCTION
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Accelerated partial breast irradiation
Advanced treatment planning
6 - 9 September 2014 | Barcelona, Spain
20 - 25 September 2014 | Budapest, Hungary
Clinical practice and implementation of imageguided stereotactic body radiotherapy
Image guided radiotherapy in gynaecological cancers with a focus on adaptive brachytherapy
7 - 11 September 2014 | Florence, Italy
Basic treatment planning
16 - 20 September 2014 | Budapest, Hungary
INTRODUCTION
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28 September - 2 October 2014 | Florence, Italy
Best practice in radiation oncology: a workshop to
train RTT trainers
20 - 24 October 2014 | Vienna, Austria
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ESTRO SCHOOL
ACCELERATED
PARTIAL BREAST
IRRADIATION
6 - 9 September 2014
Barcelona, Spain
COURSE DIRECTOR:
Philip Poortmans
Radiation oncologist
Radboud University Medical Center
Nijmegen, The Netherlands
Holá BCN! 4 dies. For
many of us this was the
first contact with the city of
Barcelona (a four-day travel
card). In this beautiful city of Cataluña,
an ESTRO teaching course specially focused on
accelerated partial breast irradiation (APBI) was
held for four days. For many years, APBI used to
be incorporated into teaching courses that were
dedicated only partially to breast cancer. This was
the first time in the history of the ESTRO School
that this increasingly popular treatment modality in early breast cancer became a focal point of
the whole course. ESTRO intends to organise this
kind of course at regular two-year intervals.
The venue was in the new part of the Hospital
de la Santa Creu i Sant Pau. This event gathered
more than 60 participants from all around Europe, some from Asia and Latin America. The
atmosphere during coffee breaks was very cosmopolitan and enriched with lively discussions.
The academic programme was well balanced and
based on a multidisciplinary approach, ranging
from pathology, imaging, surgery, to radiation
oncology and physics.
PAVOL LUKACKO
INTRODUCTION
The first day started with an essential introduction to early breast cancer, and various imaging
E-LEARNING
modalities in breast and breast histology as well.
We were guided through illustrative documentation from a radiologist and pathologist, followed by technical aspects of various techniques
in APBI. An interesting presentation on target
volume delineation was, for me personally, the
highlight of the first day. GEC-ESTRO guidelines
transformed to actual contours on computed
tomography and presented slice by slice were
very descriptive and truly helpful. At the end of
the first day, we all enjoyed a guided tour and
welcome reception in the spectacular Hospital
de la Santa Creu i Sant Pau, which is a UNESCO
World Heritage Site.
The second day was dedicated to risk factors for
recurrence in breast cancer, indications of APBI
and details of most frequently-used APBI techniques. Pictures with evidence-based data helped
us better understand various approaches to this
specific type of irradiation, all the more so that
the course teachers were renowned experts in
their particular fields. All of this was complemented with a presentation about the physical
principles underpinning each technique. An excellent dinner served on the beach only reminded
us that Barcelona is a seaside Mediterranean city
with a unique atmosphere and delicious food.
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Is APBI ready for prime-­‐@me? Is APBI ready for prime-­‐@me? Yes for all techniques Yes for all techniques Yes for EBRT Yes for EBRT Yes for mul@catheter BT Yes for mul@catheter BT Yes for single-­‐catheter BT Yes for single-­‐catheter BT Yes for IORT linacs Yes for IORT linacs Yes for Intrabeam Yes for Intrabeam No for all techniques No for all techniques 29% 11% 2% 2% 7% 29% 11% 7% 16% 16% 2% 0% 2% 0% 2% 0% 2% 0% 4% 4% 20% 20% 7% 7% 38% 38% Before debate AMer debate Before debate AMer debate 62% 62% Voting results of course participants before (blue) and after
(red) the debate entitled “Is APBI ready for prime-time?”
External radiotherapy APBI and the surgical point
of view were the main topics of the third day. It
was dominated by an impressive and controversial
debate among teachers arguing for and against
APBI being routinely used outside of clinical trials.
Day four summarised treatment-related toxicity
and future perspectives of breast radiotherapy.
At the beginning of the course all participants
were given contouring homework consisting of
two cases of early breast cancer with an indication for APBI. To complete our task we used the
ESTRO contouring tool – FALCON Educase software. It was very interesting to see how the real-
INTRODUCTION
isation of contours differed from participant to
participant. Pictorial guidelines of contouring the
volume for APBI and practical tricks were gone
through interactively in detail during the course.
The delineation workshop was divided into two
sessions and we watched the whole process on
our laptops, complemented with additional comments by our course teachers. An interactive voting system gave an opportunity to all participants
to take part in case-specific treatment decisions,
which were then discussed among the audience.
I believe that the first ESTRO teaching course
to focus exclusively on APBI was a great success
E-LEARNING
and I can only recommend it to all colleagues in
their work in treating early breast cancer patients.
The next course will take place in two years. I am
convinced that everyone involved in this area of
medicine is looking forward to the next couple of
years, as more new data will become available on
APBI from a number of large clinical trials exploring this technique.
Pavol Lukacko
St. Elisabeth Oncological Institute Bratislava
Department of radiation oncology
Bratislava, Slovakia
pavol.lukacko@gmail.com
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ESTRO SCHOOL
CLINICAL PRACTICE AND
IMPLEMENTATION OF
IMAGE-GUIDED STEREOTACTIC BODY RADIOTHERAPY
7 - 11 September 2014
Florence, Italy
COURSE DIRECTORS:
Dirk Verellen
Physicist
UZ Brussel (VUB) - Brussels, Belgium
Matthias Guckenberger
Radiation oncologist
University Hospital Zurich - Zurich, Switzerland
The third edition of “Clinical practice and implementation of image-guided stereotactic body radiotherapy (SBRT)” was my first ESTRO course.
I did not know what to expect but I was full of
enthusiasm on my way to the airport.
MARIE LAMBRECHT
INTRODUCTION
Indeed, I was going to need this positive attitude
to get me through the first day of travelling because nothing went right. Due to a strike by the
E-LEARNING
Italian air controllers my flight was cancelled, as
were most of the flights to Italy. For me and for
other participants trapped in their own country, the time for creativity had come. After 10
hours of brainstorming in the airport I took off
for Spain and even slept in Barcelona airport! I
finally arrived the next morning in Florence and
went directly to the venue. Even If I wasn’t as well
prepared as I could have been if I had rested, I
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surprised myself by listening attentively. For performing the miracle of keeping my attention after
a long 24 hours, I am grateful for a very skilled
and animated teaching committee.
The lectures were designed to enable participants,
composed of radiation oncologists, physicists
and radiation technologists, to build a gradual
and thorough understanding of the stereotactic
techniques. After an historical background from
frame-based SRT to the most advanced image
guided frameless SBRT, two case demonstrations
were shown. Then the afternoon was dedicated
to biological benefices of hypo-fractionation but
also awareness of correlated toxicity risks.
Following a logical order, the next day was designed around target management, starting with
static sites to breathing-impacted locations. Planning evaluation and quality assurance for these
treatments were then discussed. We retained the
message that no matter which device and techniques we choose, the challenge of delivering
high dose to a small volume is first to have a good
communication and understanding between us
regarding what we are doing, which prescription
to which volume, homogenous or heterogeneous
dose inside the planning target volume, or which
means to compensate for target motion.
INTRODUCTION
In the evening we were invited to the social event
held in the heart of Florence, a few footsteps from
the Duomo. At first I was surprised that the event
was more about snacks and drinks than a dinner.
However, my lasagne mourning did not last long,
as my colleagues and I started dancing. The night
was very enjoyable and accelerated our group
cohesion.
morning. After a summary and a statement about
how to start a SBRT programme, we left each other as new disciples of the good practice of SBRT
and SRT.
The next morning, despite the beautiful weather,
we were still just as eager to increase our knowledge. Lectures focused on the treatment of nonsmall cell lung cancer and the first presentation
was from a surgeon. It was much appreciated to
have their point of view. Surgery is the concurrent and still preferred option in case of operable
small lesions.
On behalf of the others participants I thank the
organisational team for the management of the
event. I felt very lucky to attend this course, and I
would encourage every novice or confirmed stereotactic lover to attend and share their questions
and experiences with this invaluable teaching
team.
During the afternoon we were split into several
groups. These split sessions were very practical
and informative, and gave us real insights. We
were encouraged to ask questions and share our
experience on the topic of the session. Wednesday
was designed similarly, with interesting lectures
in the morning about SBRT for oligometastasis
and split up sessions during the afternoon.
Marie Lambrecht
PhD student
Catharina Ziekenhuis
Eindhoven, The Netherlands
Marie.lambrecht@catharinaziekenhuis.nl
The five days went smoothly, split by coffee and
pastry breaks, and nice lunches held in the cloister of the old monastery.
There was a particular but indefinable emotion
amongst the group as we finally came to the last
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ESTRO SCHOOL
BASIC TREATMENT
PLANNING
16 - 20 September 2014
Budapest, Hungary
COURSE DIRECTOR:
Michelle Leech
Associate Professor
TCD Discipline of Radiation Therapy
Dublin, Ireland
Budapest has always fascinated me for being one
of the most beautiful cities of Europe. It has a
true blend of modern architecture and medieval
European architecture. When I was offered the
opportunity to attend ESTRO’s basic treatment
planning course to be held in Budapest, I jumped
at the opportunity and was truly excited.
AUN MUHAMMED
INTRODUCTION
At that point I did not realise that these few days
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would be some of the most memorable and rewarding days of my life. Not only did I get the
opportunity to meet some wonderful new colleagues from all over the world, ranging from
South America to Europe, Middle East and the
whole of Europe, but we also had the opportunity
to be trained by one of the finest ESTRO faculties.
Michelle Leech, the director of the course, and
Viviane Van Egten, the programme manager,
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did their utmost to make this course successful.
Sadly Michelle is going to leave the course directorship next year, but fortunately she will remain
in the faculty.
Not only did we have the opportunity to have
basic hands-on training from different faculty
members but there were also many fascinating,
engaging and brain storming sessions in which
participants very actively participated with questions and comments. Although mainly a physics and treatment planning workshop, we were
also lucky to have frequent clinical inputs from
Charles Gillham and Paul Kelly.
How can I forget the most wonderful social dinner organised by the popular Viviane, who always had a courteous smile and was ready to help
everybody with any issue. The magic host of the
dinner made the evening even more memorable
by singing the finest songs from almost all the
countries of the participants. The way he sang
a Chinese song spontaneously left our Chinese
colleagues mesmerised.
Talking to different participants, who have also
attended previous ESTRO courses, they commented that this had undoubtedly been one of
the best. The learning and training, which we got
INTRODUCTION
from this course, has increased our confidence in
handling treatment planning and will definitely
help us in our future work. The contacts that we
made during the course with the wonderful faculty members and colleagues will stay with us for
a long time.
Finally, I would like to thank the vendors and
the local organisers who worked tirelessly behind
the scenes to make this course successful, so that
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learning treatment planning was a fruitful experience for every one of us.
Aun Muhammed
Speciality registrar
Royal Marsden Hospital
London, UK
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ESTRO SCHOOL
ADVANCED TREATMENT
PLANNING
20 - 25 September 2014
Budapest, Hungary
COURSE DIRECTOR:
Gert Meijer
Physicist
UMC - Utrecht, The Netherlands
CO-CHAIR
Neil Burnet,
Radiation oncologist
Cambridge University - Addenbrooke’s Hospital, UK
I have recently started training as a medical physicist and I came across this course while browsing through the ESTRO School calendar. I was
looking for a course that would provide me with
a solid background as well as practical skills in
advanced treatment planning techniques, and
this course fully satisfied my educational needs.
CHRYSI PAPALAZAROU
INTRODUCTION
Already, before the course began, I appreciated
the focus on hands-on practice, which was clear
E-LEARNING
from the course schedule. The general structure of the five-day course was as follows: each
morning, a number of lectures addressed specific topics in advanced treatment planning. After
the lunch break, the practical part of the day was
introduced by a lecture on physical and/or clinical considerations relevant to the case discussed
on that day. This was followed by a presentation
on practical planning aspects, which gave useful
guidelines and tips for the case at hand. The
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The teaching staff consisted of a well-balanced
group of expert physicists, clinicians and RTTs,
who together created a structured, yet informal
and intimate teaching atmosphere despite the
number of participants (approximately 100). I
very much appreciated the staff’s openness and
readiness for discussion, both during and between lectures.
four cases were selected to be sufficiently challenging for planners with little to medium experience.
During the rest of the afternoon sessions the participants, working in groups of two to three people, were assigned to a treatment planning system
(TPS) station and planned the case. The results
of each day were discussed in the first session of
the following morning, where some representative plans made by participants were presented
and discussed. The participants voted for the best
plan each day, which was a nice way to keep us
motivated to generate quality plans.
INTRODUCTION
The ESTRO basic and advanced treatment planning courses (which were organised back-to-back
in Budapest) presented a unique opportunity;
namely, several different TPSs were set up in
different rooms, accompanied by company representatives. This was a rare opportunity to get
hands-on experience with TPSs, something that
is not available at one’s own institution and an
invaluable experience for someone in training
such as myself. Even for someone with no experience in a certain TPS, it was possible with the
help of the company representatives, and other
more experienced participants, to generate good
quality plans.
E-LEARNING
Budapest is a city rich in cultural life, history and
architecture. We had the chance to admire some
of its most famous monuments, beautifully illuminated, during the social dinner aboard a cruise
ship on the Danube, accompanied by Hungarian
and other delicacies and live folk music.
All in all, this was an excellent course, highly
recommended for those with some experience in
treatment planning who want to sharpen their
skills in advanced techniques.
Chrysi Papalazarou
Medical physicist in training
Erasmus MC
Rotterdam, The Netherlands
COURSE REPORTS
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ESTRO SCHOOL
IMAGE GUIDED RADIOTHERAPY IN GYNAECOLOGICAL
CANCERS WITH A FOCUS ON
ADAPTIVE BRACHYTHERAPY
28 September - 2 October 2014
Florence, Italy
COURSE DIRECTORS:
Christine Haie-Meder
Radiation oncologist
Institut Gustave Roussy - Villejuif, France
Richard Pötter
Radiation oncologist
Medical University Hospital - Vienna, Austria
REKHA NEUPANE
INTRODUCTION
Having treated patients with cervical cancers in
the orthogonal era for a long time, it was only in
the past couple of years I treated patients with
image guidance (CT in India and, more recently,
MRI at the Clatterbridge centre on the Wirral
in the UK). Of course, it was self taught and I
learnt from what I saw my peers doing. Hence, I
was keen to attend this course and hoped to gain
from it. It far exceeded my expectations.
E-LEARNING
The course was extensive and thorough, going
from the basics with attention to detail, to the
recent advances and results. It covered cross-sectional anatomy (with particular emphasis for
external beam radiotherapy and brachytherapy),
contouring, aspects and perspectives from physics; it dealt with intracavitary, interstitial techniques for cervical cancers and for endometrial,
vulval and vaginal cancers. In addition there
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I have to now speak of the faculty; all I can say is
they were knowledgeable, experienced and passionate about disseminating this. We could see
that they were keen to promote good practice
and make this as uniform as possible across the
world, especially as the incidence of cervical cancer is greater in the developing countries.
The social programme on the third day was well
attended and enjoyable. The workshop venue
and Florence were the perfect settings for this
extremely well-presented and run course. The
evenings were lovely with friendly delegates from
various countries, which was a lot of fun too.
were case discussions and contouring exercises for various scenarios with plenty of scope for
interaction and questions, with the discussions
being robust. Other useful and interesting topics
covered were the inter and intrafraction uncertainties and imaging strategies, nodal and parametrial boosts and midline blocks. Parallel workshops for clinicians and physicists and radiation
therapists were popular as well.
INTRODUCTION
The quality of the presentations and the experience of the faculty was so good that the attendance was almost 100% on all days for all of the
day, with some drop off only on the last day towards the end as the delegates had to catch their
flights back home. Even then, most tried to stay
on as long as possible. There were video presentations of interstitial brachytherapy at lunch times;
again this was enthusiastically attended and this
spoke of the interest generated by the faculty.
E-LEARNING
Finally, I have to note that the faculty and the organiser were friendly and allowed the programme
to be interactive and that we thoroughly enjoyed
it. It was easily the best course I have attended.
Rekha Neupane
Consultant clinical oncologist
North Wales Cancer centre, UK
Rekha.Neupane@wales.nhs.uk
COURSE REPORTS
E-ESO
COURSE REPORTS
ESTRO SCHOOL
BEST PRACTICE IN
RADIATION ONCOLOGY:
A WORKSHOP TO TRAIN
RTT TRAINERS
20 - 24 October 2014
Vienna, Austria
COURSE DIRECTORS:
Mary Coffey
School of Medicine
Trinity College - Dublin, Ireland
Guy Vandevelde
High School of Health Sciences
University of Brussels, Belgium
IGLIKA MIHAYLOVA
INTRODUCTION
PETKO TSENOV
DOBROMIRA
DECHKOVA
It was a great pleasure to attend the five-day
course, organised by ESTRO and supported by
IAEA, on the topic of “Best practice in radiation
oncology: a workshop to train RTT trainers” in
2014 in Vienna, Austria. The participants were
radiation therapists (RTTs), physicians, physicists
and engineers from 11 different countries in Eastern Europe, Western and Central Asia.
E-LEARNING
The main objective of the training was preparing
for the practical organisation of a course for RTTs
on a particular topic, relevant to the respective
country and clinic. As participants, we appreciated this type of training (a brilliant idea of the
course director Mary Coffey) aimed at the direct
contractors of the radiotherapy process – the
RTT.
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practice. The presentations of the leading lecturers
discussed the following topics: factors to consider
when preparing a short course, professional presentation techniques, organising a practical workshop, practical organisation of the course, and
running a journal club.
ESTRO and IAEA Core Curricula / Benchmarking revision 2003 and 2014 were presented during
the first day. The topics, highlighted and emphasised during the training, encompassed the role of
the RTT in the radiotherapy team, the RTT’s roles
and responsibilities to deliver optimum treatment
to patients, to optimise the radiotherapy process
for patients, and to develop the role and promote
the profile of the RTT within the multidisciplinary
team. In addition, other topics focused on enabling
the RTT to distinguish between good and bad
practices and to always accept only best practices,
to meet new challenges and adapt to changes in
the environment, as well as to engage in reflective
INTRODUCTION
The course format was well structured with lectures, followed by workshops. The faculty were
very warm, enthusiastic and constantly in contact
with groups from different countries. They gave
their valuable advice and recommendations for
the future organisation of courses on relevant
topics in the respective countries. The lecture
“Practical organisation of a teaching course”
helped the participants to suggest an adequate
framework for future courses. After four days of
intensive work the course ended with each group,
having prepared a draft programme for a forthcoming course in their country.
The social dinner was held in a traditional Austrian restaurant with national cuisine that enabled
communication between the course participants
in an informal setting. Vienna, the city of music,
with its beautiful sights – gothic cathedrals, palaces with art galleries and beautiful parks – allowed the participants to fully relax after a long
working day.
E-LEARNING
The training course, with its perfect organisation,
selected team of experienced lecturers and moderators, combined with the charm of the city of
Vienna, will be remembered by all participants as
a rewarding and valuable experience. Therefore,
we would like to highly recommend this course
to RTTs involved in teaching and training.
Dobromira Dechkova
Radiation therapist
Specialised Hospital for Active Treatment in
Oncology
Sofia, Bulgaria
dobromira.dechkova@gmail.com
Iglika Mihaylova
Radiation oncologist
Specialised Hospital for Active Treatment in
Oncology
Sofia, Bulgaria
iglikamihaylova@yahoo.com
Petko Tsenov
Radiation therapist
Tokuda Hospital
Sofia, Bulgaria
petko_n1@mail.bg
COURSE REPORTS
E-ESO
ESTRO SCHOOL
E-ESO
Free distance learning
programmes on the internet
The European School of Oncology, in co-operation with Nature Reviews Clinical Oncology
and Critical Reviews in Oncology Haematology,
is holding a series of free distance learning programmes on the internet, called “e-sessions”:
e-grandrounds and e-oncoreviews.
e-grandrounds are bi-monthly sessions on
hot-topics organised without commercial sponsorship and are CME and ESMO-MORA accredited.
e-oncoreviews are monthly sessions designed to
offer a balance and comprehensive overview on a
specific topic, be it a tumour type, a type of therapy, diagnostic or therapeutic approach. Some
e-oncoreviews are organised in collaboration
with the School’s sponsors, whilst ESO-organised
sessions are held in co-operation with Nature
Reviews in Clinical Oncology and Critical Reviews
in Oncology Haematology; they are CME and ESMO-MORA accredited.
ing and after the live sessions. Questions received
before and during the session will be answered
during the session directly. Questions received
after the sessions will be answered by email. Registration to e-ESO is free but is required in order
to provide a high-quality personalised service.
www.e-ESO.net
Participants are invited to attend the sessions:
• live e-grandround: these take place on the second and fourth Thursday of every month at the
same time (18.15-19.00 hrs CET)
• live e-oncoreview: the first Tuesday of the
month at the same time (18.15-19.00 hrs CET)
• recorded session: available 24 hours after the
live session.
Attendants can participate remotely, without a
webcam and without appearing in the system.
Questions can be sent to our experts before, dur-
INTRODUCTION
E-LEARNING
COURSE REPORTS
E-ESO
INTRODUCTION
E-LEARNING
COURSE REPORTS
E-ESO
ESTRO SCHOOL
OF RADIOTHERAPY AND ONCOLOGY
2015
WWW.ESTRO.ORG
COMPREHENSIVE QUALITY
MANAGEMENT IN RADIOTHERAPY:
QUALITY ASSESSMENT
AND IMPROVEMENT
CANCER SURVIVORSHIP
1 - 4 February 2015 | Turin, Italy
16 - 19 May 2015 | Manila, The Philippines
ESTRO/EANM COURSE ON
MOLECULAR IMAGING AND
RADIATION ONCOLOGY
BIOLOGICAL BASIS OF PERSONALISED
RADIATION ONCOLOGY
14 - 16 May 2015 | Brussels, Belgium
ADVANCED TREATMENT PLANNING
NEW!
22 - 25 February 2015 | Madrid, Spain
BASIC CLINICAL RADIOBIOLOGY
7 - 11 March 2015 | Brussels, Belgium
30 August - 3 September 2015 | Dublin, Ireland
22 - 24 May 2015 | Seoul, South Korea
8 - 12 March 2015 | Paris, France
TARGET VOLUME DETERMINATION:
FROM IMAGING TO MARGINS
13 - 16 March 2015 | Amman, Jordan
MODERN BRACHYTHERAPY
TECHNIQUES
15 - 18 March 2015 | Limassol, Cyprus
DOSE MODELLING AND VERIFICATION
FOR EXTERNAL BEAM RADIOTHERAPY
14 - 17 June 2015 | Beijing, China
PHYSICS FOR MODERN RADIOTHERAPY
EVIDENCE BASED RADIATION
ONCOLOGY
15 - 19 March 2015 | Barcelona, Spain
A CLINICAL REFRESHER COURSE
WITH A METHODOLOGICAL BASIS
21 - 26 June 2015 | Moscow, Russia
3rd ESTRO FORUM
PRE-MEETING COURSES
BRACHYTHERAPY FOR
PROSTATE CANCER
24 April 2015 | Barcelona, Spain
28 - 30 June 2015 | Vienna, Austria
IMAGE-GUIDED RADIOTHERAPY IN
CLINICAL PRACTICE
ADVANCED SKILLS IN MODERN
RADIOTHERAPY
10 - 14 May 2015 | Prague, Czech Republic
28 June - 2 July 2015 | Copenhagen, Denmark
RADIOTHERAPY TREATMENT PLANNING AND DELIVERY
BIOLOGY
3 - 5 September 2015
London, United Kindgom
NEW!
ESTRO/ESOR MULTIDISCIPLINARY
APPROACH OF CANCER IMAGING
15 - 17 October 2015 | Brussels, Belgium
BEST PRACTICE IN RADIATION
ONCOLOGY
A FOUR PHASE PROJECT TO TRAIN RTT
TRAINERS IN COLLABORATION WITH THE IAEA
19 - 21 October 2015 | Vienna, Austria
IMAGING FOR PHYSICISTS
IMAGE-GUIDED RADIOTHERAPY AND
CHEMOTHERAPY IN GYNAECOLOGICAL CANCER: FOCUS ON ADAPTIVE
BRACHYTHERAPY
13 - 17 September 2015 | Leiden, The Netherlands
1 - 5 November 2015 | Utrecht, The Netherlands
BASIC TREATMENT PLANNING
COMBINED DRUG-RADIATION
TREATMENT: BIOLOGICAL BASIS,
CURRENT APPLICATIONS AND
PERSPECTIVES
NEW!
3 - 6 September 2015 | Prague, Czech Republic
8 - 11 June 2015 | Florence, Italy
A JOINT COURSE FOR CLINICIANS
AND PHYSICISTS
14 - 18 June 2015 | Ljubljana, Slovenia
HAEMATOLOGICAL MALIGNANCIES
RESEARCH MASTERCLASS IN
RADIOTHERAPY PHYSICS
MULTIDISCIPLINARY MANAGEMENT
OF BREAST CANCER
MULTIDISCIPLINARY MANAGEMENT
OF HEAD AND NECK ONCOLOGY
PARTICLE THERAPY
MULTIMODAL CANCER TREATMENT
CLINICAL PRACTICE AND
IMPLEMENTATION OF IMAGE-GUIDED
STEREOTACTIC BODY RADIOTHERAPY
13 - 17 September 2015 | Lisbon, Portugal
ADVANCED TREATMENT PLANNING
18 - 22 September 2015 | Lisbon, Portugal
MULTIDISCIPLINARY MANAGEMENT
OF BRAIN TUMOURS
4 - 6 October 2015 | Turin, Italy
IMRT AND OTHER CONFORMAL
TECHNIQUES IN PRACTICE
4 - 8 October 2015 | Brussels, Belgium
15 - 18 November 2015 | Vienna, Austria
PAEDIATRIC RADIATION ONCOLOGY
19 - 21 November 2015 | Izmir, Turkey
BASIC CLINICAL RADIOBIOLOGY
ENDORSED BY ESTRO
21 - 24 November 2015 | Brisbane, Australia
4 - 8 October 2015 | Budapest, Hungary
QUANTITATIVE METHODS IN
RADIATION ONCOLOGY: MODELS,
TRIALS AND CLINICAL OUTCOMES
MULTIDISCIPLINARY MANAGEMENT
OF LUNG CANCER
ADVANCED TECHNOLOGIES
TARGET VOLUME DETERMINATION FROM IMAGING TO MARGINS
15 - 17 October 2015 | Athens, Greece
IMAGING
BEST PRACTICE
6 - 9 December 2015 | Brussels, Belgium
6 - 10 December 2015 | India
YOUNG ESTRO
INTRODUCTION
EORTC-ROG MEETING
ESTRO YOUNG TASK FORCE
MOBILITY REPORT
YOUNG ESTRO
Welcome to this new issue of the Young Corner.
The European Organisation for Research and Treatment of Cancer (EORTC) Radiation Oncology Group
(ROG) held its autumn meeting at The Institut Gustave-Roussy, France, and Orit Person, chair of the
young group, reports on the YROG-SFjRO joint session that took place during that meeting.
CATHARINE CLARK
We finish our series of Young Task Force interviews with Jean-Emmanuel Bibault and Wouter Van
Elmpt’s answers and we also publish Alexis Dimitriadis’ mobility grant report about his stay at the VU
medical centre in Amsterdam.
We hope you’ll like this new issue.
Catharine Clark and Jean-Emmanuel Bibault
INTRODUCTION
JEAN-EMMANUEL
BIBAULT
EORTC-ROG MEETING
ESTRO YOUNG TASK FORCE
MOBILITY REPORT
YOUNG ESTRO
Radiation Oncology Group of EORTC
SFjRO and YROG joint session:
YOUNG RADIATION
ONCOLOGISTS
PRESENT THEIR
RESEARCH AT THE
EORTC-ROG
MEETING
At the Institut Gustave Roussy
Villejuif, France
ORIT KAIDAR-PERSON
INTRODUCTION
THOMAS LEROY
The European Organisation for Research and
Treatment of Cancer (EORTC) Radiation Oncology Group (ROG) held its autumn meeting at the
Institut Gustave Roussy, Villejuif, France. During
this meeting the Young Radiation Oncologists
Group (YROG) held its third session. The YROG
is a new working party (WP) within the ROG,
which aims to incorporate young radiation oncologists in the work done within the ROG to encourage a new generation of radiation oncologists
who are dedicated to clinical research.
This session was unique as it was a joint session
with the French Society of Young Radiation
EORTC-ROG MEETING
Oncologists (SFjRO), the young division of the
French national society of radiation oncologists.
SFjRO, in contrast to the YROG, is a “veteran”
group of young radiation oncologists since it has
been active for over 11 years in promoting the education and training of the speciality in France.
SFjRO organises teaching courses twice a year,
delineation workshops, developing advanced
learning tools (such as applications for smart
phones), has free access to scientific journals,
courses and more. SFjRO also has a very active
website which maintains an updated database of
learning courses, video courses and more [visit
http://www.sfjro.fr]. A questionnaire conducted
ESTRO YOUNG TASK FORCE
MOBILITY REPORT
by SFjRO of the motivations for choosing the
radiation oncology speciality among the French
residents, indicated that the main driver was an
interest in innovation, technology, imaging and
research. This was a basis for a successful collaboration between these two young groups, YROG
and SFjRO, both aiming to inspire the young
members.
The session moderators were Thomas Leroy, the
secretary of SFjRO and Orit Kaidar-Person, the
chair of the YROG. The scientific agenda was
composed of presentations by young radiation
oncologists who showed studies conducted in
their institutions on various novel subjects such
as intensity-modulated radiation therapy (IMRT)
for breast cancer, stereotactic body radiation therapy (SBRT) for hepatic cellular carcinoma, and
dosimetric aspects for two irradiation techniques
of benign brain tumours. These great presentations stimulated discussions and highlighted the
potential benefit of young radiation oncologists
joining the ROG and participating in the YROG
session.
The topics aired during this session will be the
backbone of the future clinical trials launched in
Europe in the framework of the EORTC. It was
also a good example of the importance of the
collaboration of the YROG with young national
societies such as SFjRO, and having SFjRO members join and participate in the YROG and ROG
activities. The YROG sessions are a platform for
INTRODUCTION
young radiation oncologists to present research
proposals, local studies and innovative ideas, and
to be noticed in the European arena; joining the
ROG activities is an opportunity to work side by
side with world leaders in oncology and to take
part in the planning and conducting of a wide
variety of clinical trials within the EORTC. Fellowship opportunities are also available for young
radiation oncologists (EvDS fellowship, for more
details please go to the EORTC website). The
YROG will also benefit from the experience and
expertise of the SFjRO executive committee who
have devoted many years to promoting young
members.
The ROG Paris meeting was highly scientific,
included stimulating lectures from three continents, and also an enchanting dinner on a cruise
boat on the river Seine.
The idea of collaboration between the YROG
and other European young national societies
also gained the support of ESTRO, thanks to the
assistance of ESTRO’s President, Professor Philip
Poortmans, and of the Chair of ESTRO’s National Society Committee, Professor Umberto Ricardi, which will undoubtedly lead to a productive
collaboration for all.
PLEASE JOIN US AT THE NEXT
ROG MEETINGS:
12 -13 March 2015
EGAM, Crowne Plaza Hotel
Brussels, Belgium
8 -10 October 2015
Las Palmas, Canaries
For more details regarding the YROG please
go to the EORTC website:
www.eortc.org
or email:
Dr Orit Kaidar-Person, YROG Chair,
o_person@rambam.health.gov.il
For more details regarding the YROG please
go to SFjRO website:
www.sfjro.fr
Orit Kaidar-Person
YROG chair
Thomas Leroy
Secretary of SFjRO
EORTC-ROG MEETING
ESTRO YOUNG TASK FORCE
MOBILITY REPORT
ESTRO YOUNG TASK FORCE (YTF)
YOUNG ESTRO
Focus on the ESTRO Young Task Force (YTF)
Initiated in 2011, the Young Task Force (YTF) is appointed by the ESTRO
Board and is involved at governance level. Their mission is to support
ESTRO in the development of actions for the benefit of their young col-
Interview with Wouter van Elmpt
Member of the YTF
INTRODUCTION
EORTC-ROG MEETING
leagues from the radiation oncology area. In each issue, we introduce some
of the YTF members so that you get to know your representatives within
ESTRO better.
Interview with Jean-Emmanuel Bibault
Member of the YTF
ESTRO YOUNG TASK FORCE
MOBILITY REPORT
ESTRO YOUNG TASK FORCE (YTF)
YOUNG ESTRO
INTERVIEW WITH
WOUTER VAN ELMPT
Member of the YTF
PhD
Department of Radiation Oncology (MAASTRO)
Maastricht University Medical Centre
Maastricht, The Netherlands.
Email: wouter.vanelmpt@maastro.nl
Tell us about your training and your current employment.
I studied Applied Physics (Eindhoven, The Netherlands) with a specialisation in Medical Physics.
After that I took up a research position at the
Department of Radiation Oncology (MAASTRO)
at the Maastricht University Medical Centre (The
Netherlands) and defended my PhD in 2009 on
the topic of treatment verification for advanced
radiotherapy. A three-year post-doc at the Maastricht University followed and now I am a senior
scientist at MAASTRO supported by a four-year
fellowship from the Dutch Cancer Society to
study the use of multi-modality imaging for the
optimisation of lung cancer treatment.
What is your main area of interest?
Individualised patient treatment, with a focus on
lung cancer. My specific research focuses around
molecular imaging, i.e. metabolic and hypoxia
imaging, and dose delivery techniques such as
dose-painting by numbers/contours. Also treatment response assessment of both tumour and
normal tissues using (functional) imaging is one
of my key research interests.
When did you join ESTRO?
In 2004 as a student member to present a poster
at the ESTRO meeting in Amsterdam. From that
year onwards I have been an In Training member
of ESTRO.
What does your involvement with
ESTRO and the young task force (YTF)
mean to you?
I would like to connect all the young ESTRO
members that have an interest in research. A lot
of high quality research is performed in Europe
but I think it can be strengthened even more if we
combine efforts. Finding other young researchers with similar interests can be used to facilitate
collaborations in Europe. Besides that, it is fun to
talk and work together with other young ESTRO
members.
How do you balance research and clinical work?
At the moment I can devote the majority of my
time to research. However, that does not mean
that I am not involved in the clinic. I start and supervise many projects that introduce my research
findings in clinical practice. Therefore, a link to
clinical work needs to be present.
WOUTER VAN ELMPT
INTRODUCTION
EORTC-ROG MEETING
ESTRO YOUNG TASK FORCE
MOBILITY REPORT
ESTRO YOUNG TASK FORCE (YTF)
What advice would you have for new
young members entering the world of
radiation oncology?
Look around you! A lot of enthusiastic people are
united in ESTRO, and willing to help you if necessary. Do not be afraid to ask questions if you
see a nice presentation at an ESTRO conference
or read an interesting article in Radiotherapy and
Oncology.
THE ESTRO
JOB FAIR AT THE 3RD ESTRO FORUM
25 - 26 April 2015 Barcelona, Spain
The job fair at the 3rd ESTRO Forum is certainly an opportunity not
to be missed by our young colleagues.
The job fair is a unique occasion at which to meet people from leading
European institutions, offering jobs for young talents in the field of
clinical radiation oncology, medical physics, radiation biology as well
as radiation therapists. Do not miss this opportunity to discuss your
plans for your future in radiation oncology with people from research
and clinical departments during this event.
Daniela Thorwarth, on behalf of the Young Task Force
INTRODUCTION
EORTC-ROG MEETING
ESTRO YOUNG TASK FORCE
MOBILITY REPORT
ESTRO YOUNG TASK FORCE (YTF)
YOUNG ESTRO
INTERVIEW WITH
JEAN-EMMANUEL BIBAULT
Member of the YTF
MD, MSc
Department of Radiation Oncology
Hôpital Européen Georges Pompidou
Paris, France
Email: jebibault@gmail.com
Tell us about your training and your current employment.
I’ve just taken a new position as Assistant Professor in Paris after five years of residency in Lille
and a Master’s Degree in radiobiology at the Gustave Roussy Institute in Villejuif.
What is your main area of interest?
My main areas of interest include radiobiology,
biomarkers, bioinformatics and genomics. I truly
believe these tools will open new possibilities in
cancer care. I’m also very interested in new technologies such as mobile health IT and social media
with several side projects involving programming.
When did you join ESTRO?
I joined ESTRO during my third semester in
2010 to attend ESTRO 29 in Barcelona. I’ve been
involved in ESTRO activities since January 2013
when I became the editor of the Young Corner
of ESTRO’s newsletter with Catharine Clark and
later joined the Young Task Force of ESTRO.
What does your involvement with
ESTRO and the young task force (YTF)
mean to you?
JEAN-EMMANUEL
BIBAULT
INTRODUCTION
I think ESTRO is a great way to meet other European radiation oncology professionals to share our
experiences for better patient care. In that perspec-
EORTC-ROG MEETING
tive, participating in the YTF is a great way to promote exchange between young members. I think
the YTF is trying to bring together young ESTRO
members and should continue to do so through
the use, for example, of digital and online tools.
How do you balance research and
clinical work?
To this day, I’ve either been working in a clinical
setting or in a lab. I’ve never had to mix the two. But
I guess I’ll eventually have to do it. I might actually
enjoy it because it’s a great way to keep variety and
interest in one’s everyday tasks. I’ve always been fascinated by the translation of basic research in the clinical field so I can’t wait to make that part of the job.
What advice would you have for new
young members entering the world of
radiation oncology?
I’m still a little bit young to be giving advice, but
anyway I think the best advice I could give is
simply to do what you really like and not force
yourself. If you like basic science, clinical research
or patient care, there’s plenty to do in each one
of these fields. Just pick what you like and go for
it. Don’t be shy and don’t hesitate to contact and
exchange information with your mentors, fellow
residents etc.
ESTRO YOUNG TASK FORCE
MOBILITY REPORT
YOUNG ESTRO
MOBILITY REPORT
INTRACRANIAL STEREOTACTIC RADIOSURGERY WITH
THE NOVALIS TX SYSTEM
Alexis Dimitriadis
HOST INSTITUTE:
VU medical centre, Amsterdam, The Netherlands
DATE OF VISIT:
29 September - 10 October 2014
ALEXIS DIMITRIADIS
INTRODUCTION
Alexis Dimitriadis with his co-workers from the VUmc team
First of all, I would like to thank ESTRO for the
award of a mobility grant to visit VUmc in Amsterdam. I’m glad to state that the visit not only
met but exceeded my expectations. I found the
two weeks I spent in Amsterdam extremely beneficial both to my professional role and research
interests. I am currently pursuing my PhD and
my interests lie in developing the methodology
for an end-to-end audit of stereotactic radiosurgery. I am also employed by the St Luke’s Cancer
Centre, a department that will be installing a
Novalis Tx radiosurgery unit in early 2015. This
gave me two reasons for wanting to visit a centre
with experience in this field. The VUmc was an
ideal destination as it is one of the first centres in
Europe to install a Novalis Tx linac. They have
accrued substantial experience with it, proven by
a series of publications and talks at various con-
EORTC-ROG MEETING
ferences. The main aims of my visit were to gain
a better understanding of the challenges involved
in running a radiosurgery programme, and to
observe the local quality assurance procedures.
I was fortunate that my visit coincided with the
delivery of a locally engineered phantom for an
end-to-end test, or as the Dutch say “ketentest”.
The phantom was specifically designed to be used
for stereotactic treatments and I had the opportunity to help perform the first tests with it. In liaison with the radiation technicians, we performed
the local stereotactic protocol in acquiring a high
resolution CT-scan of the phantom. I then used
the treatment planning facilities to delineate four
metastatic brain lesions within the “brain” of the
phantom. Using the Eclipse system and with the
guidance of a planning team, a VMAT plan
ESTRO YOUNG TASK FORCE
MOBILITY REPORT
Plan on phantom
Cross section of the phantom showing the dose distribution in the plan created
was developed using the two non-coplanar arc
technique developed at VUmc: a full 360 arc with
the couch at 0˚ and a 180˚ “Mohawk” arc with
the couch at 90˚. This plan was then delivered to
the phantom and, using EBT3 Gafchromic film
in two planes, dosimetric tests were performed in
the low dose region between the four high dose
areas. The results showed a substantial agreement
between the predicted and measured doses in the
low dose regions between the metastatic lesions.
However, the limited time spent there did not
allow for any repeat measurements. Therefore,
we can say that even though the results were not
conclusive, they revealed the potential of the
phantom’s use for such tests and they also were
indicative of some minor adaptations that could
improve the phantom. My participation in this
project also allowed observation of the use of radiochromic film for routine measurements.
INTRODUCTION
Apart from performing these tests, I observed
the treatment of a patient with an arteriovenous
malformation from fixation of the stereotactic
frame, through angiography, CT-scanning, image fusion, target delineation, treatment planning
and treatment delivery. I also participated in
quality control measurements using electronic
portal imaging devices (EPID). On my final day
in The Netherlands it was arranged for me to visit
the Utrecht Medical Centre where I had the opportunity to see the radiotherapy department and
discuss my research with members of their physics team who have similar interests.
Finally, I would like to take this opportunity to
convey my gratitude and appreciation to all the
people at the VUmc, who, apart from making
me feel welcome during my stay, took the time
to discuss with me and help me out in any way
EORTC-ROG MEETING
they could. Special thanks to Johan Cuijpers,
Stan Heukelom, Leo Van Battum, Mustafa Zahir,
Wenze Van Klink, Omar Bohoudi and Ingrid
Kuijper.
Alexis Dimitriadis
Radiotherapy Dosimetrist
St. Luke’s Cancer Centre
Royal Surrey County Hospital
Guildford, UK
a.dimitriadis@nhs.net
Postgraduate Researcher
Advance Technology Institute
University of Surrey
Guildford, UK
a.dimitriadis@surrey.ac.uk
ESTRO YOUNG TASK FORCE
MOBILITY REPORT
BASIC CLINICAL RADIOBIOLOGY
2015
ESTRO SCHOOL
LIVE COURSE
7 - 11 March 2015 | Brussels, Belgium
BIOLOGY
TOPICS
· The basic mechanisms of cell death/
survival and the radiation response of
tumours and normal tissues.
· Formulas of tissue tolerance
· The biological basis for current approaches to the improvement of radiotherapy including novel fractionation schemes, retreatment, IMRT,
modification of hypoxia, hadron therapy, combined radiotherapy/chemotherapy and biological modifiers of
tumour and normal tissue effects.
www.estro.org/school >
WWW.ESTRO.ORG
HEALTH
ECONOMICS
INTRODUCTION
REIMBURSEMENT
HEALTH
ECONOMICS
“The burgeoning cost
of health care is a
concern in almost
every jurisdiction and
particularly in the
United States where
it currently consumes
close to 18% of GDP”
“Every health care system is shaped by its reimbursement design”. This is the opening sentence of a recently published paper by Cox and
colleagues1. The burgeoning cost of health care
is a concern in almost every jurisdiction and
particularly in the United States where it currently consumes close to 18% of GDP. It has long
been recognised that even if the current yearly
expenditures on health care are sustainable, the
rates of increase seen over the last two decades
are not. The authors of this paper discuss this
issue against the background of health care reform in the US, which, particularly in the light of
“Obamacare” (Affordable Health Care for America Act), is the subject of considerable debate. The
authors are medical oncologists who might see
the world differently from the radiation community where infrequent large capital items are
required as opposed to more frequent but often
expensive drug regimens.
YOLANDE LIEVENS
PETER DUNSCOMBE
Yolande Lievens, Peter Dunscombe and Madelon
Pijls
MADELON PIJLS
INTRODUCTION
REIMBURSEMENT
HEALTH
ECONOMICS
REIMBURSEMENT
PETER DUNSCOMBE
INTRODUCTION
Funding of radiotherapy, and other health care
activities, can be provided in the form of a global
budget for a programme or department. Global budgets are loosely coupled to workload, although frequently involve a time lag between
volume/complexity increases and the release (or
not) of additional funding. A reimbursement system, on the other hand, is a funding mechanism
which attempts to directly reflect the volume of
activities, including complexity, in somewhat
closer to real time. While there is a spectrum of
reimbursement models, the extremes are fee-forservice (FFS) and capitation. In their simplest
forms, FFS requires every patient-related activity
to be identified and billed and capitation provides
reimbursement per patient irrespective of complexity and the details of the activities performed.
FFS is obviously costly to administer and has a
tendency to drive more expensive billable activities, while capitation could lead to treatments that
may be sub-optimal in order to keep total costs
within the reimbursement limit. The challenge of
designing a reimbursement system is to provide
the best outcome, in all its dimensions, for patients while controlling costs: i.e. providing value.
The authors of the paper under discussion [1],
and many others, see some form of bundling or
episode payment as a (partial) solution to the
current dilemma. Bundling means reimbursement on the basis of expected costs for a clinically-defined episode of care for a set period of time,
perhaps from 30 days to a year. Failure to provide
a quality service would presumably result in more
remedial interventions, such as hospitalisation,
the cost of which would have to be covered within the previously negotiated bundle reimbursement, thus promoting quality medicine in some
sense. Some form of bundling could also serve
to break down the silo mentality encountered in
much of medicine, as all the service providers
would share the same pot of money and be jointly
accountable for the patient outcome.
The authors make several arguments for reform
of the FFS system. To make FFS workable at all,
only certain activities can be identified for reimbursement within the fee schedule. All the other
activities, such as phone calls to the patient and
informal discussions with colleagues, have to be
covered by the “overhead” on the billable service.
The authors see this as a shortcoming that has
a major impact on the movement towards personalised medicine. Personalised medicine, in
their interpretation, includes questioning huge
databases and looking for successful treatments
for patients with similar profiles to the patient of
interest. With no reimbursement for learning the
skills and taking the time to personalise medicine, it’s unlikely to be widely adopted.
Lack of transparency is another negative aspect
of the current FFS system that the authors cite.
By transparency, the authors mean knowing both
the costs and the benefit or value of a service.
Only armed with such information can informed
judgements be made on the allocation of scarce
resources. With the piecemeal billing of the FFS
approach to reimbursement, the actual cost of
REIMBURSEMENT
an episode of care to a patient will be variable,
depending on what diagnostic and therapeutic
activities are actually performed for that particular patient, and difficult to quantify as overhead
and ancillary support services are somehow incorporated into the billing codes. While methods
for calculating the benefit of an intervention, in
QALYs or some other metric, are still the subject
of debate, in principle it should be possible to get
a reasonable handle on costs if an appropriate
alternative to FFS were to be implemented.
Next, the authors discuss the issue of palliative
care. They stress the importance of palliative
care, which, for them, starts with a conversation
about the goals of treatment and prognosis, and
point out that a one-size-fits-all approach may
not be appropriate in this context. They then float
the idea of “time-based billing” which sounds a
lot like fee for service. The main message in this
section of the paper seems to be that while palliative care, by any definition, has assumed greater importance in recent years, reimbursement
schemes have yet to acknowledge the resource
implications.
The paper concludes with a description of an
initiative by one of the authors, Dr McAneny.
She has been promoting the value to the patient
of moving as much patient care as possible out
of the hospital into the physician’s office, which
is cheaper, more acceptable to the patient but,
apparently, not adequately reimbursed by the
current US FFS system. The implication here is
INTRODUCTION
that a new payment model should include the full
spectrum of services from financial counselling
to symptom management to be delivered in a
community practice.
This paper obviously has a US (and medical
oncology) flavour but issues surrounding reimbursement are of concern in every health care
jurisdiction. Strategies for containing costs whilst
meeting patients’ increasing expectations of quality care should be formulated by the radiation
community before key decisions are taken out of
our hands to the possible detriment of the patient
population we serve. The ESTRO-HERO project
has accumulated data on reimbursement systems
for radiotherapy in the European countries. Such
information will fuel this important discussion
and hopefully will support the development of
reimbursement strategies that promote the highest quality and most cost-effective care for the
radiotherapy patient, in each individual European country.
Peter Dunscombe
University of Calgary,
Calgary, Alberta, Canada
REFERENCE
1. Cox, J.V., Ward, J.C, Hornberger, J. C., Temel, J.S. and
McAneny, B. L. Community Oncology in an Era of Payment Reform 2014 ASCO Educational Book asco.org/
edbook
REIMBURSEMENT
INSTITUTIONAL
MEMBERSHIP
INTRODUCTION
THE LAUSANNE
UNIVERSITY HOSPITAL
INSTITUTIONAL
MEMBERSHIP
INSTITUTIONAL ESTRO MEMBERSHIP
BECOME AN INSTITUTIONAL
MEMBER
The possibility of signing up groups of
five people represents a very interesting
economical opportunity, whilst benefitting
from all regular membership advantages
as well as a few extra advantages created
just for your institute. The packages include
various membership types and a minimum
of thee disciplines need to be represented.
Detailed information can be found on the
website: www.estro.org
The Institutional membership category has been especially designed for European hospitals, clinics
or other institutions that seek to continuously develop and support their radiotherapy and oncology
professionals. In this Corner we invite our institutional members to provide you and us with some
feedback on their experience and institute.
This month we have invited Jean Bourhis, Chair of the Radiation Oncology Department of the Lausanne
University Hospital in Switzerland to introduce his institute.
Contact: institutional-membership@estro.org
INTRODUCTION
THE LAUSANNE
UNIVERSITY HOSPITAL
INSTITUTIONAL
MEMBERSHIP
THE LAUSANNE
UNIVERSITY
HOSPITAL
Lausanne, Switzerland
Number of ESTRO institutional members: 40
Spokesperson: Professor Jean Bourhis,
Chair of the Radiation Oncology Department
www.chuv.ch/radio-oncologie
for medical physics: www.chuv.ch/ira
Radiation Oncology / Biology and Medical Physics at Lausanne University Hospital
How would you describe the radiation oncology department of your institute?
JEAN BOURHIS
INTRODUCTION
The Radiation Oncology Department of the Lausanne Cancer Centre treats a little over 1,000 new patients per year and has 15 medical staff (junior and
senior) 20 RTTs, two nurses and 12 physicists (junior and senior, under the leadership of Dr Raphaël
Moeckli), and five biologists (under the leadership
of Dr. Marie-Catherine Vozenin). A majority of us
(40) are ESTRO members through the institutional
membership.
What are the main areas of specialisation
in your department?
The Radiation Oncology Department is very well
integrated in the newly created Lausanne Cancer
Centre, where the development of synergies between
the sub-specialities of oncology is a major priority.
The Radiation Oncology Department is in charge of
treating all types of tumours and some clinical areas
are very strong due to excellent connections with
our surgical colleagues, such as lung, head and neck,
sarcoma, brain/spine and gynaecology.
THE LAUSANNE
UNIVERSITY HOSPITAL
What are the main achievements so far and
the main challenges on your daily work
and for the future?
3D conformal radiotherapy is no longer used in our
institute and has been replaced by either IMRT/
IGRT, 4D-RT or SBRT for all our patients. SBRT is
used increasingly in the context of metastatic patients, due to its excellent cure rate potential with
minimal, if any side effects. All this can be provided
to our patients through a CyberKnife, two Tomotherapies (along with a strong partnership with
Accuray) a Gammaknife and a Synergy (Elekta).
Brachytherapy is still used for some cases. PET-CT
or 4D PET-CT are used for planification purposes
for many of our patients. We have recently launched
under the same umbrella and under the direction of
Dr. Marie-Catherine Vozenin two radiobiological
laboratories: one is dedicated to functional imaging
and adaptive radiotherapy (with micro-PET and
X-Rad 225 Cx 3D irradiator), and the other one is
focused on new therapeutics and the combination
of radiation therapy with molecular targeted drugs
or immunotherapy (in collaboration with the Lausanne branch of the Ludwig Institute).
Is your department currently undertaking some studies or clinical trials that you
would like to share with the ESTRO community?
We would be delighted to share with other centres
in the ESTRO community some of our current
clinical research programmes. These are focused
INTRODUCTION
on SBRT (ex: dose escalation, five fractions in prostate cancers, or generating EBM level 1 on SBRT in
oligo-metastatic patients) or SBRT combined with
various types of immuno-stimulation. Functional
imaging and adaptive radiotherapy are also important avenues for potential collaboration (we have
easy access to many types of tracers). Along with the
Swiss Institute of Bioinformatics, we have launched
a programme to design new drugable molecules that
could be of interest for combinatory approaches and
that are first tested in our lab, and later transferred
in patients.
We have also created some innovations that are
about to be shared with the ESTRO community, for
example the “supergating”, which can fully control
lung motion (Dr Peguret/Professor Ozsahin). Other
examples will follow relatively soon, for example we
are testing a totally new and promising radiation
therapy prototype... Stay tuned!
What attracted you to apply for an institutional membership and why is it important
for your institute that its staff members are
part of ESTRO?
The newly created radiobiology team under the leadership of Dr. Marie-Catherine Vozenin (centre of the
picture)
In your opinion, what additional benefits
would be useful as part of the institutional
membership package?
This is an excellent initiative created in 2013, and
we have a very positive view on it. Congratulations
to Vincenzo Valentini (ESTRO past President),
Alessandro Cortese (ESTRO CEO), Dirk Verellen
(ESTRO membership officer) and the ESTRO Board
who promoted it.
What a strange question! ESTRO is “The” European
Radiation Oncology Society . . . Could we imagine
radiation oncology in Europe without a strong
ESTRO . . . and not being part of it?
The institutional membership is probably the easiest
and most practical way to bring most of our department within the ESTRO network.
THE LAUSANNE
UNIVERSITY HOSPITAL
NATIONAL
SOCIETIES
INTRODUCTION
SURVEY ON THE RELATIONSHIP OF ESTRO
WITH THE NATIONAL SOCIETIES
NATIONAL
SOCIETIES
Welcome to another issue of the National Societies
Committee (NSC) Corner.
In this issue, the NSC presents a critical summary
of results from a survey on the relationship of ESTRO with the national societies (NS).
“National societies on
the role of ESTRO and
the National Societies
Committee: on the right
path …”
These results are part of a broader survey performed by
Joana Poggemann in June 2014 as a case study for
her International Business Bachelor thesis on “Value creation in non-profit organisations: a stakeholder approach” during her internship at ESTRO.
PANAGIOTIS
PAPAGIANNIS
We would like to thank Joana, as well as NS representatives that responded, once more for the opportunity to refine the NSC role and road map.
Panagiotis Papagiannis
Member of the ESTRO national societies committee
Medical School, University of Athens
Athens, Greece
If your national society would like to share
views on these topics, please contact the
National Societies Committee via Chiara
Gasparotto: c.gasparotto@estro.org
INTRODUCTION
Read about the Belgian national societies
for radiation therapists in the RTT Corner
on p 56>
SURVEY ON THE RELATIONSHIP OF ESTRO
WITH THE NATIONAL SOCIETIES
NATIONAL
SOCIETIES
ESTRO is a strategic partner: 24.56%
SUMMARY OF
RESULTS FROM A
SURVEY ON THE
RELATIONSHIP OF
ESTRO WITH THE
NATIONAL
SOCIETIES (NS)
PANAGIOTIS
PAPAGIANNIS
INTRODUCTION
ESTRO is a partner: 24.56%
ESTRO is important to us as one of our external points of reference: 47.37%
ESTRO is not important to us: 1.75%
Other: 1.75%
Fig 1. Replies to the survey question: Describe the relationship you have with ESTRO
The degree of participation is an immediate and
unambiguous indicator. The response rate for this
survey was 45%. This is typical for NS responses
to questionnaire-based surveys. While adequate,
this figure certainly implies that there is room for
improvement. Especially considering that, while
NS involvement is strong in annual meetings, it
has been quite weak so far in terms of contributing or stimulating discussion in this Corner. So
the NSC would like to take the opportunity to
stress the importance of a two-way communication once more.
The NS deem their relationship with ESTRO to
be important. A closed-form question asking the
NS to define their relationship with ESTRO was
included in the questionnaire and replies indicate that ESTRO serves mainly as one of the NS’s
external points of reference, rather than a partner (fig 1). The non-exclusiveness of ESTRO in
this regard is understood in view of the currently
available means for swift and effortless information gathering. The NS also acknowledge ESTRO
as a provider of education and technology support, as well as a force in acting towards international integration.
The positive response to the question of whether NS members feel included in ESTRO was an
overwhelming 89.5%. This, however, is
SURVEY ON THE RELATIONSHIP OF ESTRO
WITH THE NATIONAL SOCIETIES
by strengthening the communication and cooperation with the NS. This need is also supported by
the fact that ESTRO communicates with the NS
more frequently than they do with ESTRO.
No: 4%
Yes: 96%
Fig. 2a. Replies to the survey question: Is the information
provided by ESTRO sufficient?
> Education and Training, especially grant possibilities
> Events and Congresses
> Oncopolicy, standards and regulations
> Research, developments, updates on new techniques
A selection of the open comments to the question:
On what matters would you like to be informed?
explained to a certain degree by the fact that
most NS members are also ESTRO members as
individuals.
According to the constructive comments accompanying negative responses, the NS are more readily accessible than ESTRO and also better accommodate issues associated with daily practice. The
latter is a field where the NSC is called to act upon
INTRODUCTION
Undoubtedly, the information provided by
ESTRO is deemed sufficient by the NS (fig 2a).
Most importantly, the NSC ranks high in the
list of information channels on ESTRO matters,
following the ESTRO office, newsletter and website (fig 2b). The list of topics on which NS prefer
to be informed about, mirrors the NS expectations from ESTRO, as well as the main points of
the NSC agenda. The latter focuses on: communication (newsletter Corner, annual meetings,
support of HERO and results dissemination to
NS), education (NS feedback on annual planning,
promoting/improving attendance, links with
other European education and training initiatives), support of young members (promoting the
establishment and cooperation of young societies
within NS), continuing personal and professional
development (core curricula, professional standards, training harmonisation, link to ACROP and
oncopolicy), and quality.
While a rewarding 83% believes that the introduction of the NSC has improved the communication between ESTRO and the NS, only 69% of
the NS feel better integrated within ESTRO after
the committee’s introduction. This is interpreted
as a clear need for further communicating the
NSC agenda and advancing the pace at which it is
realised.
According to replies to a closed question on the
NS’s organisational goals, the NS’s priorities are
the development of high quality standards, fostering adoption of standards of care, and science
dissemination (fig 3). Survey results also indicate
the strong belief of NS that information exchange
at the European level is necessary to facilitate
health research in radiotherapy and oncology as
well as to support lobbying activities (fig 4). It is
worth noting that NS share the belief that health
care is not a national issue, and this is also evident in the balance between the perceived importance of lobbying at national and international
levels.
0
10
20
30
40
50
National Societies Committee/ NSC contact person
ESTRO Office
ESTRO Website
ESTRO Newsletter
ESTRO Flash
Other
Fig. 2b. Collection of the open replies to the question:
Who informs you on ESTRO matters?
SURVEY ON THE RELATIONSHIP OF ESTRO
WITH THE NATIONAL SOCIETIES
NATIONAL SOCIETIES PRIORITIES
It does not fit
to our goals. (1)
It is important but it
It is one of our most
is not one of our preimportant goals. (3)
eminent goals. (2)
Σ
%
Σ
%
Σ
%
Ø
±
Dissemination of science
1x
1,92
20x
38,46
31x
59,62
2,58
0,54
Development of high quality
standards
-
-
7x
13,46
45x
86,54
2,87
0,34
Foster adoption of standards
of care
-
-
15x
28,85
37x
71,15
2,71
0,46
Health and economics
4x
7,69
36x
69,23
12x
23,08
2,15
0,54
Dissemination and adoption
of European Core Curricula
2x
3,85
25x
48,08
25x
48,08
2,44
0,57
EU policy monitoring and
intelligence gathering
5x
9,62
29x
55,77
18x
34,62
2,55
0,62
This corroborates the currently favoured action
plan wherein information is provided from
ESTRO to NS for them to act at a national level,
and collected by ESTRO from NS to lobby in the
interest of the radiation oncology field at an international level.
Fig. 3. Replies to the survey question: Please rate if your organisational goals correspond to the following.
NECESSITY OF INFORMATION EXCHANGE
Because it facilitates lobbying activities on
a European Level
Because it enables health research in radiotherapy and oncology
Does not make sense as health care is a
national issue
Is too much of an effort
0%
5%
10%
15%
20%
25%
30%
35%
Continuous development and improvement of RT: 18%
Expectations arising from ESTROs position in Oncopolicy
on EU level
More acces to resources and support: 24%
More visibility and activity within ESTRO: 12%
Other
0
10
20
30
40
50
Fig.4. Replies to the survey question: Exchange of data, databases, guidelines and best practices at European Level is necessary... (more than one answer is possible)
INTRODUCTION
A strong dialogue: 32%
Fig. 5. Collection of the open replies to the question:
What do you expect from the collaboration with ESTRO?
SURVEY ON THE RELATIONSHIP OF ESTRO
WITH THE NATIONAL SOCIETIES
ESTRO
CONFERENCES
INTRODUCTION
FOCUS ON NEXT ESTRO CONGRESSES
FOCUS ON PAST ESTRO CONGRESSES
ESTRO
CONFERENCES
“It appears that the
need to build bridges
between disciplines is
a concept that many
of you have found
appealing and useful”
A NEW YEAR WITH A PROMISING CONGRESS IN
VIEW…
We are very pleased to announce that 1,637 abstracts have been submitted for the 3rd ESTRO Forum – a record for this congress. It appears that
the need to build bridges between disciplines is a concept that many of
you have found appealing and useful.
There are a lot of radiation oncology events to look forward to in the
first part of 2015. In the following pages, we introduce the next Wolfsberg meeting; this meeting, initiated in 1997 and organised in scientific
collaboration with ESTRO, brings together both experienced as well as
young basic and clinical scientists from radiobiology and radiation oncology disciplines to discuss the newest developments in molecular radiation biology oncology. Do not miss the call for applications for the Varian - Juliana Denekamp award.
The next head and neck oncology event that should not be missed in
early 2015 is ICHNO, the multidisciplinary conference co-organised by
ESTRO, European Head and Neck Society (EHNS) and European Society
for Medical Oncology (ESMO). We hope to see you in Nice next month.
AGOSTINO BARRASSO
ESTRO Congress manager
ERALDA AZIZAJ
ESTRO Programme manager
Finally, we report on some of the 2014 conferences: EMUC in Lisbon,
with a report from the ESTRO representatives on the scientific committee, as well as the view from an ESTRO member; and the EHNS conference in Liverpool. The latter is the opportunity to give an update on
the “Make sense” campaign, to raise awareness on head and neck cancer
among the general public and the healthcare community in Europe.
We wish you an excellent 2015.
Agostino Barrasso and Eralda Azizaj
INTRODUCTION
FOCUS ON NEXT ESTRO CONGRESSES
FOCUS ON PAST ESTRO CONGRESSES
ESTRO
CONFERENCES
FOCUS ON NEXT ESTRO CONGRESSES
14TH INTERNATIONAL
WOLFSBERG MEETING
3RD ESTRO FORUM
24 - 28 April 2015
Barcelona, Spain
20 - 22 June 2015
Ermatingen, Switzerland
5TH ICHNO
International Conference on Innovative
Approaches in Head and Neck Oncology
12 - 14 February 2015
Nice, France
INTRODUCTION
FOCUS ON NEXT ESTRO CONGRESSES
EUROPEAN CANCER
CONGRESS
25 - 29 September 2015
Vienna, Austria
FOCUS ON PAST ESTRO CONGRESSES
CLINICAL
24 - 28 April 2015
Barcelona, Spain
PHYSICS
BRACHYTHERAPY
RADIOBIOLOGY
RTT
INTRODUCTION
FOCUS ON NEXT ESTRO CONGRESSES
FOCUS ON PAST ESTRO CONGRESSES
FOCUS ON NEXT ESTRO CONGRESSES
3rd ESTRO Forum
ESTRO
CONFERENCES
FIVE MEETINGS WITH
OUTSTANDING SCIENTIFIC
PROGRAMME
3rd ESTRO Forum
24 - 28 April 2015
Barcelona, Spain
The 3rd ESTRO Forum will provide a wonderful opportunity to explore innovations and the latest advances in radiation oncology. Five meetings, each offering an outstanding scientific programme, will be
hosted in parallel under its umbrella:
• Clinical and translational meeting
• Biennial physics meeting
• GEC-ESTRO-ISIORT meeting
• RTT meeting
• PREVENT and TARGET meetings
Placing interdisciplinarity under the spotlight, clinicians, physicists, brachytherapists, radiobiologists
and radiation therapists (RTTs) will also find, in addition to the five meetings, a broad range of interdisciplinary sessions in which they can participate to explore topics of interest to all.
ABSTRACTS IN FIGURES
1,637 abstracts submitted, an increase of 39% compared to the 2nd ESTRO Forum in 2013.
The number of abstracts submitted per track is in the table below.
IMPORTANT DATES
Late registration deadline: 24 March 2015
Desk registration: from 25 March 2015
INTRODUCTION
2015 - Clinical and translational meeting
594
2015 - Biennial physics meeting
2015 - RTT meeting
2015 - GEC-ESTRO
2015 - ISIORT meeting
2015 - PREVENT & TARGET meeting
2015 - 3rd ESTRO Forum TOTAL
630
197
133
31
52
1637
FOCUS ON NEXT ESTRO CONGRESSES
FOCUS ON PAST ESTRO CONGRESSES
FOCUS ON NEXT ESTRO CONGRESSES
3rd ESTRO Forum
ESTRO
CONFERENCES
Clinical and translational meeting
HIGHLIGHT TOPICS
We can expect a broad range of science during
these five days. Below is an overview of the
topics for each meeting.
• Palliative care, including a report of the consensus meeting
• Individualisation: to the cancer or to the patient?
•Lung cancer: how radiation therapy can improve the outcome of SCLC
•Lung cancer, NSCLC: treatment intensification
and individualisation
•Regional radiation therapy in breast cancer
•Breast cancer: technical issues for the clinician
•HPV and cancer: impact on radiation therapy
•Management of HPV-negative head and neck
cancer
•Organ sparing in bladder cancer
•Imaging for radiation therapy in prostate cancer
•Sequence of radiation and systemic therapy in
rectal cancer.
Physics meeting
•From 4D imaging to 4D delivery
•MR-only workflow in external-beam radiotherapy
•Proton therapy practical and advances
•Radiobiology on particle therapy
•Risks of hypo-fractionation
•Planning strategies for SBRT
INTRODUCTION
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•Innovations in functional imaging for radiotherapy
•Imaging to predict toxicity and tumour control
•Molecular radionuclide therapy and external
beam radiotherapy
•Secondary cancer: measuring / estimating organ doses and models of prediction
•Clinical and genetic factors in dose-volume
models of side-effects
•Geometric uncertainties
•Overview of recent detectors
•Detector response in small photon fields
•Nanodosimetry
•Treatment planning improvements
•Application of Monte Carlo methods in radiation treatment planning
•Role, clinical application and validation of
deformable image registration and dose mapping tools
•Low and medium energy radiotherapy
•Research in the field of medical physics
•Have we reached the technology edge in radiation therapy?
GEC-ESTRO-ISIORT meeting
•State-of-the-art breast brachytherapy
•QA of treatment planning and delivery in image-guided brachytherapy
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3rd ESTRO Forum
•Clinical outcome of 4D brachytherapy in cervix
cancer
•Role of brachytherapy and contact X-ray in rectal cancer
•Focused and focal therapy via brachytherapy in
prostate cancer.
•Immunotherapy and radiotherapy
•Tumour metabolism and radioresistance
•High-throughput biological screens and translation to new targets
•New targets and evaluation in model systems
and early trials.
PREVENT Meeting
RTT meeting
Prediction, Recognition, EValuation, and Eradication of Normal Tissue effects of radiotherapy
•Creating uncomplicated cures in oncology – a
paradigm shift
•Combination therapy and new mechanisms
regulating toxicity in the gut
•Combination therapy and new mechanisms
regulating toxicity in the heart
•Biomarkers of normal tissue toxicity
•Evaluating toxicity of targeted agents
•Targeted therapy, stem cells, and normal tissue
toxicity.
TARGET Meeting
Targeted therapy and personalised medicine in
radiation oncology
•Challenges of combining targeted therapy with
radiotherapy
•Using imaging to assess biomarkers of biological response
INTRODUCTION
•Advanced technology assessment and health
economics
•Adaptive radiation therapy
•Future of radiation oncology.
•IGRT, margin calculation and minimising
treatment volumes
•Advanced treatment planning techniques
•A site-specific symposium on breast cancer
•Proton therapy
•MRI imaging throughout the treatment chain.
Interdisciplinary track
•Tumour biology for treatment planning and
response evaluation
•Paediatrics
•Elderly
•Psycho-social aspects of radiation therapy
•Databases and data-mining
•Risk management
•Stereotactic ablative radiotherapy
•Re-irradiation, including a session on hyperthermia
•Particle therapy
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3rd ESTRO Forum
ESTRO
CONFERENCES
HIGHLIGHTS OF SESSIONS
The chairs of the five meetings have selected for
you some topics, sessions and speakers that are
not to be missed…
Clinical and translational meeting
Physics meeting
Saturday 25 April 2015 | 16.45
Symposium on patient individualisation versus
cancer individualisation
Patient perspective of quality. patient-reported
outcomes versus physician reported outcomes
Kathrin Kirchheiner (AT)
Saturday 25 April | 8.45-10.00
Symposium on MR-only workflow in
external-beam radiotherapy
Full integration of MRI in the work flow of
external-beam radiotherapy
Lars Olsson (SE)
Monday 27 April 2015 | 8.00-8.40
Teaching lecture on regional nodes radiotherapy in early breast cancer
Brigitte Offersen (DK) speaker
Saturday 25 April | 8.45-10.00
Symposium on proton therapy
Current developments in proton and ion beam
production and delivery
Oliver Jäkel (DE)
Monday 27 April 2015 | 14.45
Symposium on HPV and cancer and radiotherapy (Head and neck, cervix, vulva, anal)
How come that HPV status has an effect on
radiotherapy and is it true for all tumour entities?
Marie-Catherine Vozenin (CH)
Sunday 26 April | 8.45-10.00
Symposium on nanodosimetry
Requirements for multiscale models of
radiation action – activities in EU projects
nano-IBCT and BioQuaRT
Hans Rabus (DE)
Tuesday 28 April 2015 | 9.15-10.30
Symposium on prostate: use of imaging for
treatment planning
Local or focal dose prescription
Barbara Jereczek-Fossa (IT)
INTRODUCTION
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3rd ESTRO Forum
GEC-ESTRO-ISIORT meeting
Saturday 25 April | 14:45-16:15
Symposium on clinical outcome of image
guided brachytherapy in cervical cancer
Clinical impact of IGABT in cervical cancer
Richard Pötter (AT)
Sunday 26 April | 8:45-10:00
Symposium on role of brachytherapy and contact X-ray in the treatment of rectal cancer
Role of contact x-ray brachytherapy (CXB) for
rectal cancer: current status and Challenges
Jean-Pierre Gérard (FR)
Sunday 26 April | 8:45-10:00
Symposium on focused and focal therapy via
brachytherapy in prostate cancer
Focal boosts: the best of both worlds?
Roberto Alonzi (UK)
PREVENT and TARGET meeting
Saturday 25 April | 14.45
Symposium around organs / combination
therapy: heart
Ischemic heart disease after radioptherapy
Sarah Darby (UK)
Monday 27 April 2015 | 8.45
Symposium on biomarkers - using imaging to
assess biology
Imaging biology in the cancer patient
Kevin Brindle (UK)
Monday, 27 April 2015 | 14.45
Symposium on immunotherapy and radiotherapy
Radio-immunotherapy of cancer: therapeutic
efficacy, underlying mechanisms and potential
applications
Jacques Neefjes (NL)
RTT meeting
BREAST
Sunday 26 April | 8.00-08.40
Teaching lecture on current overview of radiotherapy for breast cancer
Philip Poortmans (NL)
Sunday 26 April | 8.45-10.00
Symposium on current issues in breast radiotherapy
The symposium will include a presentation on
psychosocial aspects of breast cancer from a
patient's point of view
Carmen Boronat (ES)
PROTON THERAPY
Monday 27 April | 8.00-08.40
Teaching lecture on introduction to proton
therapy
Håkan Nyström (SE)
Monday 27 April | 8.45-10.00
Symposium on proton therapy, from rationale
to planning and delivery
Treatment planning for proton therapy – a
challenge for the whole team
I. Kristensen (SE)
INTRODUCTION
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International Conference
on innovative approaches in
HEAD & NECK
ONCOLOGY
12 - 14 February 2015
Nice, France
INTRODUCTION
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5th ICHNO
ESTRO
CONFERENCES
KEYNOTE LECTURES
5th ICHNO
12 - 14 February 2015
Nice, France
Jointly organised by ESTRO, the European Head and Neck Society (EHNS) and the European Society of
Medical Oncology (ESMO), the biennial international conference will focus on multidisciplinarity and
innovation in the treatment of head and neck cancers. Of special interest are the sessions on randomised
trials, the debates and also the sessions mimicking a tumour board.
Thursday 12 February 2015 | 13.15-13:45
The evolving role of surgery in the treatment of head and neck cancer
Randal Weber (USA)
Prof Randal S. Weber
Chair of the Department of
Head and Neck Surgery
University of Texas MD
Anderson Cancer Center
Houston, USA
Randal S. Weber, M.D., F.A.C.S., is a renowned
surgeon and expert in the treatment of patients
with head and neck cancer. He is Chairman of
the Department of Head and Neck Surgery, with
a joint appointment as Professor, Department of
Radiation Oncology, at The University of Texas
MD Anderson Cancer Center in Houston, Texas.
He is the recipient of the John Brooks Williams
and Elizabeth Williams Distinguished University
Chair in Cancer Medicine. A leader in healthcare
INTRODUCTION
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initiatives to improve cancer care, Dr Weber has
been instrumental in the establishment of performance-driven processes and evidence-based
medicine for patients with head and neck cancer. He is active in clinical research investigating
various head and neck cancers and is a pioneer
in the use of organ-sparing oncologic techniques.
Highly sought after for his expertise and professional insights, Dr Weber has been the guest
lecturer and visiting professor on more than 80
occasions in the United States and internationally
and has led numerous courses and seminars. Dr
Weber was honored as the Hayes Martin Lecturer
and recipient of the Distinguished Service Award
at the April 2011 meeting of the American Head
and Neck Society. He has served as President of
the Society of University Otolaryngologists–Head
and Neck Surgeons, the American Radium
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5th ICHNO
Thursday 12 February 2015 | 13:45-14:15
Novel opportunities in cancer immunotherapy
George Coukos (CH)
Society, and the American Head and Neck Society. He is currently a Director and President-elect
of the American Board of Otolaryngology and
past Chair of the Head and Neck Surgery Committee of the Radiation Therapy Oncology Group.
Dr Weber is a prolific author whose works include scientific articles, book chapters, and textbooks. He is the immediate past Editor in Chief
of Head & Neck: Journal for the Sciences and
Specialties of the Head and Neck, is an Associate
Editor for Annals of Surgical Oncology, and serves
on the editorial boards of American Journal of
Rhinology; Clinical Medicine Insights: Ear, Nose
and Throat; and Head & Neck.
INTRODUCTION
Prof George Coukos
Head of the Ludwig Institute
for Cancer Research at the
University of Lausanne
Director of the Swiss Cancer
Center
Lausanne, Switzerland
George Coukos obtained his MD in 1986 at the
University of Modena and his PhD in 1991 at the
University of Patras. He completed training in
obstetrics and gynaecology at the University of
Modena in 1991. He did a post-doc at the University of Pennsylvania in Philadelphia, USA, in cell
biology (1991-1994), and he completed residency
training in obstetrics and gynaecology (1994-1997)
and fellowship training in gynaecologic oncology
(1997-2000) at the University of Pennsylvania. In
2000 he became Assistant Professor at the University of Pennsylvania. He became Associate Professor in 2006 and Full Professor in 2010. In 2007,
George Coukos founded and directed the Ovarian
Cancer Research Center at the University of Pennsylvania, and served as Associate Director of the
Division of Gynecologic Oncology. He relocated to
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Switzerland in 2012, to become Director of the new
Department of Oncology at the University Hospital
of Lausanne (CHUV-UNIL) in 2013. He is also the
head of the Ludwig Institute for Cancer Research
at the University of Lausanne (LICR@UNIL) and
Director of the Swiss Cancer Centre, Lausanne.
Prof. Coukos is interested in elucidating fundamental mechanisms in the tumour microenvironment (TME) that determine the fate of antitumour
immunity, focusing on the study of the deregulation of tumour-infiltrating lymphocytes (TILs).
These studies are expected to yield novel pharmacologic approaches to restore antitumour immunity as well as novel methodologies to select and expand TILs for adoptive therapy. He is also involved
in the study of the tumour vasculature as a barrier
to effective T cell infiltration in many tumours, but
also as a potential target for therapy. Prof. Coukos is pursuing T cell engineering approaches as a
means of addressing the deregulation of T cells in
the TME, and redirecting them against relevant
tumour targets, including the vasculature, with the
ultimate goal of translating basic discovery to the
clinic.
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ESTRO
29 April - 3 May 2016
Turin, Italy
INTRODUCTION
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14th International Wolfsberg Meeting
ESTRO
CONFERENCES
14TH INTERNATIONAL
WOLFSBERG
MEETING
on Molecular Radiation
Biology/Oncology
20 - 22 June 2015
Wolfsberg Conference Centre
Ermatingen (Lake Constance), Switzerland
In collaboration with ESTRO
The International Wolfsberg Meeting started in 1997 and has been organised since 2005 in collaboration
with ESTRO. The meeting brings together both experienced, as well as young, basic and clinical scientists in the disciplines of molecular and cell biology, tumour and normal tissue biology, radiobiology and
radiation oncology, to discuss the newest developments that are most likely to have the greatest impact
on the development of future treatment strategies in radiation oncology.
Topics to be discussed:
DNA repair and radiation-induced signalling cascades; molecular and micro-environmental aspects of
tumour and radiation biology; biomarkers and targeting strategies for radiation oncology.
Keynote speakers invited:
IMPORTANT DATE
Abstract submission deadline: 26 January 2015
INTRODUCTION
Randall J. Kimple, Madison (USA), Ira-Ida Skvortsova (Innsbruck, Austria), Karen E. Knudsen (Philadelphia, USA), Amato J. Giaccia (Stanford, USA), Michele De Palma (Lausanne, Switzerland), Lars Zender (Tübingen, Germany), and Dan G. Duda (Boston, USA).
More information: www.wolfsberg-meeting.com
Contact: hans-peter.rodemann@uni-tuebingen.de
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14th International Wolfsberg Meeting
VARIAN-JULIANA DENEKAMP AWARD 2015
Call for applications
The VARIAN-Juliana Denekamp Award, established in 2005 by ESTRO, honours the great and
dearly-missed European radiobiologist Professor
Dr Juliana Denekamp. This award is sponsored by
VARIAN Medical Systems, Switzerland. In concordance with the outstanding scientific achievements of Prof Denekamp and her enthusiasm for
promoting young talent, the award will be given
to young scientists (junior radiobiologists/radiotherapists) who, at a very early stage in their career, have demonstrated excellence and passion
for biologically-driven cancer research relevant to
radiation oncology, and who are likely to assume a
scientific leadership role in this field in the future.
Born in 1943, Prof Denekamp grew up in south
Wales, UK. She studied zoology and botany at the
University of London and received her PhD at the
Royal Postgraduate Medical School, Hammersmith Hospital, London, in 1968. Prof Denekamp
was a leading international scientist in radiation
biology applied to radiotherapy, a field now called
translational research in radiation oncology. Between 1988 and 1994 she was director of the Gray
Laboratory, UK. Thereafter, she was appointed as
INTRODUCTION
a Professor of Translational Research at the Umea
University, Sweden, a position that she filled very
actively both as researcher and teacher until her
much too early death in June 2001.
The VARIAN-Juliana Denekamp Award is a single
prize of €2,500 which is awarded on the occasion
of the International Wolfsberg Meeting on Molecular Radiation Biology/Oncology in collaboration
with ESTRO in uneven years. In 2015, the award
will be presented during the 14th International
Wolfsberg Meeting to be held at Wolfsberg Castle
from 20-22 June 2015.
Criteria for eligibility are:
• Candidates should be ESTRO members.
• Candidates should be no older than 36. Exceptions will be made for female applicants who
have interrupted their research for pregnancy/
maternity reasons – in this case the maximum
age is fixed at 40.
• Candidates should have published at least two to
three, first author, high-quality publications on a
particular topic in the field of biologically-driven
cancer research relevant for radiation oncology.
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Candidates should submit a curriculum vitae, including a list of publications and the two or three
articles published on one particular topic. If the
articles were not published in English, an English
summary (max two pages) should be submitted.
Deadline for application is 16 February 2015
Applications should be addressed to:
Eralda Azizaj
ESTRO Scientific Programme Manager
ESTRO Office Rue Martin V 40 1200 Brussels, Belgium Tel: +32 2 775 93 40 Fax: +32 2 779 54 94 E-mail: eralda.azizaj@estro.org
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INTRODUCTION
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European Cancer Congress
ESTRO
CONFERENCES
18th ECCO - 40th ESMO
EUROPEAN CANCER
CONGRESS
The European Cancer Congress will combine the efforts of all partner organisations to continue positioning multidisciplinarity as the way forward for improving the prevention, diagnosis, treatment and
care of cancer patients – placing the patient at the heart of all our efforts and discussions.
KEY DATES
Reinforcing Multidisciplinarity
• 26 January 2015: Abstract submission opens
25 - 29 September 2015
Vienna, Austria
• 28 April 2015: Abstract submission deadline
In collaboration with ESTRO
• 7 April 2015: Early rate registration deadline
• 29 April 2015: Fellowship grant application deadline
• 22 July 2015: Late breaking abstract submission opens
• 4 August 2015: Regular rate registration deadline
• 5 August 2015: Late breaking abstract submission deadline
• 18 September 2015: Late rate registration deadline
More information:
www.europeancancercongress.org/en >
Registration:
www.europeancancercongress.org/Registration >
INTRODUCTION
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ESTRO
CONFERENCES
INTRODUCTION
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EMUC
ECHNO 2014
13 - 16 November 2014
Lisbon, Portugal
24 - 26 April 2014
Liverpool, UK
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EMUC
ESTRO
CONFERENCES
REPORT BY THE ESTRO
REPRESENTATIVES
ON THE SCIENTIFIC
COMMITTEE
EMUC
6th European Multidisciplinary Meeting on
Urological Cancers
13 - 16 November 2014
Lisbon, Portugal
MARCO VAN VULPEN
INTRODUCTION
VINCENT KHOO
The sixth European Multidisciplinary Meeting
on Urological Cancers (EMUC) took place in
Lisbon from 13-16 November 2014. More than
1,300 professionals from all over the world, involved in the management of urological cancers,
gathered to discuss recent achievements in the
field. The number of participants had increased
by more than 50% since the previous year’s
EMUC in Marseille, as the EMUC meeting seems
to be increasingly appreciated. This increase can
probably be explained by the growing need for a
multidisciplinary approach in urological cancer
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care. The attendees consisted of a broad range
of professionals: urologists (approximately 50%),
radiation oncologists (20%), medical oncologists
(20%), radiologists, pathologists, trainees, physician assistants and other professions (10%). The
faculty represented the major societies involved
in urological cancers: ESTRO, EAU, ESMO,
ESUP, ESUR and ESUI.
The conference was entitled “Multidisciplinary
Consensus on the Management of Urological
Malignancies”. Around 200 abstract were
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EMUC
presented during oral sessions or displayed as
posters. The format featured state-of-the art lectures, practice-oriented case discussions with
voting and debates over the most controversial
aspects in everyday clinical practice. The facility
to text questions and comments to the faculty by
keypad enabled real-time interaction with the audience. Further, there were several voting rounds,
before and after presentations, which in some
cases resulted in changed opinions. These interactions provided a better understanding of each
other’s perspectives.
Several sessions were of great interest to the radiation oncology community. Albert Bossi had
a very interesting presentation on the high level
of quality control in radiotherapy. In the bladder
cancer management section, Robert Huddart
discussed the options for bladder preservation.
This was concluded generally to be a very promising treatment option, which should be considered more in clinical practice. In the session on
the “best of journals, radiotherapy part”, David
Dearnaley’s Lancet Oncology paper on the survival outcome of the MRC RT01 randomised trial on
dose escalation was discussed, together with the
forthcoming results of the ConcepT trial, a randomised trial between active surveillance, radical
prostatectomy and external beam radiotherapy.
INTRODUCTION
In localised kidney cancer, Gert de Meerleer
debated the pros and cons of using radiotherapy
as a kidney-sparing approach. At the end of this
session several attendees changed their opinion to
considering SBRT as a future option to treat small
renal masses.
Riccardo Valdagni gave an overview on the
possibilities for predicting and preventing radiation-induced toxicity. Marco van Vulpen discussed the possibilities and pitfalls of performing (focal) salvage after a previous radiotherapy
treatment in prostate cancer and addressed the
need for a multidisciplinary approach in this
topic. In the section on very high-risk prostate
cancer, Ofer Yossepowitch discussed the current
standard of the combination of external beam
radiotherapy and hormonal treatment. Also, the
role of radiotherapy in penile cancer and testicular cancer was discussed during the conference.
All speakers pleaded for the more direct involvement of radiation oncologists in multidisciplinary
decision-making for patients. Translational and
basic science topics were also addressed during
the various sessions of the meeting.
A Hands-On-Training (HOT) session was presented by Carl Salambier on prostate delineation
using CT and MRI. By using the ESTRO FAL-
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CON software, prostate examples were delineated
online and discussed in a lively fashion by the
group.
The next EMUC meeting will take place in Barcelona, Spain, from 12-15 November 2015. This
meeting promises to review developments in
management of the fast-changing practice of
urological cancers. These developments are only
possible as part of a multidisciplinary approach.
This is evolving and gaining strength year by year
in EMUC in an interactive way... So please block
your agenda for the 7th EMUC in Barcelona.
Marco van Vulpen
Radiation oncologist
UMC Utrecht
Utrecht, The Netherlands
Vincent Khoo
Clinical oncologist
Royal Marsden Hospital,
London, UK
In collaboration with Philip Poortmans
ESTRO President
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EMUC
ESTRO
CONFERENCES
REPORT BY A
PARTICIPANT
AND ESTRO MEMBER
EMUC
6th European Multidisciplinary Meeting on
Urological Cancers
13 - 16 November 2014
Lisbon, Portugal
For radiation oncologists with a specific interest
in urological cancer, the yearly European Multidisciplinary Meeting on Urological Cancers
(EMUC) has become an obligatory event. The
sixth meeting took place in Lisbon this year and
confirmed the truly multidisciplinary aspect of
the conference.
PIET DIRIX
INTRODUCTION
On Thursday 13 November, the 3rd EAU Section
of Urological Imaging (ESUI) meeting preced-
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ed the actual EMUC conference, but also had
some interesting topics for radiation oncologists.
Of particular interest was the joint session with
the European Association of Nuclear Medicine
(EANM) on new PET tracers. The growing enthusiasm for 68Gallium-labelled Prostate-specific
Membrane Antigen (PSMA) was noteworthy and
could have implications for staging and especially
re-staging of prostate cancer patients. This was
also reflected in the oral presentations, two of
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EMUC
which dealt with this particular subject. Tobias
Maurer and colleagues from München deservedly
won the best poster award with their abstract on
68Ga-PSMA PET-MRI for pre-operative lymph
node staging in intermediate and high-risk prostate cancer patients, which could also inform
individualised treatment planning. The following session on multiparametric MRI for prostate
cancer management was, although not particularly geared towards radiation oncologists, highly
informative.
EMUC 2014 itself got off to an extremely promising start with a very interesting (and well-attended) session on management of progressive
disease. Jelle Barentsz suggested that multiparametric MRI, particularly using dynamic-contrast
enhancement sequences, could detect local recurrence after surgery even at very low PSA levels
and could help guide focal salvage radiotherapy.
For lymph node staging, current imaging modalities (both MRI and Choline PET-CT) remain
rather unsatisfactory. Again, the particular promise of 68Ga-PSMA PET-CT (or indeed PET-MRI)
and Ferumoxtran-10 ultrasmall superparamagnetic iron oxide-enhanced (USPIO) MRI was
stated, although there remain some regulatory
issues with general USPIO usage. Marco Van
Vulpen clearly described how local progression
INTRODUCTION
after primary radiotherapy can be salvaged with
brachytherapy or other focal treatment options,
but stressed the need for increased quality (assurance). Steven Joniau had a particularly interesting
talk on salvage surgery, suggesting that in the
case of an isolated pelvic recurrence, a broad template resection should be preferred over a limited
resection of gross disease only. This suggests that
there could be a role for elective radiotherapy,
rather than focal treatment only, in those cases
as well. The last speaker of the session, Gerhardt
Attard, addressed what is arguably the most controversial topic in the management of progressive
prostate cancer: the timing of the different systemic treatment options. The second session of
the day dealt with adjuvant treatment in stage I
testicular cancer (chemotherapy vs. surveillance),
followed by a very stimulating talk on checkpoint
inhibition by Joaquim Bellmunt. In particular,
the combination of anti-CTLA-4 or PD-(L)1
with radiotherapy is very exciting, although early
results in prostate cancer appear somewhat disappointing. In the afternoon, Robert Huddart
made a strong case for bladder preservation as a
sensible and clinically viable alternative to radical
cystectomy.
On Saturday morning, there was a Hands-OnTraining (HOT) on prostate delineation using
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CT and MRI, presented by Carl Salembier, Marco Van Vulpen, and Vincent Khoo. By using the
ESTRO FALCON software, a prostate cancer case
was delineated online and discussed afterwards.
This was an extremely interesting workshop
where many “tips and tricks” were shared by true
experts in the field, which apparently resulted in
decreased inter-observer variability between the
start and the end of the session. In a parallel session, Gert De Meerleer elaborated on his recent
Lancet Oncology paper and made the case for stereotactic body radiotherapy in the management
of renal cell carcinoma, both in primary settings
and in treatment of oligometastatic disease. In
the afternoon, there were interesting sessions on
the value of quality assurance (QA) in clinical
practice and how radiotherapy has led this field
from the outset. This was closely followed by a
session on the prevention of treatment-related
toxicity based on knowledge from dose constraints derived through the QA process.
The conference ended on a high note with an
exceedingly interesting session on high-risk prostate cancer. Ofer Yossepowitch made the case for
surgery as a potential option for such patients,
but Alberto Bossi very eloquently stressed the
risks with such an approach. Bertrand Tombal
summed up the rationale for radiotherapy on
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EMUC
the prostate in metastatic patients, which is currently being investigated in the PEACE-1
(EORTC 1201) and STAMPEDE trials.
EMUC 2015
7th European Multidisciplinary
Meeting on Urological Cancers
In conclusion, I would really recommend this
conference to any radiation oncologist with an
interest in uro-oncology. Even the sessions not
directly discussing radiation oncology topics will
increase your general understanding of these
cancers and will ultimately improve both clinical
decision-making as well as communication with
the other specialties. In that regard, EMUC was
also an excellent opportunity for networking and
getting to know imaging specialists, urologist,
and clinical oncologists in the wonderful setting
of Lisbon.
Barcelona, Spain
12-15 November 2015
www.emuc15.org
Piet Dirix
Radiation oncologist
Iridium Cancer Network
University Hospital Antwerp
Antwerp, Belgium
INTRODUCTION
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ECHNO 2014
ESTRO
CONFERENCES
REPORT BY RENÉ
LEEMANS
President of EHNS
Co-Chair of ICHNO
ECHNO 2014
6th European Conference on Head and
Neck Oncology
24 - 26 April 2014
Liverpool, UK
RENÉ LEEMANS
INTRODUCTION
ECHNO, the biennial congress of the European
Head and Neck Society (EHNS), has become a
leading forum for presenting the latest and most
innovative research, both basic and clinical, in
the field of head and neck oncology in Europe.
The 2014 meeting, organised jointly by the British Association of Head and Neck Oncologists
(BAHNO) and EHNS under the leadership of
James Brown, certainly met every expectation,
honouring its motto: a singular event, a multidisciplinary approach.
Emphasis was placed on addressing the need for
a multidisciplinary approach to facilitate cooperation between the various clinical and research
specialties involved in the management of head
and neck cancer. ECHNO 2014 presented the
latest research and techniques in the ongoing
effort to improve the lives of patients everywhere.
The stellar scientific programme featured experts
from around the world, who facilitated stimulating debates about the most controversial topics in
proton therapy, robotics and transoral laser, and
many others.
A total of 900 participants, 54 speakers and 73
exhibitors attended ECHNO 2014 in the city of
the “Yellow Submarine”. There were special sessions on the question of whether surgery is still
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the best treatment of oral cavity cancer, on the
future of clinical trials, on basic science, and the
influence of hypoxia in head and neck cancer.
The programme was supplemented by several
pre-congress courses. Prizes were awarded for
best oral presentation and poster, as well as for
best young clinician and young scientist. During
the congress, four special recognition awards for
outstanding services to EHNS were presented to
the former President, Jean Louis Lefebvre, and
three former officers, Patrick Bradley, Jan Olofsson and Dominique Chevalier.
Under the newly elected board, EHNS will continue to bring together medical experts from
many disciplines, including: head and neck cancer specialists, oral and plastic surgeons, radiation therapists, medical oncologists, imaging
specialists and pathologists. The society also
brings together other stakeholders, including:
speech therapists, cancer nurses, psychologists,
physiotherapists, dieticians, social workers, basic
scientists and patient organisations involved in
any aspect of head and neck oncology.
We hope to welcome you to the 7th ECHNO to
be held in Istanbul from 28-30 April 2016, under
the leadership of Sefik Hosal, for a stimulating
programme covering the various aspects of
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ECHNO 2014
head and neck oncology with special emphasis
on larynx, skin and melanoma, nasopharyngeal
cancer, supportive care, and oral cancer, taking
advantage of new technologies and state-of-theart basic research, accompanied by a more than
fitting social programme.
In the meantime, we look forward to welcoming
you to ICHNO in February in Nice.
René Leemans
President of EHNS
Co-Chair of ICHNO
INTRODUCTION
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ECHNO 2014
2ND MAKE SENSE CAMPAIGN
European Head & Neck cancer awareness week
22 - 26 September 2014
The 2014 Make Sense campaign called for action to drive change for head and neck cancer
patients in Europe. There is little awareness of
head and neck cancer among the general public
and the healthcare community in Europe, resulting in the majority of diagnosed cases being
late stage. Consequently, treatment outcomes
for patients are poor and chances of survival
are significantly reduced.
Head and neck cancer is the sixth most common type of cancer in Europe and its incidence
is on the rise. In 2012 alone, more than 150,000
new patients were diagnosed. Despite major
advances in the treatment of head and neck
cancer over the past three decades, patient
outcomes remain disappointingly unchanged.
Earlier diagnosis and referral to specialised
healthcare professionals can have a major impact on improving the outcomes for head and
neck cancer patients across Europe.
INTRODUCTION
To drive change for head and neck cancer patients in Europe, the European Parliament, in
partnership with the EHNS and the European
Cancer Patient Coalition (ECPC) has set out
the following action points and calls on the
European Commission to:
ing treatment and care to ensure best possible health outcomes
6. Encourage further research on head and
neck cancer to ensure better prevention
strategies, treatment options and, ultimately,
outcomes, for all patients.
1. Actively engage in awareness campaigns on
disease prevention and highlight the signs
and symptoms of head and neck cancer
2. Support early diagnosis and referral to qualified healthcare professionals
3. Support a multidisciplinary treatment approach for head and neck cancer, by integrating experts across disciplines
4. Provide guidelines at EU level to ensure that
all European citizens have equal access to
the best available treatment, and support the
dissemination of best practices in disease
management across EU member states
5. Promote patient rehabilitation programmes
to drive engagement and adherence to ongo-
www.makesensecampaign.eu
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CALENDAR
OF EVENTS
2015
FEBRUARY
5 - 6 February
RUSSCO breast cancer conference
Moscow, Russia
ESTRO recommended event
5 - 7 February
EACR Conference Series 2015
Radiation Biology and Cancer: From
Molecular Responses to the Clinic
Essen, Germany
ESTRO recommended event
www.eacr.org/radiationbiology2015/ > hb
12 - 14 February
5th ICHNO
Nice, France
ESTRO, ESMO and EHNS joint event
www.estro.org/congresses-meetings/
items/5th-ichno > hb
12 - 14 March
Advanced prostate cancer consensus
conference 2015
St. Gallen, Switzerland
ESTRO recommended event
www.prostatecancerconsensus.org/ >
22 - 26 March
Radiobiology & radiobiological modelling in radiotherapy course
Port Sunlight, Wirral, UK
ESTRO supported course
www.estro.org/binaries/content/assets/estro/
school/supported-courses/ccc_rblgy_flyer_2015.pdf >
27 - 28 March
Trends in Central Nervous System
Malignancies
EORTC-EANO-ESMO Conference
Istanbul, Turkey
ESTRO endorsed event
MARCH
6 - 7 March
Perspectives in Lung cancer
Turin, Italy
ESTRO endorsed event
imedex.com/lung-cancer-congress-europe/ >
www.ecco-org.eu/EEE2015 >
2015
APRIL
29 April - 1 May
EMSOS
28th Annual meeting of the European
Musculo-Skeletal Oncology Society
14 - 15 April
5th European Lung Cancer Conference
(ELCC)
Geneva, Switzerland
Athens, Greece
In collaboration with ESTRO
ESTRO endorsed event
www.emsos.org > hb
www.esmo.org/Conferences/ELCC-2015-LungCancer >
20 - 22 April
10th International Conference on Carbonic Anhydrases
MAY
8 - 9 May
Modern Radiation For Lymphoma
New York, USA
Maastricht, The Netherlands
ESTRO recommended event
ESTRO endorsed event
www.carbonicanhydrasemaastricht.info/ > hb
24 - 28 April
3rd ESTRO Forum
www.mskcc.org/events/cme/modern-radiation-lymphoma-updated-role-and-new-rules/
form > http
ESTRO interdisciplinary congress
18 - 22 May
25th Advanced Multichannel Teaching Course
www.estro.org/congresses-meetings/
items/3rd-estro-forum > hb
ESTRO endorsed event
Barcelona, Spain
Rome, Italy
2015
25 - 29 May
15th International Congress of Radiation Research (ICRR 2015)
Kyoto, Japan
In collaboration with ESTRO
www.congre.co.jp/icrr2015/ > http
SEPTEMBER
18
18th ECCO - 40th ESMO
European Cancer Congress
Reinforcing multidisciplinarity
VIENNA, AUSTRIA, 25 - 29 SEPTEMBER 2015
25 - 29 September
European Cancer Congress 2015
(ECC2015)
Vienna, Austria
www.ecco-org.eu/Events/ECC2015.aspx >
35
SIOP
SIOP Europe
the European Society for Paediatric Oncology
www.ecco-org.eu
NOVEMBER
JUNE
20 - 22 June
Wolfsberg Meeting
Wolfsberg, Switzerland
In collaboration with ESTRO
www.wolfsberg-meeting.com/ >
JULY
26-30 July
World Congress on Larynx Cancer
Cairns, Australia
ESTRO endorsed event
www.wclc2015.org/home/ >
12 - 15 November
EMUC
7th European Multidisciplinary Meeting on Urological Cancers
Barcelona, Spain
Joint EAU, ESTRO and ESMO conference
2016
APRIL
29 April - 04 May
ESTRO 35
Turin, Italy
ESTRO congress
CREDITS
ESTRO
Bimonthly newsletter
N° 98 | January - February 2015
European Society for
Radiotherapy & Oncology
OFFICERS
President: Philip Poortmans
President-elect: Yolande Lievens
Past-president: Vincenzo Valentini
EDITOR
Cécile Hardon-Villard
EDITORIAL ADVISERS
Joanna Kazmierska and Ludvig Muren
(ESTRO Board Members)
Emma Mason and Mary Rice
GRAPHIC DESIGN
Daneel Bogaerts
Published every two months and distributed
by the European Society for Radiotherapy
& Oncology.
DEADLINES FOR SUBMISSION
OF ARTICLES IN 2014 AND 2015
May/June 2015 Issue > 2 March 2015
July/August 2015 Issue > 4 May 2015
Sept./Oct. 2015 Issue > 1 July 2015
Nov./Dec. 2015 Issue > 1 September 2015
For permission to reprint articles please
contact the editor.
If you want to submit articles for
publication, please contact the editor:
cecile.hardon@estro.org
For advertising, please contact:
valerie.cremades@estro.org
Opinions expressed in the ESTRO newsletter do
not necessary reflect those of the Society or of its
officers.