NEWSLETTER MARCH - APRIL ESTRO | EUROPEAN SOCIETY FOR RADIOTHERAPY & ONCOLOGY CONFERENCES 3rd ESTRO Forum: Education, Job Fair, Super Run, awards… what to mark in your calendar CLINICAL First ESTRO patients’ workshop BRACHYTHERAPY Report on the 2nd GEC-ESTRO workshop RADIOBIOLOGY Role of stem cells in radiation responses N° 99 | BIMONTHLY | MARCH - APRIL 2015 CONTENTS Editorial Society Life NEWSLETTER N° 99 MARCH - APRIL 2015 4 6 Clinical 10 Read it before your patients 16 Brachytherapy 44 Physics 61 RTT 70 Radiobiology 83 ESTRO School 91 Young ESTRO 108 Health Economics Institutional Membership 118 122 National Societies 127 ESTRO Conferences 131 Calendar of events 172 Gaudi’s mosaics - Barcelone, Spain, where the 3rd ESTRO Forum will take place, 24-28 April 2015. ESTRO | EUROPEAN SOCIETY FOR RADIOTHERAPY & ONCOLOGY 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 EDITORIAL “The governance structure will change, including revision of some of the roles of ESTRO bodies” Dear friends and colleagues, Spring is on its way and so is the 3rd ESTRO Forum. The congress is the place to meet and network with colleagues from around the world, with a superb scientific programme and one of our largest technical exhibitions. I hope to see you all in April in Barcelona to enjoy together the magnificent congress we have organised for you. The situation with ECCO and ESMO is slowly evolving. I hope that I can bring some good news to the ESTRO Forum. In the meantime, we have finalised the scientific programme for the next joint multidisciplinary ECCO-ESMO congress in Vienna, from 25-29 September 2015. I am happy to inform you all that the contract between ESTRO and Elsevier for Radiotherapy & Oncology, our beloved Green Journal, has been signed. The contract is valid for the next two years. The ESTRO Board will announce more details at the 3rd ESTRO Forum General Assembly on the Elsevier contract. The ESTRO Board is working on the governance changes with Ernst & Young as consultants to finalise the decisions taken at the June strategy review (JSR) meeting last year. As already announced in the previous editorial, the governance structure will change, including revision of some of the roles of ESTRO bodies. Following this, the statutes will be updated. All these changes will be reported at the General Assembly. At the end of last year ESTRO signed a renewed Memorandum of Understanding with the American Society for Radiation Oncology (ASTRO) of which you can read more in the Society Life Corner. I hope to see you all in Barcelona for the 3rd ESTRO Forum. Philip Poortmans ESTRO President SOCIETY LIFE INTRODUCTION ASTRO MOU SOCIETY LIFE “I hope to see all my fellow members at our general assembly” The annual congress is not only a place for professionals to meet and network with colleagues from around the world, but also for ESTRO full members to assemble and find out about important developments in the Society, as well as approve governance issues. I hope to see all my fellow members at our general assembly. One of ESTRO’s aims is to “take all reasonable measures to further develop as the pre-eminent scientific society in radiotherapy and oncology, and through this role, the Society will have a unique long-term strategic responsibility for the future development of the clinical discipline of radiation and clinical oncology within Europe and at a global level”. To this end we continue to make strategic collaborations with other radiation oncology societies worldwide. We are happy to announce our continued collaboration with ASTRO. PHILIP POORTMANS Philip Poortmans ESTRO President GENERAL ASSEMBLY The ESTRO General Assembly will be organised during the 3rd ESTRO Forum in Barcelona and takes place on Monday 27 April at 18.00-19.00 hrs in room 118/119 at the CCIB. The agenda will be sent to all full members. Please note that you need to have renewed your 2015 ESTRO membership by 22 April in order to attend. All 2015 members are welcome to join. INTRODUCTION ASTRO MOU SOCIETY LIFE ASTRO MOU The American Society for Radiation Oncology (ASTRO) and ESTRO have been collaborating fruitfully for years on joint symposia. On 16 December 2014 both societies signed a renewal of the Memorandum of Understanding (MoU) confirming this valued collaboration for the next five years. The MoU is valid until the end of 2020 and covers themes including joint symposia, possible “Best of” sessions, guidelines and global initiatives. The joint ESTRO-ASTRO symposia will be held each year, taking place at both the ESTRO and ASTRO congresses. ESTRO looks forward to a successful and rewarding continuation of the collaboration with ASTRO. ESTRO President Philip Poortmans is delighted with this outcome. He commented: “It is logical that we share our knowledge and join forces to improve the quality of radiation oncology faster than we would be able to do on our own. This is a good example of a “win-win” agreement, with patients being the main beneficiaries.” INTRODUCTION ASTRO MOU 2015 ESTRO MEMBERSHIP Join ESTRO and benefit from services specially designed to support your career FULL Active Membership (95 EUR) Supporting Ambassador (250 EUR) ASSOCIATE In Training Membership (75 EUR) Affiliate (55 EUR) Corporate Representative (55 EUR) TAKE ADVANTAGE OF THE MANY BENEFITS THE ESTRO MEMBERSHIP HAS ON OFFER. THESE BENEFITS ARE IN RELATION TO THE LEVEL OF INVOLVEMENT WITHIN THE SOCIETY. Subscription to the Green Journal Reduced fees for attending ESTRO conferences, teaching courses and joint events Online access to scientific information through DOVE (events webcasts, delineation cases, etc.) Eligibility for grants, awards, working groups, faculties and governance positions And much more! INSTITUTIONAL MEMBERSHIP ESTRO offers European institutes the possibility to purchase several individual memberships in a batch (minimum of five) for their members. Not only is this very economical, but it also offers several other advantages. Please contact us at [email protected] For more information on the available package deals and to download the application forms: http://www.estro.org/members/institutional-membership/institutional-membership > 2015 MEMBERSHIP AVAILABLE ON WWW.ESTRO.ORG CLINICAL INTRODUCTION ESTRO FIRST PATIENTS’ WORKSHOP CLINICAL “Every cancer patient in Europe will have access to state of the art radiation therapy, as part of a multidisciplinary approach where treatment is individualised for the specific patient’s cancer, taking account of the patient’s personal circumstances” - ESTRO’s vision for 2020 - After some delay, we finally managed to meet just before Christmas in Brussels (despite a public strike in Belgium) to have our workshop with European patient representatives. Many thanks to them for supporting ESTRO’s activities. On the following pages we have a report on this workshop, written by Chiara Gasparotto, ESTRO Public Affairs Manager. I hope you enjoy reading it. I am sure you have your own views and thoughts on how to include patients and patient advocacy groups in ESTRO activities to promote radiation oncology, so please email me your comments: [email protected] med.uni-tuebingen.de DANIEL ZIPS Daniel Zips Chair of the Clincal Committee ESTRO CLINICAL COMMITTEE View the activities of the Clinical committee: www.estro.org/about-us/governance-organisation/committees-activities/clinical-committee-activities > View the members: www.estro.org/about-us/governance-organisation/scientific-council/committees/clinical-committee > The committee is contactable through Eralda Azizaj at the ESTRO office [email protected] INTRODUCTION ESTRO FIRST PATIENTS’ WORKSHOP CLINICAL ESTRO FIRST PATIENTS’ WORKSHOP ESTRO’s vision for 2020 puts the patient at the very centre of everything we do, as follows: “Every cancer patient in Europe will have access to state of the art radiation therapy, as part of a multidisciplinary approach where treatment is individualised for the specific patient’s cancer, taking account of the patient’s personal circumstances”. CHIARA GASPAROTTO INTRODUCTION Keeping the central role of patients clearly in mind, and observing the increasing amount of patients receiving radiation therapy as part of their cancer treatment, ESTRO is eager to develop activities addressing the main stakeholders: the patients. While raising awareness and conveying a positive and safe image of radiation treatment, ESTRO feels the need to be more inclusive and develop a structured strategy towards patients. The clinical committee is particularly interested in the subject, and for this reason the development of a strategic view for patients has been included in their three-year roadmap. Daniel Zips and Joanna Kazmierska are responsible for this new area within the clinical committee. Our journey started during the ECCO conference in September 2013 with a preliminary meeting with Ian Banks, chair of the ECCO Patient ESTRO FIRST PATIENTS’ WORKSHOP Advisory Committee and president of the European Men’s Health Forum. The goal was to establish a first, formal contact with patient representatives and to have some initial indications on how to build a new bridge with them. The meeting was very fruitful and left us with two main messages: firstly, that the patients must have a relevant voice within the Society, a main stakeholder to collaborate with, especially with regard to raising awareness of radiation oncology and positioning of the discipline. Secondly, that a good way to start could be the organisation of a meeting with various patients’ representatives to establish a link, understand their perception of radiation oncology, and to brainstorm with them on the format for this new collaboration. meeting, in order to facilitate discussion and allow brainstorming easily. Following this suggestion, the first ESTRO exploratory meeting with patients took place on 11 December at the ESTRO office. We wanted to get inputs from patients’ representatives and to understand their expectations, needs and wishes, with a two-fold outcome: to understand the perception of radiotherapy from a patient’s point of view; and to direct the ESTRO strategy by using the inputs to draft a strategic document to be submitted to the ESTRO Board, with recommendations on how best to include patients in ESTRO. After the introduction of the strategic background, the meeting was structured around broad questions to be answered in relation to patients’ perception and awareness of radiotherapy, and their needs, wishes and expectations concerning representation. The questions were very useful for stimulating a lively discussion. The patients reminded us of the importance of the patient, their relationship with their doctors, and the sense of responsibility that the inclusion of patients in a society entails. The meeting highlighted the fact that raising awareness was an important area for collaboration with patient organisation, as the role of radiation oncology can be overlooked and its status varies from country to country. General knowledge on radiation therapy, and how the treatment is included in the patient journey, is often lacking. Multidisciplinary cancer care remains problematic, as in many countries patients don’t get to see or are not referred to a radiation oncologist. There is a need for radiation oncology to be seen as an equal partner on tumour boards. Multidisciplinary teams are key to enabling patients to make an informed choice. We tried to have a broad spectrum of patients’ representatives, from gender to age, to cancer type and also to type of organisation. At the same time, we wanted to have a small and informal Another main point of discussion that was brought up by all patients’ representatives was the inequalities across Europe and the major differences in cancer care that a patient can encounter There is a lack of knowledge concerning the side-effects of radiation therapy and patients are sometimes afraid to ask; moving towards safety and highlighting the quality of treatment will INTRODUCTION The meeting started with an introduction to the ESTRO Vision and the strategy underlying the engagement of ESTRO with patients: the ESTRO Vision puts the patients at its very centre and is based on the three main pillars of ESTRO (science, education and profession). Therefore, the ESTRO roadmap needs to be inclusive. Focusing on patients, ESTRO should be the provider of information and education and should enhance the concept of multidisciplinary cancer care and multidisciplinary teams, to allow patients to make informed choices and ensure their access to the best treatment option for them. in Europe. There is a general call for improved standards and the need to build common positions and strong statements from the European scientific societies in order to fill those gaps. Patients play a key role in identifying the problem, so that doctors and professional societies can then tackle it. In this regard, European guidelines are of paramount importance, drafted at European level and then implemented at national level. It is important to ensure that the national perspective is aligned with the European one. National societies are key players in ensuring this too, both for dissemination of information and for tailoring it to individual national circumstances. ESTRO FIRST PATIENTS’ WORKSHOP help in dispelling misconceptions, negative myths and the stigmas linked to cancer. This is where the relationship with the doctor and the concept of individualised treatment is of paramount importance; the side-effects should be communicated and the patient should be reassured. The connection between radiation therapy and toxicity needs to be addressed, underlining safety and focusing on risk management. Board to draft a strategy and to pursue more regular cooperation with patients, in order to ensure the continuity of this process. Communication is central, without any doubt. There was a firm agreement that the whole radiation therapy team has a role to play in this: RTTs, physicists, doctors. In collaboration with Daniel Zips and Joanna Kazmierska, chair and member of the ESTRO clinical committee respectively. Linked to communication, the patients reminded us of the importance of having access to objective, trusted, certified information and recommendations that are evidence-based and that are given by the Society that is the recognised expert in radiation oncology. This would be a great help to patients, families, and to future patients. We warmly thank all the attendees for sharing their experience with us and allowing us to have such a clear overview of the different pathways we can investigate further. Now we have many ideas and, above all, very good collaborators to work with in drafting a comprehensive strategy, focusing on the main points of the discussion: communication, awareness, and positioning of the discipline. The clinical committee will work closely with the INTRODUCTION Chiara Gasparotto Public Affairs Manager ESTRO office Brussels, Belgium PARTICIPANTS ORGANISATIONS REPRESENTATIVES Ian Banks EMHF and Chair of PAC at ECCO Louis Denis Europa Uomo, responsible liaison EU / EAU George Kapetanakis ECPC Ken Mastris Europa Uomo, Chair of the Board Mojca Miklavcic Europa Donna, member of the Board, Slovenia Edward David Naessens Trinity College Dublin, Ireland Vlad Voiculescu ECPC Vice President and Treasurer ESTRO REPRESENTATIVES Alessandro Cortese ESTRO CEO Joanna Kazmierska Great Poland Cancer Centre Poznan, Poland Member of the ESTRO Clinical Committee Daniel Zips Universitätsklinik für Radio-Onkologie, Tübingen, Germany Chair of the ESTRO Clinical Committee Mary Coffey TCD School of Radiation Therapy St. James’s Hospital - Dublin, Ireland Member of the RTT committee Chiara Gasparotto ESTRO Public Affairs Manager Tanja Wolff General Manager ESTRO Cancer Foundation ESTRO FIRST PATIENTS’ WORKSHOP DYNAMIC ONCOLOGY VIRTUAL ESTRO DOVE THE ESTRO PLATFORM FOR SCIENTIFIC AND EDUCATIONAL DATA DOVE is the e-library developed by ESTRO giving you access to educational and scientific material, produced and disseminated by the Society: the Green Journal articles, conference abstracts, webcasts, e-posters, slides, access to FALCON (our delineation tool), guidelines, our newsletter, etc. HOW DOES IT WORK? DOVE works as a search engine encompassing all kinds of data in radiation oncology. Just type in your key words and then refine your search by ticking the boxes if you are looking for a particular type of support (abstract, webcast, etc.). Or simply type a key word to see all the information available linked to the topic. HOW TO ACCESS DOVE? Simply go to www.estro.org: DOVE appears on the welcome page. The level of free access to the content you search will depend on your membership type. WWW.ESTRO.ORG READ IT BEFORE YOUR PATIENTS INTRODUCTION BREAST CERVIX PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION READ IT BEFORE YOUR PATIENTS 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 Read the interview with Philip Poortmans, chair of the clinical and translational meeting, at the 3rd ESTRO Forum, in the Conference Corner on p137 > INTRODUCTION BREAST CERVIX HANS KAANDERS PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION BACKGROUND READ IT BEFORE YOUR PATIENTS BREAST Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, openlabel, phase 3 non-inferiority trial. Mila Donker MD, Geertjan van Tienhoven MD, Marieke E Straver MD, Philip Meijnen MD, Prof Cornelis J H van de Velde MD, Prof Robert E Mansel MD, Prof Luigi Cataliotti MD, A Helen Westenberg MD, Prof Jean H G Klinkenbijl MD, Lorenzo Orzalesi MD, Willem H Bouma MD, Huub C J van der Mijle MD, Grard A P Nieuwenhuijzen MD, Sanne C Veltkamp MD, Leen Slaets PhD, Nicole J Duez MSc, Peter W de Graaf MD, Thijs van Dalen MD, Andreas Marinelli MD, Herman Rijna MD, Prof Marko Snoj MD, Prof Nigel J Bundred MD, Jos W S Merkus MD, Prof Yazid Belkacemi MD, Prof Patrick Petignat MD, Dominic A X Schinagl MD, Corneel Coens MSc, Carlo G M Messina MD, Jan Bogaerts PhD, Prof Emiel J T Rutgers MD. If treatment of the axilla is indicated in patients with breast cancer who have a positive sentinel node, axillary lymph node dissection is the present standard. Although axillary lymph node dissection provides excellent regional control, it is associated with harmful side-effects. We aimed to assess whether axillary radiotherapy provides comparable regional control with fewer sideeffects. METHODS Patients with T1-2 primary breast cancer and no palpable lymphadenopathy were enrolled in the randomised, multicentre, open-label, phase III non-inferiority EORTC 10981-22023 AMAROS trial. Patients were randomly assigned (1:1) by a computer-generated allocation schedule to receive either axillary lymph node dissection or axillary radiotherapy in case of a positive sentinel node, stratified by institution. The primary endpoint was non-inferiority of five-year axillary recurrence, considered to be not more than 4% for the axillary radiotherapy group compared with an expected 2% in the axillary lymph node dissection group. Analyses were by intention to treat and per protocol. The AMAROS trial is registered with ClinicalTrials.gov, number NCT00014612. Lancet Oncol. 2014;15(10): 1303–10 INTRODUCTION BREAST CERVIX PROSTATE HEAD AND NECK RECTAL FINDINGS Between 19 February 2001 and 29 April 2010, 4,823 patients were enrolled at 34 centres from nine European countries, of whom 4,806 were eligible for randomisation. 2,402 patients were randomly assigned to receive axillary lymph node dissection and 2,404 to receive axillary radiotherapy. Of the 1,425 patients with a positive sentinel node, 744 had been randomly assigned to axillary lymph node dissection and 681 to axillary radiotherapy; these patients constituted the intention-to-treat population. Median followup was 6.1 years (IQR 4.1—8.0) for the patients with positive sentinel lymph nodes. In the axillary lymph node dissection group, 220 (33%) of 672 patients who underwent axillary lymph node dissection had additional positive nodes. Axillary recurrence occurred in four of 744 patients in the axillary lymph node dissection group and seven of 681 in the axillary radiotherapy group. Fiveyear axillary recurrence was 0.43% (95% CI 0.00092) after axillary lymph node dissection versus 1.19% (0.31-2.08) after axillary radiotherapy. The planned non-inferiority test was underpowered because of the low number of events. The one-sided 95% CI for the underpowered noninferiority test on the hazard ratio was 0.005.27, with a non-inferiority margin of two. Lymphoedema in the ipsilateral arm was noted significantly more often after axillary lymph node dissection than after axillary radiotherapy at one year, three years, and five years. LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION INTERPRETATION Axillary lymph node dissection and axillary radiotherapy after a positive sentinel node provide excellent and comparable axillary control for patients with T1-2 primary breast cancer and no palpable lymphadenopathy. Axillary radiotherapy results in significantly less morbidity. INTRODUCTION BREAST CERVIX PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION BACKGROUND READ IT BEFORE YOUR PATIENTS BREAST Whole-breast irradiation with or without a boost for patients treated with breastconserving surgery for early breast cancer: 20-year follow-up of a randomised phase III trial. Bartelink H, Maingon P, Poortmans P, Weltens C, Fourquet A, Jager J, Schinagl D, Oei B, Rodenhuis C, Horiot JC, Struikmans H, Van Limbergen E, Kirova Y, Elkhuizen P, Bongartz R, Miralbell R, Morgan D, Dubois JB, Remouchamps V, Mirimanoff RO, Collette S, Collette L; on behalf of the European Organisation for Research and Treatment of Cancer Radiation Oncology and Breast Cancer Groups. Lancet Oncol. 2014 Dec 8. pii: S1470-2045(14)71156-8. doi: 10.1016/S1470-2045(14)71156-8. [Epub ahead of print] INTRODUCTION BREAST CERVIX Since the introduction of breast-conserving treatment, various radiation doses after lumpectomy have been used. In a phase III randomised controlled trial, we investigated the effect of a radiation boost of 16 Gy on overall survival, local control, and fibrosis for patients with stage I and II breast cancer who underwent breast-conserving treatment compared with patients who received no boost. Here, we present the 20-year follow-up results. METHODS Patients with microscopically complete excision for invasive disease followed by wholebreast irradiation of 50 Gy in five weeks were centrally randomised (1:1) with a minimisation algorithm to receive 16 Gy boost or no boost, with minimisation for age, menopausal status, presence of extensive ductal carcinoma in situ, clinical tumour size, nodal status, and institution. Neither patients nor investigators were masked to treatment allocation. The primary endpoint was overall survival in the intention-totreat population. The trial is registered with ClinicalTrials.gov, number NCT02295033. FINDINGS Between 24 May 1989 and 25 June 1996, 2,657 patients were randomly assigned to receive no radiation boost and 2,661 patients randomly assigned to receive a radiation boost. Median PROSTATE HEAD AND NECK RECTAL follow-up was 17.2 years (IQR 13.0-19.0). Twenty-year overall survival was 59.7% (99% CI 56.3-63.0) in the boost group versus 61.1% (57.6-64.3) in the no boost group, hazard ratio (HR) 1.05 (99% CI 0.92-1.19, p=0.323). Ipsilateral breast tumour recurrence was the first treatment failure for 354 patients (13%) in the no boost group versus 237 patients (9%) in the boost group, HR 0.65 (99% CI 0.52-0.81, p<0.0001). The 20-year cumulative incidence of ipsilateral breast tumour recurrence was 16.4% (99% CI 14.1-18.8) in the no boost group versus 12.0% (9.8-14.4) in the boost group. Mastectomies as first salvage treatment for ipsilateral breast tumour recurrence occurred in 279 (79%) of 354 patients in the no boost group versus 178 (75%) of 237 in the boost group. The cumulative incidence of severe fibrosis at 20 years was 1.8% (99% CI 1.1-2.5) in the no boost group versus 5.2% (99% CI 3.9-6.4) in the boost group (p<0.0001). INTERPRETATION A radiation boost after whole-breast irradiation has no effect on long-term overall survival, but can improve local control, with the largest absolute benefit in young patients, although it increases the risk of moderate to severe fibrosis. The extra radiation dose can be avoided in most patients older than age 60 years. LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION OBJECTIVE READ IT BEFORE YOUR PATIENTS Conflicting results have been reported for adenoand adenosquamous carcinomas of the cervix with respect to their response to therapy and prognosis. The current study sought to evaluate impact of adeno- and adenosquamous histology in the randomised trials of primary cisplatinbased chemoradiation for locally advanced cervical cancer. CERVIX Locally advanced adenocarcinoma and adenosquamous carcinomas of the cervix compared to squamous cell carcinomas of the cervix in Gynecologic Oncology Group trials of cisplatin-based chemoradiation. Rose PG, Java JJ, Whitney CW, Stehman FB, Lanciano R, Thomas GM. Gynecol Oncol. 2014 Aug 23. pii: S0090-8258(14)012712. PMID:25152438. [Epub ahead of print] INTRODUCTION BREAST CERVIX METHODS Patients with adeno- and adenosquamous cervical carcinomas were retrospectively studied and compared to squamous cell carcinomas in GOG trials of chemoradiation. of the cervix. However, when treated with radiation therapy with concurrent cisplatin-based chemotherapy, the 112 patients with adeno- and adenosquamous carcinomas had a similar overall survival (p=0.459) compared the 842 patients with squamous cell carcinoma. Adverse effects to treatment were similar across histologies. CONCLUSION Adeno- and adenosquamous carcinomas of the cervix are associated with worse overall survival when treated with radiation alone but with similar progression-free and overall survival compared to squamous cell carcinomas of the cervix when treated with cisplatin-based chemoradiation. RESULTS Among 1671 enrolled in clinical trials of chemoradiation, 182 adeno- and adenosquamous carcinomas were identified (10.9%). A higher percentage of adeno- and adenosquamous carcinomas were stage IB2 (27.5% versus 20.0%) and fewer had stage IIIB (21.4% versus 28.6%). The mean tumour size was larger for squamous than adeno- and adenosquamous. Adeno- and adenosquamous carcinomas were more often poorly differentiated (46.2% versus 26.8%). When treated with radiation therapy alone, the 70 patients with adeno- and adenosquamous carcinoma of the cervix showed a statistically poorer overall survival (p=0.0499) compared to the 647 patients with squamous cell carcinoma PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION READ IT BEFORE YOUR PATIENTS PROSTATE Management of prostate cancer in older patients: updated recommendations of a working group of the International Society of Geriatric Oncology. In 2010, the International Society of Geriatric Oncology (SIOG) developed treatment guidelines for men with prostate cancer who are older than 70 years old. In 2013, a new multidisciplinary SIOG working group was formed to update these recommendations. The consensus of the task force is that older men with prostate cancer should be managed according to their individual health status, not according to age. On the basis of a validated rapid health status screening instrument and simple assessment, the task force recommends that patients are classed into three groups for treatment: healthy or fit patients who should have the same treatment options as younger patients; vulnerable patients with reversible impairment who should receive standard treatment after medical intervention; and frail patients with non-reversible impairment who should receive adapted treatment. Droz JP, Aapro M, Balducci L, Boyle H, Van den Broeck T, Cathcart P, Dickinson L, Efstathiou E, Emberton M, Fitzpatrick JM, Heidenreich A,Hughes S, Joniau S, Kattan M, Mottet N, Oudard S, Payne H, Saad F, Sugihara T. Lancet Oncol. 2014 Aug;15(9):e404-14. doi: 10.1016/ S1470-2045(14)70018-X. INTRODUCTION BREAST CERVIX PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION PURPOSE READ IT BEFORE YOUR PATIENTS In a recent analysis of a large clinical database, post-diagnosis aspirin use was associated with 57% lower prostate cancer–specific mortality (PCSM) among men diagnosed with nonmetastatic prostate cancer. However, information on this association remains limited. We assessed the association between daily aspirin use and PCSM in a large prospective cohort. PROSTATE Daily aspirin use and prostate cancer-specific mortality in a large cohort of men with nonmetastatic prostate cancer. Jacobs EJ, Newton CC, Stevens VL, Campbell PT, Freedland SJ, Gapstur SM. J Clin Oncol. 2014 Nov 20;32(33):3716-22. doi: 10.1200/ JCO.2013.54.8875. Epub 2014 Oct 20. PATIENTS AND METHODS This analysis included men diagnosed with nonmetastatic prostate cancer between enrolment in the Cancer Prevention Study-II Nutrition Cohort in 1992 or 1993 and June 2009. Aspirin use was reported at enrolment, in 1997, and every two years thereafter. During follow-up through 2010, there were 441 prostate cancer deaths among 8,427 prostate cancer cases with information on pre-diagnosis aspirin use and 301 prostate cancer deaths among 7,118 prostate cancer cases with information on post-diagnosis aspirin use. high-risk cancers (≥ T3 and/or Gleason score ≥ 8), post-diagnosis daily aspirin use was associated with lower PCSM (HR = 0.60; 95% CI, 0.37 to 0.97), with no clear difference by dose (low-dose, typically 81 mg per day, HR = 0.50; 95% CI, 0.27 to 0.92, higher dose, HR = 0.73; 95% CI, 0.40 to 1.34). CONCLUSION A randomised trial of aspirin among men diagnosed with non-metastatic prostate cancer was recently funded. Our results suggest any additional randomised trials addressing this question should prioritise enrolling men with high-risk cancers and need not use high doses. RESULTS Compared with no aspirin use, neither prediagnosis nor post-diagnosis daily aspirin use were statistically significantly associated with PCSM (pre-diagnosis use, multivariable-adjusted hazard ratio (HR) = 0.92, 95% CI 0.72 to 1.17, post-diagnosis use, HR = 0.98; 95% CI, 0.74 to 1.29). However, among men diagnosed with INTRODUCTION BREAST CERVIX PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION PURPOSE READ IT BEFORE YOUR PATIENTS The role of adjuvant radiotherapy (aRT) in treating patients with pN1 prostate cancer is controversial. We tested the hypothesis that the impact of aRT on cancer-specific mortality (CSM) in these individuals is related to tumour characteristics. PROSTATE 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 Dec 10;32(35):3939-47. doi: 10.1200/ JCO.2013.54.7893. Epub 2014 Sep 22. METHODS We evaluated 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. 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. 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 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 score 7 to 10, pT3b/pT4 stage, or positive surgical INTRODUCTION BREAST CERVIX PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION BACKGROUND READ IT BEFORE YOUR PATIENTS We investigated whether 18 months of androgen suppression plus radiotherapy, with or without 18 months of zoledronic acid, is more effective than six months of neoadjuvant androgen suppression plus radiotherapy with or without zoledronic acid. PROSTATE Short-term androgen suppression and radiotherapy versus intermediate-term androgen suppression and radiotherapy, with or without zoledronic acid, in men with locally advanced prostate cancer (TROG 03.04 RADAR): an open-label, randomised, phase 3 factorial trial. Denham JW, Joseph D, Lamb DS, Spry NA, Duchesne G, Matthews J, Atkinson C, Tai KH, Christie D, Kenny L, Turner S, Gogna NK, Diamond T, Delahunt B, Oldmeadow C, Attia J, Steigler A. Lancet Oncol 2014;15(10):1076-89. INTRODUCTION BREAST CERVIX METHODS We did an open-label, randomised, 2 × 2 factorial trial in men with locally advanced prostate cancer (either T2a N0 M0 prostatic adenocarcinomas with prostate-specific antigen [PSA] ≥10 μg/L and a Gleason score of ≥7, or T2b-4 N0 M0 tumours regardless of PSA and Gleason score). We randomly allocated patients by computergenerated minimisation – stratified by centre, baseline PSA, tumour stage, Gleason score, and use of a brachytherapy boost – to one of four groups in a 1:1:1:1 ratio. Patients in the control group were treated with neoadjuvant androgen suppression with leuprorelin (22.5 mg every three months, intramuscularly) for six months (shortterm) and radiotherapy alone (designated STAS); this procedure was either followed by another 12 months of androgen suppression with leuprorelin (intermediate-term; ITAS) or accompanied by 18 months of zoledronic acid (4 mg every three months for 18 months, intravenously; STAS plus zoledronic acid) or by both (ITAS plus zoledronic acid). The primary endpoint was prostate cancerspecific mortality. This analysis represents the first, pre-planned assessment of oncological PROSTATE HEAD AND NECK RECTAL endpoints, five years after treatment. Analysis was by intention-to-treat. This trial is registered with ClinicalTrials.gov, number NCT00193856. FINDINGS Between 20 October 2003 and 15 August 2007, 1,071 men were randomly assigned to STAS (n=268), STAS plus zoledronic acid (n=268), ITAS (n=268), and ITAS plus zoledronic acid (n=267). Median follow-up was 7.4 years (IQR 6.5-8.4). Cumulative incidences of prostate cancer-specific mortality were 4.1% (95% CI 2.2-7.0) in the STAS group, 7.8% (4.9-11.5) in the STAS plus zoledronic acid group, 7.4% (4.611.0) in the ITAS group, and 4.3% (2.3-7.3) in the ITAS plus zoledronic acid group. Cumulative incidence of all-cause mortality was 17.0% (13.022.1), 18.9% (14.6-24.2), 19.4% (15.0-24.7), and 13.9% (10.3-18.8), respectively. Neither prostate cancer-specific mortality nor all-cause mortality differed between control and experimental groups. Cumulative incidence of PSA progression was 34.2% (28.6-39.9) in the STAS group, 39.6% (33.6-45.5) in the STAS plus zoledronic acid group, 29.2% (23.8-34.8) in the ITAS group, and 26.0% (20.8-31.4) in the ITAS plus zoledronic acid group. Compared with STAS, no difference was noted in PSA progression with ITAS or STAS plus zoledronic acid; however, ITAS plus zoledronic acid reduced PSA progression (subhazard ratio [SHR] 0.71, 95% CI 0.53-0.95; p=0.021). Cumulative incidence of local LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION progression was 4.1% (2.2-7.0) in the STAS group, 6.1% (3.7-9.5) in the STAS plus zoledronic acid group, 1.5% (0.5-3.7) in the ITAS group, and 3.4% (1.7-6.1) in the ITAS plus zoledronic acid group; no differences were noted between groups. Cumulative incidences of bone progression were 7.5% (4.8-11.1), 14.6% (10.6-19.2), 8.4% (5.5-12.2), and 7.6% (4.8-11.2), respectively. Compared with STAS, STAS plus zoledronic acid increased the risk of bone progression (SHR 1.90, 95% CI 1.14-3.17; p=0.012), but no differences were noted with the other two groups. Cumulative incidence of distant progression was 14.7% (10.7-19.2) in the STAS group, 17.3% (13.0-22.1) in the STAS plus zoledronic acid group, 14.2% (10.3-18.7) in the ITAS group, and 11.1% (7.6-15.2) in the ITAS plus zoledronic acid group; no differences were recorded between groups. Cumulative incidence of secondary therapeutic intervention was 25.6% (20.5-30.9), 28.9% (23.5-34.5), 20.7% (16.1-25.9), and 15.3% (11.3-20.0), respectively. Compared with STAS, ITAS plus zoledronic acid reduced the need for secondary therapeutic intervention (SHR 0.67, 95% CI 0.48-0.95; p=0.024); no differences were noted with the other two groups. An interaction between trial factors was recorded for Gleason score; therefore, we did pairwise comparisons between all groups. Post-hoc analyses suggested that the reductions in PSA progression and decreased need for secondary therapeutic intervention with ITAS plus zoledronic acid were restricted to tumours with a Gleason score of 8-10, and that ITAS was better than STAS INTRODUCTION BREAST CERVIX in tumours with a Gleason score of 7 or lower. Long-term morbidity and quality-of-life scores were not affected adversely by 18 months of androgen suppression or zoledronic acid. INTERPRETATION Compared with STAS, ITAS plus zoledronic acid was more effective for treatment of prostate cancers with a Gleason score of 8-10, and ITAS alone was effective for tumours with a Gleason score of 7 or lower. Nevertheless, these findings are based on secondary endpoint data and posthoc analyses and must be regarded cautiously. Long-term follow-up is necessary, as is external validation of the interaction between zoledronic acid and Gleason score. STAS plus zoledronic acid can be ruled out as a potential therapeutic option. PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION PURPOSE READ IT BEFORE YOUR PATIENTS National Comprehensive Cancer Network guidelines recommend patients with head and neck cancer (HNC) receive treatment at centres with expertise, but whether provider experience affects survival is unknown. HEAD AND NECK Institutional clinical trial accrual volume and survival of patients with head and neck cancer. Wuthrick EJ, Zhang Q, Machtay M, Rosenthal DI, Nguyen-Tan PF, Fortin A, Silverman CL, Raben A, Kim HE, Horwitz EM, Read NE, Harris J, Wu Q, Le QT, Gillison ML. J Clin Oncol. 2014 Dec 8. pii: JCO.2014.56.5218. [Epub ahead of print] HHACs (18% v 6%; P < .001). When compared with HHACs, patients at HLACs had worse OS (5 years: 51.0% v 69.1%; P = .002). Treatment at HLACs was associated with increased death risk of 91% (hazard ratio [HR], 1.91; 95% CI, 1.37 to 2.65) after adjustment for prognostic factors and 72% (HR, 1.72; 95% CI, 1.23 to 2.40) after radiotherapy compliance adjustment. PATIENTS AND METHODS The effect of institutional experience on overall survival (OS) in patients with stage III or IV HNC was investigated within a randomised trial of the Radiation Therapy Oncology Group (RTOG 0129), which compared cisplatin concurrent with standard versus accelerated fractionation radiotherapy. As a surrogate for experience, institutions were classified as historically low(HLACs) or high-accruing centres (HHACs) based on accrual to 21 RTOG HNC trials (1997 to 2002). The effect of accrual volume on OS was estimated by Cox proportional hazards models. CONCLUSION OS is worse for patients with HNC treated at HLACs versus HHACs to cooperative group trials after accounting for radiotherapy protocol deviations. Institutional experience substantially influences survival in locally advanced HNC. Read the editorial in the Journal of Clinical Oncology on this paper on the next page > RESULTS Median RTOG accrual (1997 to 2002) at HLACs was four versus 65 patients at HHACs. Analysis included 471 patients in RTOG 0129 (2002 to 2005) with known human papillomavirus and smoking status. Patients at HLACs versus HHACs had better performance status (0: 62% v 52%; P = .04) and lower T stage (T4: 26.5% v 35.3%; P = .002) but were otherwise similar. Radiotherapy protocol deviations were higher at HLACs versus INTRODUCTION BREAST CERVIX PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION The study reported by Wuthrick et al in the article that accompanies this editorial provides additional evidence that patients with advanced head and neck cancer (HNC) should be treated in high-volume HNC centres for optimal survival outcomes. READ IT BEFORE YOUR PATIENTS HEAD AND NECK Impact of centre size and experience on outcomes in head and neck cancer. Corry J, Peters LJ, Rischin D. J Clin Oncol. 2014 Dec 8. pii: JCO.2014.58.2239. [Epub ahead of print] INTRODUCTION BREAST CERVIX This study was a retrospective subgroup analysis of the impact of treatment centre expertise on the overall survival (OS) of patients with oropharyngeal cancer and known human papillomavirus and smoking status who were treated as part of the Radiation Therapy Oncology Group (RTOG) 0129 randomised trial. In this study, high patient accrual to previous RTOG trials was used as a surrogate for HNC expertise. There were a total of 471 patients: the majority (321 patients) were treated at one of 88 historically low-accrual centres (HLACs), whereas 150 patients were treated at one of 13 historically high-accrual centres (HHACs). Looking back over a 15-year history of RTOG HNC trials, the authors defined HHACs as the top tertile of accrual centres, with an average of more than 42 patients accrued per centre. Patients treated at HLACs had inferior outcomes, with five-year locoregional failure rates of 36% compared with 21% for patients treated at HHACs, and five-year OS rates of 51% compared with 69% for patients treated at HHACs. There was a 91% increased risk of death for patients treated at HLACs after adjusting for age, T and N classification, performance status, smoking, and human papillomavirus status. Sensitivity analysis showed PROSTATE HEAD AND NECK RECTAL the results to be consistent when the cut-off for high accrual was decreased from 42 patients (top 5% of centres) to 25 patients (top 10% of centres) or when accrual was treated as a continuous variable. The authors showed that unacceptable radiotherapy (RT) protocol non-compliance was higher in HLACs compared with HHACs (11% v 5%; P = .04), but in multivariable analysis, the impact of this on OS was only approximately 20% of the total impact of accrual volume on OS. This discrepancy likely reflects the requirement for expertise across the gamut of diagnostic, therapeutic, and support services to ensure optimal patient outcomes. However, it is also likely that RT quality could have contributed more to the observed difference, given that the quality assurance (RT QA) analysis was limited to total dose, overall treatment time, and field borders. There was no review of the diagnostic imaging and accuracy of gross tumour volume delineation, and no assessment of radiation dosimetry to the gross tumour volume or planning target volumes. There were no significant differences between HLACs and HHACs with respect to acute or late grade 3 to 5 treatment toxicities, but specific data on treatment-related deaths would have been of interest. The overall message from this study is remarkably similar to that from the Trans Tasman Radiation Oncology Group (TROG) LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION 02.02 sub-study published in 2010 that investigated the impact of radiation protocol compliance and quality in a randomised trial evaluating the addition of the hypoxic cytotoxin tirapazamine to chemoradiotherapy. It was the first HNC trial to include comprehensive RT QA and was able to quantify the impact of major RT protocol violations on patient outcomes. RT was found to be protocol non-compliant in 208 of 820 patients (25%). A secondary review was conducted of 206 of the 208 non-compliant plans, with 97 of 206 (47%) predicted to have an adverse impact on outcome. Indeed, these patients, compared with patients with protocol-compliant plans, had double the two-year locoregional failure rate (46% v 22%) and an absolute reduction in two-year OS of 20% (50% v 70%). Importantly, the probability of receiving poorquality RT was most highly correlated with the number of patients who were enrolled at centres. The centres with the lowest accrual numbers (< five patients) had a disproportionate number of RT protocol violations compared with centres with large accrual numbers (> 20 patients): 30% versus 5% (P < .001). mandible, and pharyngeal muscles), it can also increase the risk of a geographic miss. This may occur if there is inaccurate patient assessment and/or tumour voluming, which is more likely to result in a geographic miss than with previous large-volume, treat-everything RT fields. Hence, the potential for even greater disparity in HNC outcomes in low-volume centres could be much higher in the current IMRT era. The other factor to note is that at least the RTOG HLACs were enrolling some patients in clinical trials. There is another layer of HNC work that is being performed around the world in community centres that rarely or never enrol their patients onto clinical trials and rarely publish their treatment outcomes. So these patients could quite possibly have worse outcomes than the patients in this study who were seen at HLACs. This lack of data from such HNC centres contributes to the difficulties in demonstrating what essentially seems to be a prima facie case – the more you practice, the better you get. As Wuthrick et al have highlighted in their article, the effect of centre experience and expertise may be much greater with intensitymodulated RT (IMRT), which was not used in the RTOG 0129 and TROG 02.02 studies but is now the standard of care. Although the conformality of IMRT provides many advantages, specifically, the reduced dose to normal tissues (salivary, There are retrospective studies that demonstrate the value of being treated (both non-surgically and surgically) in large-volume HNC centres. Analyses of American national databases show better survival for patients with laryngeal cancer and cancer in other head and neck sites who are treated in high-volume centres. Lassig et al reviewed 388 patients with HNC who underwent consultation at an academic institution, including 145 patients who subsequently, for unstated reasons, were treated at a community INTRODUCTION PROSTATE BREAST CERVIX HEAD AND NECK RECTAL centre. They reported a 20% OS difference in favour of the academic centre, although not all significant prognostic factors were included in the multivariable analysis. In contrast, a Canadian study of laryngeal cancer across Ontario, although finding significant differences in treatment outcomes between centres, did not find a correlation with centre patient volumes, possibly because of the large variations seen in treatment practice across the nine centres. Overall, retrospective database analyses should be seen as essentially hypothesis-generating because they cannot account for the important issues of patient selection and treatment bias. These analyses generally do not include information about all of the factors that can affect patient outcomes, such as comorbidities, performance status, tumour biomarkers, and smoking history, nor do they include full treatment details or data on treatment quality assurance. A prospective study by Loevner et al showed the considerable impact of diagnostic radiology expertise in HNC. In this study, cross-sectional imaging for 136 consecutive patients with HNC who were referred to a high-volume tertiary referral centre was reviewed. There was a change in the interpretation of the imaging studies in 56 of 136 patients (41%), which altered the planned treatment in 55 of the 56 patients (98%). Verification of the interpretative change was confirmed by pathologic analysis (75%), characteristic radiologic findings (18%), or clinical and imaging follow-up (7%). A large LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION network of support is required by patients with HNC who are undergoing curative treatment. This includes not only the diagnostic radiologists, surgeons, and radiation oncologists, but also HNC sub-specialty medical oncologists and nursing staff and allied health and social workers. This network of subspecialised support that is the basis for comprehensive multidisciplinary care cannot generally be replicated in centres that treat only small numbers of patients with HNC. The data that were collected prospectively from this study by Wuthrick et al and the TROG 02.02 study suggest that we can improve outcomes in HNC simply by centralising care at highvolume HNC treatment centres. The magnitude of benefit, approximately 20% absolute improvement in OS, far exceeds the postulated benefit from any new treatment intervention that we test in randomised trials in HNC. How should we translate these findings into clinical practice? The authors suggest ways to potentially improve results from low-volume HNC centres: increased use of contouring atlases, auto-contouring software programs, and continuing medical education that is focused on target delineation and treatment planning for HNC. In addition, there are many HHACs that have robust internal RT QA programmes. Linking HLAC patients into such RT QA programmes could be another mechanism for potentially improving the survival of patients with HNC treated at HLACs. INTRODUCTION BREAST CERVIX However, we would argue that no matter how much time and money is invested in trying to improve HNC outcomes for patients in small HNC centres, it is unrealistic to expect that such centres can provide the necessary depth, scope, and currency of expertise across the whole multidisciplinary team that is required to optimally manage patients with complex HNC. It is likely that there is a minimum annual number of patients with HNC that is required to establish and maintain multidisciplinary expertise. It must be stated that in both the study by Wuthrick et al and in the TROG02.02 study, there is an assumption that lower trial accrual numbers equate to treatment of smaller numbers of patients with HNC. It would be useful to obtain the total number of patients with HNC seen in HHACs, as opposed to those enrolled onto trials, to enable a solid recommendation to be made for the minimum annual number of patients with HNC per centre that is required to achieve these optimal HNC survival outcomes. Notwithstanding these considerations, we believe that the evidence is now compelling to recommend that curative treatment of patients with complex HNC be consolidated at high-volume centres to achieve optimal outcomes. A practical approach to achieve this that also recognises the benefit to patients of treatment close to home would be to link small centres to high-volume centres in a network arrangement. In this model, all patients with HNC who potentially require multimodality treatment would initially be assessed and have a management plan formulated at a highvolume centre. A collaborative triage process would then enable the less complex patient cases to be directed back to the local centre for treatment with appropriate support as required. Other models, such as those involving videoconferencing, for instance, are also possible, but irrespective of the model adopted, we believe that the benefits of high-volume HNC expertise must be made accessible to all patients with HNC for optimal outcomes to be achieved. We understand the reluctance of many patients to travel beyond a local centre to receive treatment at a more distant but larger cancer centre with HNC experience and expertise. There may be financial, physical, social, and emotional impediments that need to be addressed. There may also be an unwillingness on the part of many small centres to acknowledge the limitations of the services that they can reasonably provide. PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION PURPOSE READ IT BEFORE YOUR PATIENTS HEAD AND NECK Externally validated HPVbased prognostic nomogram for oropharyngeal carcinoma patients yields more accurate predictions than TNM staging. Due to the established role of the human papillomavirus (HPV), the optimal treatment for oropharyngeal carcinoma is currently under debate. We evaluated the most important determinants of treatment outcome to develop a multifactorial predictive model that could provide individualised predictions of treatment outcome in oropharyngeal carcinoma patients. METHODS Rios Velazquez E, Hoebers F, Aerts HJ, Rietbergen MM, Brakenhoff RH, Leemans RC, Speel EJ, Straetmans J, Kremer B, Lambin P. We analysed the association between clinicopathological factors and overall and progressionfree survival in 168 OPSCC patients treated with curative radiotherapy or concurrent chemoradiation. A multivariate model was validated in an external dataset of 189 patients and compared to the TNM staging system. This nomogram will be made publicly available at www.predictcancer.org. Radiother Oncol. 2014 Oct 24. pii: S0167-8140(14)003922. doi: 10.1016/j.radonc.2014.09.005. [Epub ahead of print] RESULTS INTRODUCTION PROSTATE BREAST CERVIX 0.76-0.88), with a validation C-index of 0.67, (95% CI, 0.59-0.74). Stratification of model estimated probabilities showed statistically different prognosis groups in both datasets (p<0.001). CONCLUSION This nomogram was superior to TNM classification or HPV status alone in an independent validation dataset for prediction of overall and progression-free survival in OPSCC patients, assigning patients to distinct prognosis groups. These individualised predictions could be used to stratify patients for treatment deescalation trials. Predictors of unfavourable outcomes were negative HPV-status, moderate to severe comorbidity, T3-T4 classification, N2b-N3 stage, male gender, lower haemoglobin levels and smoking history of more than 30 pack years. Prediction of overall survival using the multi-parameter model yielded a C-index of 0.82 (95% CI, 0.76-0.88). Validation in an independent dataset yielded a C-index of 0.73 (95% CI, 0.66-0.79. For progression-free survival, the model’s C-index was 0.80 (95% CI, HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION PURPOSE READ IT BEFORE YOUR PATIENTS HEAD AND NECK Randomised phase III trial of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage III to IV head and neck carcinoma: RTOG 0522. Ang KK, Zhang Q, Rosenthal DI, Nguyen-Tan PF, Sherman EJ, Weber RS, Galvin JM, Bonner JA, Harris J, El-Naggar AK, Gillison ML, Jordan RC, Konski AA, Thorstad WL, Trotti A, Beitler JJ, Garden AS, Spanos WJ, Yom SS, Axelrod RS. BREAST PATIENTS AND METHODS Eligible patients with stage III or IV HNC were randomly assigned to receive radiation and cisplatin without (arm A) or with (arm B) cetuximab. Acute and late reactions were scored using Common Terminology Criteria for Adverse Events (version 3). Outcomes were correlated with patient and tumour features and markers. CONCLUSION Adding cetuximab to radiation-cisplatin did not improve outcome and hence should not be prescribed routinely. PFS and OS were higher in patients with p16-positive OPC, but outcomes did not differ by EGFR expression. RESULTS Of 891 analysed patients, 630 were alive at analysis (median follow-up, 3.8 years). Cetuximab plus cisplatin-radiation, versus cisplatin-radiation alone, resulted in more frequent interruptions in radiation therapy (26.9% v 15.1%, respectively); similar cisplatin delivery (mean, 185.7 mg/m2 v 191.1 mg/m2, respectively); and more grade 3 to 4 radiation mucositis (43.2% v 33.3%, respectively), rash, fatigue, anorexia, and hypokalaemia, but not more late toxicity. No differences were found J Clin Oncol. 2014;32(27):2940-50. INTRODUCTION Combining cisplatin or cetuximab with radiation improves overall survival (OS) of patients with stage III or IV head and neck carcinoma (HNC). Cetuximab plus platinum regimens also increase OS in metastatic HNC. The Radiation Therapy Oncology Group launched a phase III trial to test the hypothesis that adding cetuximab to the radiation-cisplatin platform improves progression-free survival (PFS). between arms A and B in 30-day mortality (1.8% v 2.0%, respectively; P = .81), three-year PFS (61.2% v 58.9%, respectively; P = .76), three -year OS (72.9% v 75.8%, respectively; P = .32), locoregional failure (19.9% v 25.9%, respectively; P = .97), or distant metastasis (13.0% v 9.7%, respectively; P = .08). Patients with p16-positive oropharyngeal carcinoma (OPC), compared with patients with p16-negative OPC, had better three-year probability of PFS (72.8% v 49.2%, respectively; P < .001) and OS (85.6% v 60.1%, respectively; P < .001), but tumour epidermal growth factor receptor (EGFR) expression did not distinguish outcome. CERVIX PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION PURPOSE READ IT BEFORE YOUR PATIENTS We tested the efficacy and toxicity of cisplatin plus accelerated fractionation with a concomitant boost (AFX-C) versus standard fractionation (SFX) in locally advanced head and neck carcinoma (LA-HNC). HEAD AND NECK Randomised phase III trial to test accelerated versus standard fractionation in combination with concurrent cisplatin for head and neck carcinomas in the Radiation Therapy Oncology Group 0129 Trial: long-term report of efficacy and toxicity. Nguyen-Tan PF, Zhang Q, Ang KK, Weber RS, Rosenthal DI, Soulieres D, Kim H, Silverman C, Raben A, Galloway TJ, Fortin A, Gore E, Westra WH, Chung CH, Jordan RC, Gillison ML, List M, Le QT. J Clin Oncol. 2014;32(34):3858-67. PATIENTS AND METHODS Patients had stage III to IV carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Radiation therapy schedules were 70 Gy in 35 fractions over seven weeks (SFX) or 72 Gy in 42 fractions over six weeks (AFX-C). Cisplatin doses were 100 mg/m(2) once every three weeks for two (AFX-C) or three (SFX) cycles. Toxicities were scored by using National Cancer Institute Common Toxicity Criteria 2.0 and the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer criteria. Overall survival (OS) and progression-free survival (PFS) rates were estimated by using the KaplanMeier method and were compared by using the one-sided log-rank test. Locoregional failure (LRF) and distant metastasis (DM) rates were estimated by using the cumulative incidence method and Gray’s test. patients, no differences were observed in OS (hazard ratio [HR], 0.96; 95% CI, 0.79 to 1.18; P = .37; eight-year survival, 48% v 48%), PFS (HR, 1.02; 95% CI, 0.84 to 1.24; P = .52; eight-year estimate, 42% v 41%), LRF (HR, 1.08; 95% CI, 0.84 to 1.38; P = .78; eight-year estimate, 37% v 39%), or DM (HR, 0.83; 95% CI, 0.56 to 1.24; P = .16; eightyear estimate, 15% v 13%). For oropharyngeal cancer, p16-positive patients had better OS than p16-negative patients (HR, 0.30; 95% CI, 0.21 to 0.42; P < .001; eight-year survival, 70.9% v 30.2%). There were no statistically significant differences in the grade 3 to 5 acute or late toxicities between the two arms and p-16 status. CONCLUSION When combined with cisplatin, AFX-C neither improved outcome nor increased late toxicity in patients with LA-HNC. Long-term high survival rates in p16-positive patients with oropharyngeal cancer support the ongoing efforts to explore deintensification. RESULTS In all, 721 of 743 patients were analysable (361, SFX; 360, AFX-C). At a median follow-up of 7.9 years (range, 0.3 to 10.1 years) for 355 surviving INTRODUCTION BREAST CERVIX PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION PURPOSE READ IT BEFORE YOUR PATIENTS Physical inactivity has been associated with higher mortality risk among survivors of colorectal cancer (CRC), but the independent effects of pre- versus post-diagnosis activity are unclear, and the association between watching television (TV) and mortality in survivors of CRC is previously undefined. COLORECTAL Pre- and postdiagnosis physical activity, television viewing, and mortality among patients with colorectal cancer in the National Institutes of HealthAARP Diet and Health study. Arem H, Pfeiffer RM, Engels EA, Alfano CM, Hollenbeck A, Park Y, Matthews CE. J Clin Oncol. 2014 Dec 8. pii: JCO.2014.58.1355. [Epub ahead of print] INTRODUCTION BREAST CERVIX METHODS We analysed the associations between prediagnosis (n = 3,797) and post-diagnosis (n = 1,759) leisure time physical activity (LTPA) and TV watching and overall and disease-specific mortality among patients with CRC. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs, adjusting for known mortality risk factors. a 22% increased all-cause mortality risk (HR, 1.22; 95% CI, 1.06 to 1.41; P trend = .002), and more post-diagnosis TV watching was associated with a non-significant 25% increase in all-cause mortality risk (HR, 1.25; 95% CI, 0.93 to 1.67; P for trend = .126). CONCLUSION LTPA was inversely associated with all-cause mortality, whereas more TV watching was associated with increased mortality risk. For both LTPA and TV watching, post-diagnosis measures independently explained the association with mortality. Clinicians should promote both minimising TV time and increasing physical activity for longevity among survivors of CRC, regardless of previous behaviours. RESULTS Comparing survivors of CRC reporting more than seven hours per week (h/wk) of pre-diagnosis LTPA with those reporting no LTPA, we found a 20% lower risk of all-cause mortality (HR, 0.80; 95% CI, 0.68 to 0.95; P for trend = .021). Post-diagnosis LTPA of ≥ 7 h/wk, compared with none, was associated with a 31% lower all-cause mortality risk (HR, 0.69; 95% CI, 0.49 to 0.98; P for trend = .006), independent of pre-diagnosis activity. Compared with 0-2 TV hours per day (h/d) before diagnosis, those reporting ≥ 5 h/d of TV before diagnosis had PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION PURPOSE READ IT BEFORE YOUR PATIENTS This study investigated the long-term probability of developing a second cancer in a large pooled cohort of patients treated with surgery with or without radiotherapy (RT). RECTAL/ ENDOMETRIAL PATIENTS AND METHODS No increased risk of second cancer after radiotherapy in patients treated for rectal or endometrial cancer in the randomised TME, PORTEC-1, and PORTEC-2 trials. Wiltink LM, Nout RA, Fiocco M, Meershoek-Klein Kranenbarg E, Jürgenliemk-Schulz IM, Jobsen JJ, Nagtegaal ID, Rutten HJ, van de Velde CJ,Creutzberg CL, Marijnen CA. J Clin Oncol. 2014 Dec 22. pii: JCO.2014.58.6693. [Epub ahead of print] INTRODUCTION BREAST CERVIX All second cancers diagnosed in patients included in the TME, PORTEC-1, and PORTEC-2 trials were analysed. In the TME trial, patients with rectal cancer (n = 1,530) were randomly allocated to preoperative external-beam RT (EBRT; 25 Gy in five fractions) or no RT. In the PORTEC trials, patients with endometrial cancer were randomly assigned to postoperative EBRT (46 Gy in 2-Gy fractions) versus no RT (PORTEC-1; n = 714) or EBRT versus vaginal brachytherapy (VBT; PORTEC-2; n = 427). matched general population. The standardised incidence ratio for any second cancer was 2.98 (95% CI, 2.82 to 3.14). CONCLUSION In this pooled trial cohort of > 2,500 patients with pelvic cancers, those who underwent EBRT or VBT had no higher probability of developing a second cancer than patients who were treated with surgery alone. However, patients with rectal or endometrial cancer had an increased probability of developing a second cancer compared with the general population. RESULTS A total of 2,554 patients were analysed (median follow-up, 13 years; range 1.8 to 21.2 years). No differences were found in second cancer probability between patients who were treated without RT (10and 15-year rates, 15.8% and 26.5%, respectively) and those treated with EBRT (10- and 15-year rates, 15.4% and 25.6%, respectively) or VBT (10-year rate, 14.9%). In the individual trials, no significant differences were found between treatment arms. All cancer survivors had a higher risk of developing a second cancer compared with an age- and sex- PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION PURPOSE READ IT BEFORE YOUR PATIENTS The optimal chemotherapy regimen to use with radiotherapy in stage III non-small-cell lung cancer is unknown. Here, we compare the outcome of patents treated within the Veterans Health Administration with either etoposidecisplatin (EP) or carboplatin-paclitaxel (CP). LUNG Cisplatin and etoposide versus carboplatin and paclitaxel with concurrent radiotherapy for stage III non-small-cell lung cancer: an analysis of Veterans Health Administration Data. METHODS The authors identified patients treated with EP and CP with concurrent radiotherapy from 2001 to 2010. Survival rates were compared using Cox proportional hazards regression models with adjustments for confounding provided by propensity score methods and an instrumental variables analysis. Co-morbidities and treatment complications were identified through administrative data. with centres where EP was used in less than 10% of the patients (HR, 1.07; 95% CI, 0.90 to 1.26). Patients treated with EP, compared with patients treated with CP, had more hospitalisations (2.4 v 1.7 hospitalisations, respectively; P < .001), outpatient visits (17.6 v 12.6 visits, respectively; P < .001), infectious complications (47.3% v 39.4%, respectively; P = .0022), acute kidney disease/ dehydration (30.5% v 21.2%, respectively; P < .001), and mucositis/oesophagitis (18.6% v 14.4%, respectively; P = .0246). CONCLUSION After accounting for prognostic variables, patients treated with EP versus CP had similar overall survival, but EP was associated with increased morbidity. Santana-Davila R, Devisetty K, Szabo A, Sparapani R, Arce-Lara C, Gore EM, Moran A, Williams CD, Kelley MJ, Whittle J. J Clin Oncol. 2014 Nov 24. pii: JCO.2014.56.2587. [Epub ahead of print] INTRODUCTION BREAST CERVIX RESULTS A total of 1,842 patients were included; EP was used in 27% (n = 499). Treatment with EP was not associated with a survival advantage in a Cox proportional hazards model (hazard ratio [HR], 0.97; 95% CI, 0.85 to 1.10), a propensity score matched cohort (HR, 1.07; 95% CI, 0.91 to 1.24), or a propensity score adjusted model (HR, 0.97; 95% CI, 0.85 to 1.10). In an instrumental variables analysis, there was no survival advantage for patients treated in centres where EP was used more than 50% of the time as compared PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION PURPOSE READ IT BEFORE YOUR PATIENTS LUNG In vivo quantification of hypoxic and metabolic status of NSCLC tumours using [18F] HX4 and [18F]FDG-PET/CT imaging. Zegers CM, van Elmpt W, Reymen B, Even AJ, Troost EG, Ollers MC, Hoebers FJ, Houben RM, Eriksson J, Windhorst AD, Mottaghy FM, De Ruysscher D, Lambin P. Clin Cancer Res. 2014 Dec 15;20(24):6389-97. Increased tumour metabolism and hypoxia are related to poor prognosis in solid tumours, including non-small cell lung cancer (NSCLC). PET imaging is a non-invasive technique that is frequently used to visualise and quantify tumour metabolism and hypoxia. The aim of this study was to perform an extensive comparison of tumour metabolism using 2[18F]fluoro-2-deoxyd-glucose (FDG)-PET and hypoxia using HX4PET imaging. EXPERIMENTAL DESIGN FDG- and HX4-PET/CT images of 25 patients with NSCLC were co-registered. At a global tumour level, HX4 and FDG parameters were extracted from the gross tumour volume (GTV). The HX4 high-fraction (HX4-HF) and HX4 high-volume (HX4-HV) were defined using a tumour-to-blood ratio > 1.4. For FDG highfraction (FDG-HF) and FDG high-volume (FDG-HV), a standardised uptake value (SUV) > 50% of SUVmax was used. We evaluated the spatial correlation between HX4 and FDG uptake within the tumour, to quantify the (mis)match between volumes with a high FDG and high HX4 uptake. For the primary GTV, the HX4-HF was three times smaller compared with the FDG-HF. In 53% of the primary lesions, less than 1 cm3 of the HX4-HV was outside the FDG-HV; for 37%, this volume was 1.9 to 12 cm3. Remarkably, a distinct uptake pattern was observed in 11%, with large hypoxic volumes localised outside the FDG-HV. CONCLUSION Hypoxic tumour volumes are smaller than metabolic active volumes. Approximately half of the lesions showed a good spatial correlation between the PET tracers. In the other cases, a (partial) mismatch was observed. The addition of HX4-PET imaging has the potential to individualise patient treatment. RESULTS At a tumour level, significant correlations were observed between FDG and HX4 parameters. INTRODUCTION BREAST CERVIX PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION BACKGROUND READ IT BEFORE YOUR PATIENTS LUNG A prospective study comparing the predictions of doctors versus models for treatment outcome of lung cancer patients: a step toward individualised care and shared decision-making. Oberije C, Nalbantov G, Dekker A, Boersma L, Borger J, Reymen B, van Baardwijk A, Wanders R, De Ruysscher D, Steyerberg E, Dingemans AM, Lambin P. Radiother Oncol. 2014 Jul;112(1):37-43. doi: 10.1016/j.radonc.2014.04.012. Epub 2014 May 17. Decision Support Systems, based on statistical prediction models, have the potential to change the way medicine is being practised, but their application is currently hampered by the astonishing lack of impact studies. Showing the theoretical benefit of using these models could stimulate conductance of such studies. In addition, it would pave the way for developing more advanced models, based on genomics, proteomics and imaging information, to further improve the performance of the models. PURPOSE In this prospective single-centre study, previously developed and validated statistical models were used to predict the two-year survival (2yrS), dyspnoea (DPN), and dysphagia (DPH) outcomes for lung cancer patients treated with chemo-radiation. These predictions were compared to probabilities provided by doctors and guideline-based recommendations currently used. We hypothesised that model predictions would significantly outperform predictions from doctors. Differences in the performances of doctors and models were assessed using Area Under the Curve (AUC) analysis. RESULTS A total number of 155 patients were included. At timepoint #1 the differences in AUCs between the ROs and the models were 0.15, 0.17, and 0.20 (for 2yrS, DPN, and DPH, respectively), with p-values of 0.02, 0.07, and 0.03. Comparable differences at timepoint #2 were not statistically significant due to the limited number of patients. Comparison to guideline-based recommendations also favoured the models. CONCLUSION The models substantially outperformed ROs’ predictions and guideline-based recommendations currently used in clinical practice. Identification of risk groups on the basis of the models facilitates individualised treatment, and should be further investigated in clinical impact studies. MATERIALS AND METHODS Experienced radiation oncologists (ROs) predicted all outcomes at two timepoints: (1) after the first consultation of the patient, and (2) after the radiation treatment plan was made. INTRODUCTION BREAST CERVIX PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION BACKGROUND READ IT BEFORE YOUR PATIENTS The role of bleomycin and dacarbazine in the ABVD regimen (i.e. doxorubicin, bleomycin, vinblastine, and dacarbazine) has been questioned, especially for treatment of early-stage favourable Hodgkin’s lymphoma, because of the drugs’ toxicity. We aimed to investigate whether omission of either bleomycin or dacarbazine, or both, from ABVD reduced the efficacy of this regimen in treatment of Hodgkin’s lymphoma. HODGKIN’S LYMPHOMA Omission of dacarbazine or bleomycin, or both, from the ABVD regimen in treatment of early-stage favourable Hodgkin’s lymphoma (GHSG HD13): an open-label, randomised, noninferiority trial. Behringer K, Goergen H, Hitz F, Zijlstra JM, Greil R, Markova J, Sasse S, Fuchs M, Topp MS, Soekler M, Mathas S, Meissner J, Wilhelm M, Koch P, Lindemann H, Schalk E, Semrau R, Kriz J, Vieler T, Bentz M, Lange E, Mahlberg R, Hassler A, Vogelhuber M, Hahn D, Mezger J, Krause SW, Skoetz N, Böll B, von Tresckow B, Diehl V, Hallek M, Borchmann P, Stein H, Eich H, Engert A; on behalf of the German Hodgkin Study Group; the Swiss Group for Clinical Cancer Research; the Österreichische Arbeitsgemeinschaft für Klinische Pharmakologie und Therapie. Lancet. 2014 Dec 19. pii: S0140-6736(14)61469-0. doi: 10.1016/S0140-6736(14)61469-0. [Epub ahead of print] INTRODUCTION BREAST CERVIX FINDINGS METHODS In this open-label, randomised, multicentre trial (HD13) we compared two cycles of ABVD with two cycles of the reduced-intensity regimen variants ABV (doxorubicin, bleomycin, and vinblastine), AVD (doxorubicin, vinblastine, and dacarbazine), and AV (doxorubicin and vinblastine), in patients with newly diagnosed, histologically proven, classic or nodular, lymphocyte predominant Hodgkin’s lymphoma. In each treatment group, 30 Gy involved-field radiotherapy (IFRT) was given after both cycles of chemotherapy were completed. From 28 January 2003, patients were centrally randomly assigned (1:1:1:1) with a minimisation method to the four groups. Because of high event rates, assignment to the AV and ABV groups stopped early, on 30 September 2005 and 10 February 2006; assignment to ABVD and AVD continued (1:1) until 30 September 2009. Our primary objective was to show non-inferiority of the PROSTATE experimental variants compared with ABVD in terms of freedom from treatment failure (FFTF), by excluding a difference of 6% after five years corresponding to a hazard ratio (HR) of 1.72, via a 95% CI. Analyses reported here include qualified patients only, and between-group comparisons include only patients recruited during the same period. The trial was registered, number ISRCTN63474366. HEAD AND NECK RECTAL Of 1,502 qualified patients, 566, 198, 571, and 167 were randomly assigned to receive ABVD, ABV, AVD, or AV, respectively. Five-year FFTF was 93.1%, 81.4%, 89.2%, and 77.1% with ABVD, ABV, AVD, and AV, respectively. Compared with ABVD, inferiority of the dacarbazine-deleted variants was detected with five-year differences of -11.5% (95% CI -18.3 to -4.7; HR 2.06 [1.21 to 3.52]) for ABV and -15.2% (-23.0 to -7.4; HR 2.57 [1.51 to 4.40]) for AV. Non-inferiority of AVD compared with ABVD could also not be detected (five-year difference -3.9%, -7.7 to -0.1; HR 1.50, 1.00 to 2.26). 178 (33%) of 544 patients given ABVD had WHO grade III or IV toxicity, compared with 53 (28%) of 187 given ABV, 142 (26%) of 539 given AVD, and 40 (26%) of 151 given AV. Leucopoenia was the most common event, and highest in the groups given bleomycin. LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION INTERPRETATION Dacarbazine cannot be omitted from ABVD without a substantial loss of efficacy. With respect to our predefined non-inferiority margin, bleomycin cannot be safely omitted either, and the standard of care for patients with early-stage favourable Hodgkin’s lymphoma should remain ABVD followed by IFRT. INTRODUCTION BREAST CERVIX PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION PURPOSE READ IT BEFORE YOUR PATIENTS This prospective phase II study was designed to assess disease control and to describe acute and late adverse effects of treatment with proton radiotherapy in children with rhabdomyosarcoma (RMS). PAEDIATRICS CONCLUSION PATIENTS AND METHODS Preliminary results of a phase II trial of proton radiotherapy for paediatric rhabdomyosarcoma. Ladra MM, Szymonifka JD, Mahajan A, Friedmann AM, Yong Yeap B, Goebel CP, MacDonald SM, Grosshans DR, Rodriguez-Galindo C, Marcus KJ,Tarbell NJ1 Yock TI. J Clin Oncol. 2014 Nov 20;32(33):3762-70. doi: 10.1200/ JCO.2014.56.1548. Epub 2014 Oct 20. LC by risk group was 93% for low-risk and 77% for intermediate-risk disease. There were 13 patients with grade 3 acute toxicity and three patients with grade 3 late toxicity. There were no acute or late toxicities higher than grade 3. Fifty-seven patients with localised RMS (age 21 years or younger) or metastatic embryonal RMS (age 2-10 years) were enrolled between February 2005 and August 2012. All patients were treated with chemotherapy based on either vincristine, actinomycin, and cyclophosphamide or vincristine, actinomycin, and ifosfamide– based chemotherapy and proton radiation. Surgical resection was based on tumour site and accessibility. Common Terminology Criteria for Adverse Events, Version 3.0, was used to assess and grade adverse effects of treatment. Concurrent enrolment onto Children’s Oncology Group or European Paediatric Sarcoma Study Group protocols was allowed. All pathology and imaging were reviewed at the treating institution. Five-year LC, EFS, and OS rates were similar to those observed in comparable trials that used photon radiation. Acute and late toxicity rates were favourable. Proton radiation appears to represent a safe and effective radiation modality for paediatric RMS. RESULTS Median follow-up was 47 months (range: 14 to 102 months) for survivors. Five-year eventfree survival (EFS), overall survival (OS), and local control (LC) were 69%, 78%, and 81%, respectively, for the entire cohort. The five-year INTRODUCTION BREAST CERVIX PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION READ IT BEFORE YOUR PATIENTS PALLIATION Impact of reirradiation of painful osseous metastases on quality of life and function: a secondary analysis of the NCIC CTG SC.20 randomised trial. Chow E, Meyer RM, Chen BE, van der Linden YM, Roos D, Hartsell WF, Hoskin P, Wu JS, Nabid A, Tissing-Tan CJ, Oei B, Babington S, Demas WF, Wilson CF, Wong RK, Brundage M. J Clin Oncol. 2014 Oct 27. pii: JCO.2014.57.6264. [Epub ahead of print] PURPOSE The authors previously demonstrated that 48% of patients with pain at sites of previously irradiated bone metastases benefit from reirradiation. It is unknown whether alleviating pain also improves patient perception of quality of life (QOL). and improved QOL, as determined by scores on the EORTC QLQ-C30 scales of physical, role, emotional and social functioning, global QOL, fatigue, pain, and appetite. Similar results were obtained using the BPI-PS; observed improvements were typically of lesser magnitude. PATIENTS AND METHODS CONCLUSION The investigators used the database of a randomised trial comparing radiation treatment dose fractionation schedules to evaluate whether response, determined using the International Consensus Endpoint (ICE) and Brief Pain Inventory pain score (BPI-PS), is associated with patient perception of benefit, as measured using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and functional interference scale of the BPI (BPI-FI). Evaluable patients completed baseline and twomonth follow-up assessments. Patients responding to reirradiation of painful bone metastases experience superior QOL scores and less functional interference associated with pain. Patients should be offered re-treatment for painful bone metastases in the hope of reducing pain severity as well as improving QOL and pain interference. RESULTS Among 850 randomly assigned patients, 528 were evaluable for response using the ICE and 605 using the BPI-PS. Using the ICE, 253 patients experienced a response and 275 did not. Responding patients had superior scores on all items of the BPI-FI (i.e. general activity, mood, walking ability, normal work, relations with other people, sleep, and enjoyment of life) INTRODUCTION BREAST CERVIX PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION PURPOSE READ IT BEFORE YOUR PATIENTS PALLIATION Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during wholebrain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial. Gondi V, Pugh SL, Tome WA, Caine C, Corn B, Kanner A, Rowley H, Kundapur V, DeNittis A, Greenspoon JN, Konski AA, Bauman GS, Shah S, Shi W, Wendland M, Kachnic L, Mehta MP. J Clin Oncol. 2014 Dec 1;32(34):3810-6. PMID:25349290 [PubMed - in process] Hippocampal neural stem-cell injury during whole-brain radiotherapy (WBRT) may play a role in memory decline. Intensity-modulated radiotherapy can be used to avoid conformally the hippocampal neural stem-cell compartment during WBRT (HA-WBRT). RTOG 0933 was a single-arm phase II study of HA-WBRT for brain metastases with pre-specified comparison with a historical control of patients treated with WBRT without hippocampal avoidance. PATIENTS AND METHODS analysable at four months. Mean relative decline in HVLT-R DR from baseline to four months was 7.0% (95% CI, -4.7% to 18.7%), significantly lower in comparison with the historical control (P < .001). No decline in QOL scores was observed. Two grade 3 toxicities and no grade 4 to 5 toxicities were reported. Median survival was 6.8 months. CONCLUSION Conformal avoidance of the hippocampus during WBRT is associated with preservation of memory and QOL as compared with historical series. Eligible adult patients with brain metastases received HA-WBRT to 30 Gy in 10 fractions. Standardised cognitive function and qualityof-life (QOL) assessments were performed at baseline and two, four and six months. The primary end point was the Hopkins Verbal Learning Test-Revised Delayed Recall (HVLT-R DR) at four months. The historical control demonstrated a 30% mean relative decline in HVLT-R DR from baseline to four months. To detect a mean relative decline ≤ 15% in HVLT-R DR after HA-WBRT, 51 analysable patients were required to ensure 80% statistical power with α = 0.05. RESULTS Of 113 patients accrued from March 2011 through to November 2012, 42 patients were INTRODUCTION BREAST CERVIX PROSTATE HEAD AND NECK RECTAL LUNG HODGKIN’S LYMPHOMA PAEDIATRICS PALLIATION BRACHYTHERAPY INTRODUCTION GEC-ESTRO MEETINGS EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY Welcome to the Brachytherapy Corner. BRACHYTHERAPY “The Corner concludes with the announcement of the 2nd edition of the GEC-ESTRO handbook of brachytherapy” GEC-ESTRO ASSEMBLY Sunday 26 April 2015 at the 3rd ESTRO Forum, Barcelona Room 122/123 from 13:30 - 14:30 INTRODUCTION In this Corner you can read about the well-attended and successful 2nd GEC-ESTRO workshop in Brussels. Simon Buus summarises this one day event by highlighting the main topics. The day after the 2nd GEC-ESTRO workshop, an in vivo dosimetry seminar was held in Brussels and Alexandra Rink reports on the day’s activities. Dr Juli Jamnasi from Vina Cancer Center in Indonesia visited Universitätklinikum Schleswig-Holstein in Lübeck and also took the opportunity to visit the 2nd GECESTRO workshop. This Corner carries an account of his experiences during his short stay in Europe. As usual, we have the editors’ pick of brachytherapy papers. María del Carmen Pujades tells us about a study on air-kerma evaluation at the entrance of HDR facilities. Michael Zelefsky discusses a paper about the bladder neck dose as a predictive factor for toxicity in LDR prostate brachytherapy. This is an important study that can contribute to the sparse data on dosimetry and toxicity. The Corner concludes with the announcement of the 2nd edition of the GEC-ESTRO handbook of brachytherapy under the editorship of Erik Van Limbergen, Richard Pötter, Peter Hoskin and Dimos Baltas. This edition will be an online version and some chapters are already online; it will be completed gradually with the addition of the other chapters. PETER HOSKIN BRADLEY PIETERS KARI TANDERUP Peter Hoskin, Bradley Pieters and Kari Tanderup GEC-ESTRO MEETINGS EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY GEC-ESTRO MEETINGS BRACHYTHERAPY 4 - 5 December 2014 - Brussels , Belgium GEC-ESTRO workshop State of the art brachytherapy to maximise the therapeutic window Simon Buus Focusing on multidisciplinary approaches in brachytherapy Dr Julijamnasi In vivo dosimetry seminar Alexandra Rink INTRODUCTION GEC-ESTRO MEETINGS EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY GEC-ESTRO MEETINGS BRACHYTHERAPY 4 - 5 December 2014 - Brussels , Belgium GEC-ESTRO WORKSHOP State of the art brachytherapy to maximise the therapeutic window Simon Buus Department of Oncology Aarhus University Hospital Denmark 2nd GEC-ESTRO workshop in session SIMON BUUS INTRODUCTION The 2nd GEC-ESTRO workshop was held in Brussels on 4 December 2014. The workshop followed in the steps of last year’s successful 1st GEC-ESTRO workshop. About 200 people participated in this year’s event, but the number could have been even higher, as there was an upper limit for participants. At the time of writing, a 3rd GEC-ESTRO workshop is being planned on 19 November 2015, and we have to consider the GEC-ESTRO MEETINGS optimal venue for the next workshop, so that no one is rejected. Brussels is, in many ways, the perfect location for a meeting held in December with all the Christmas trees and lights. Add a few traditional Belgian Christmas beers, a happy mix of oncologists and physicists, and you have the recipe for a good and very dynamic workshop. EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY GEC-ESTRO MEETINGS 4 - 5 December 2014 - Brussels , Belgium Alex Rijnders on the impact of improvements in dosimetry on the therapeutic window Good news was announced about the much awaited update of the GEC-ESTRO handbook (2002), which is getting off the ground. The second edition is launched with three chapters covering dosimetry, radioprotection, and prostate cancer, and the handbook will be updated continuously to contain a planned 37 chapters. The GEC-ESTRO handbook is available on the DOVE platform at www.estro.org/about-us/governance-organisation/committees-activities/gec-estro-hand- INTRODUCTION book-of-brachytherapy, but you need to log in with your ESTRO username and password. The overall topic of the workshop was “State of the art brachytherapy to maximise the therapeutic window”. In my opinion, the different working groups successfully addressed this. The BRAPHYQS group explained about their ongoing work to reduce the uncertainties of do- GEC-ESTRO MEETINGS simetry, imaging, and dose delivery. The ANORECTAL group presented an update of their results in rectal cancer, and informed us about the planned randomised OPERA trial examining the organ preserving effect of a 90/3 Gy HDR boost added to standard chemoradiotherapy. The gynae group showed updated results in cervical cancer on their very fruitful retroEMBRACE and EMBRACE – benchmarking studies to establish evidence-based dose recommendations to target volumes and constraints to organs at risk. Based on these results, the gynae group will continue their research in the proposed EMBRACE II study, which intends to reduce dose to small tumours and improve target coverage in larger tumours using MRI-guided radiotherapy. The head and neck group explained about their efforts to establish a database within the COBRA database frame, and showed examples of visual preserving ENT brachytherapy. The BREAST group proposed guidelines for conformal target delineation in breast brachytherapy. The URO-GEC presented an update on the results of brachytherapy boost in bladder cancer, and presented the early results of laparoscopic and robotic assisted bladder implants – impressive pioneering work that may change our current practice in bladder cancer. Finally, an overview of prostate cancer brachytherapy was presented – showing the EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY GEC-ESTRO MEETINGS 4 - 5 December 2014 - Brussels , Belgium rapid development from whole gland boost to focal salvage brachytherapy. Inspired by the time of Christmas, I asked the three wise men from GEC-ESTRO what they believed to be the most important issue/event at the workshop. Jacob Lindegaard (GEC-ESTRO, present chair) “That the GEC-ESTRO handbook has been launched in a new format and on a new platform that provides very interesting perspectives in terms of interactivity between the GEC-ESTRO working groups, the ESTRO brachytherapy courses and the GEC-ESTRO members.” Being modest about the suggested wisdom, Jacob stated: “I’m surely not one of the three wise men, who were as you know Kasper, Melchior, and Balthasar. Perhaps Dimos Baltas is the closest we get in the GEC community.” Peter Hoskin (GEC-ESTRO, past chair), referring to Christian’s comment: “This was also a feature for me, with several people telling me how valuable it was for them to have the opportunity to meet in that way, which they had not been able to achieve in the main ESTRO meeting.” Simon Buus Department of Oncology Aarhus University Hospital Denmark Christian Kirisits (GEC-ESTRO, chair-elect) “I am definitely not wise... but what I really liked about the workshop is that I met so many colleagues from the different fields of brachytherapy again – most of them I did not meet during the big ESTRO meeting in Vienna last year.” INTRODUCTION GEC-ESTRO MEETINGS Read the interview with Jacob Lindegaard, chair of the GECESTRO-ISIORT meeting at the 3rd ESTRO Forum, in the Conference Corner on p 141 > EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY GEC-ESTRO MEETINGS BRACHYTHERAPY 4 - 5 December 2014 - Brussels , Belgium GEC-ESTRO WORKSHOP Focusing on multidisciplinary approaches in brachytherapy Dr Julijamnasi Vina Cancer Center, Murni Teguh Memorial Hospital Medan, Indonesia After reading an email from ESTRO, it only took me a few minutes before I decided to join the 2nd GEC-ESTRO workshop on 4 December 2014 in Brussels, Belgium. For most Indonesian young oncologists, it is not easy (or cheap) to travel to Europe, but I believe this meeting is of the highest standard. DR JULIJAMNASI INTRODUCTION Fortunately, my request to join a four-week training course in brachytherapy was approved by Professor Georgy Kovács at Universitätklinikum Schleswig-Holstein (UKSH) Lubeck, Germany. GEC-ESTRO MEETINGS He urged me to join the GEC-ESTRO meeting and another ESTRO-endorsed “Interdisciplinary Teaching Course in Head and Neck Cancers Brachytherapy” (ITCHNB) in Rome, which was held just a week before the 2nd GEC-ESTRO meeting. The ITCHNB was marvellous. The faculty managed to provide hands-on implantation training on some models, creatively made to represent a human head and neck. This three-day course discussed almost everything about head and neck EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY GEC-ESTRO MEETINGS 4 - 5 December 2014 - Brussels , Belgium ESTRO website online: www.estro.org/about-us/ governance-organisation/committees-activities/ gec-estro-handbook-of-brachytherapy. This handbook contains a chapter on dosimetry. It discusses both TG-43 and the new model-based algorithms. While therapeutic benefits versus complication burdens are yet to be carefully measured with modern image-guided techniques, the brachytherapists attending the meeting were optimistic. György Kovács on the interdisciplinary cooperation resulting in visual acuity preservation in ENT cancers. brachytherapy, including physics, the American Brachytherapy Society and GEC-ESTRO protocols, techniques, and the long-term experiences of using low dose rate versus high dose rate versus pulse dose rate. There was a strong emphasis on multidisciplinary collaboration and I believe this biennial site-specific course is a “must” for anyone who is interested in head and neck cases. The GEC-ESTRO workshop was orchestrated superbly. It started by introducing the new GECESTRO handbook, which can be accessed on the INTRODUCTION 26-hour journey time from Medan, Indonesia, to come to Europe. Bravo ESTRO! Dr Julijamnasi Vina Cancer Center, Murni Teguh Memorial Hospital Medan, Indonesia Another interesting topic was the COBRA project, which is now undergoing feasibility testing before being launched in the next few months. This project may expand on the opportunities to explore more about brachytherapy applications in most solid tumours. THE GEC-ESTRO COMMITTEE WISHES TO THANK: Elekta Brachytherapy, Eckert & Ziegler BEBIG and Varian Medical Systems for their support of this workshop as exhibitors;Elekta Brachytherapy for their support of this workshop as sponsors. I was greatly impressed with all the topics at the GEC-ESTRO meeting. It paid off my strenuous GEC-ESTRO COMMITTEE View the activities of the GEC-ESTRO committee: www.estro.org/about-us/governanceorganisation/committees-activities/gec-estro-brachytherapy-committee-activities > View the members: www.estro.org/about-us/governance-organisation/scientific-council/ committees/gec-estro-brachytherapy-committee > The committee is contactable through Evelyn Chimfwembe [email protected] at the ESTRO office. GEC-ESTRO MEETINGS EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY GEC-ESTRO MEETINGS BRACHYTHERAPY 4 - 5 December 2014 - Brussels , Belgium IN VIVO DOSIMETRY SEMINAR Alexandra Rink Medical physicist Princess Margaret Hospital Assistant Professor, Department of Radiation Oncology, University of Toronto Toronto, Canada Dr Luc Beaulieu presenting “Development of multiple-points PSD for in vivo dosimetry” ALEXANDRA RINK INTRODUCTION The inaugural Braphyqs & GEC-ESTRO Seminar on On-line treatment verification could not have come soon enough. Held in beautiful Brussels, Belgium, at the beginning of December, it attracted the attention of oncologists, post-doctoral fellows, medical physicists and industry alike. One of the key organisers, Dr Kari Tanderup, provided arguments for on-line dosimetry in brachytherapy in a recent publication (K. Tanderup et al, Med Phys 40: 2013). She concluded that GEC-ESTRO MEETINGS there was a need for further development and the establishment of a robust method for the independent verification of dose delivery. This, I believe, is recognised by many in the brachytherapy field. Perhaps that is why this first meeting was attended by 85 participants from 21 countries, and representatives from several main industry players, including Elekta, Varian Medical Systems and Eckert & Ziegler BEBIG. EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY GEC-ESTRO MEETINGS 4 - 5 December 2014 - Brussels , Belgium Dr Joanna Cygler presenting “MOSFET applications in brachytherapy” Dr Sam Beddar presenting “In vivo dosimetry with PSDs to monitor the rectal dose during EBRT and the prospects for HDR brachytherapy” The meeting started with the greeting from Dr Tanderup herself, who pointed out that when you search for “in vivo dosimetry in radiotherapy” there are just over 1,500 hits in total, providing a small glimpse into the types of errors that occur. Not a large number to start, but what is noteworthy is that only 133 of them are for brachytherapy. This is not surprising, since only a quarter of centres do any in vivo dosimetry in brachytherapy, and most are not on-line. In one of the first talks of the day, Dr Gustavo Kertzscher argued for the necessity of real-time feedback. He provided an example of a simulated treatment with two swapped transfer tubes, showing no difference in total delivered dose at a point used by a cumulative dosimeter, despite an error being made. The only way to have caught this error during treatment, he concluded, would have been by using a system with real-time capabilities. INTRODUCTION GEC-ESTRO MEETINGS The talks throughout the day covered a variety of on-line dose verification strategies. Advances in dosimetry techniques using MOSFETs and MOSkins, as well as fibre-optic probes using scintillators, radiochromic thin films, doped silica, and radioluminescent aluminum crystals, were presented by a number of speakers. Some illustrated the use of these systems in rectum and bladder during treatment delivery. There was even a presentation by Dr Rien Moerland on EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY GEC-ESTRO MEETINGS 4 - 5 December 2014 - Brussels , Belgium Presentation slide, courtesy of Dr Francois TherriaultProulx verifying position of Ir192 source with respect to patient anatomy by treating and simultaneously imaging within an MRI, an endeavour requiring a modified MR-safe afterloader, with a much longer source cable and transfer tubes. The day was not without a little controversy. Dr Francois Therriault-Proulx proposed an opensource approach. Armed with historical successes of this strategy in other industries, he pleaded INTRODUCTION with the group to join forces in order to expedite and improve the development of in vivo real-time dosimetry systems and their testing platforms. While not all in the audience agreed with the feasibility of this approach, it started an interesting discussion that continued into the evening, with several people brainstorming ideas over pints of beer at a local university pub. Another feather ruffling moment came when I shared my view of an ideal dosimetry system implementation, where irradiating the probes beforehand to measure their calibration factors for subsequent use is no longer required. If rigorous QA/QC is done at the manufacturer end, something we as end-users can pressure the industry for, an optical verification of calibration factor in certain fibre-optic dosimetry systems is sufficient at the user end. This approach would eventually significantly reduce physics involvement, and therefore increase the probability of in vivo dosimetry implementation within centres. However, given several faux pas committed by dosimeter manufacturers in the not-too-distant past, Dr Joanna Cygler and several others objected to my line of thinking. At this point, it appears that we cannot trust the manufacturers to do the calibration and documentation correctly, but I hope that can change in the near future. I am happy to report that no tomatoes were thrown at this point. GEC-ESTRO MEETINGS At the end of the day, everybody was hoping for an off-the-shelf solution appropriate for brachytherapy, as voiced multiple times by Dr Dimos Baltas. However, it is hard to imagine this without serious involvement and support from industry. In order to facilitate ease of use in a clinic and interpretation of measurements, the dosimetry system should be integrated with the treatment planning and delivery systems. Therefore, it seems obvious that the market leaders mentioned above should get involved, and do it soon. By the end of the meeting, it was clear that this was really only the beginning – the first of more events yet to come. We were all excited about meeting again with an even larger group of participants, perhaps at the next Brachytherapy World Congress to be held in San Francisco, California in 2016, and sharing our progress. Alexandra Rink Medical physicist Princess Margaret Hospital Assistant Professor, Department of Radiation Oncology, University of Toronto Toronto, Canada EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY EDITORS’ PICKS BRACHYTHERAPY Highlight Brachytherapy Papers Air-kerma evaluation at the maze entrance of high dose rate brachytherapy facilities María del Carmen Pujades J Radiol Prot. 2014 Sep 15;34(4):741-753. [Epub ahead of print] Dose to the bladder neck is the most important predictor for acute and late toxicity after lowdose-rate prostate brachytherapy: implications for establishing new dose constraints for treatment planning Michael J. Zelefsky Int J Radiat Oncol Biol Phys. 2014 Oct 1;90(2):312-9. doi: 10.1016/j.ijrobp.2014.06.031. INTRODUCTION GEC-ESTRO MEETINGS EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY EDITORS’ PICKS BRACHYTHERAPY Highlight Brachytherapy Papers Air-kerma evaluation at the maze entrance of high dose rate brachytherapy facilities M.C. Pujades, D. Granero, J. Vijande, F. Ballester, J. PerezCalatayud, P. Papagiannis and F. A. Siebert J Radiol Prot. 2014 Sep 15;34(4):741-753. [Epub ahead of print] Corresponding author: María del Carmen Pujades Centro Nacional de Dosimetría (CND) Valencia, Spain [email protected] What was your motivation for initiating this study? There are not specific recommendations to evaluate the air kerma rate at the door of high dose rate (HDR) brachytherapy facilities. So, the motivation for initiating this study was to propose an adaptation of the National Council on Radiation Protection and Measurements (NCRP) 151 methodology for this task. Such methodology is checked against Monte Carlo calculations. We had previously studied a conventional 192Ir bunker, i.e. similar to those for megavoltage units with the door at the end of the maze. The next step was to apply the methodology to 60 Co facilities and to study less conventional design bunkers. Five different facility designs were studied for 192Ir and 60Co HDR applications to account for several different bunker layouts. What were the main challenges during the work? MARÍA DEL CARMEN PUJADES INTRODUCTION Some real bunkers present complicated geometries, often because they were not originally designed for HDR. In these cases, adapting the methodology of NCRP 151 may require interpre- GEC-ESTRO MEETINGS tations. Accurate radiation protection calculations are of interest especially in such instances. The most challenging task in this study was trying to separate the MC results in the equivalent NCRP 151 components of the scatter radiation, to see if they worked well separately. It resulted in a task that was not straightforward. We have divided the scatter components in MC calculation into ones that resemble those defined by the NCRP 151. What are the most important findings of your study? The photon spectrums at the door entrance of the facilities were obtained with MC calculations. One of the most interesting things we found is that all the spectra were similar independently of the bunker design and radionuclide, with an average energy of about 110 keV for 192Ir facilities and 130 keV for 60Co facilities. The impact on door lead shielding estimation using the photon spectrum at the door instead of the one for 192Ir or 60 Co was evaluated comparing transmission data for both spectra. We concluded that the use of transmission data for the real spectra at the door instead of the ones emitted by source would EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY EDITORS’ PICKS Highlight Brachytherapy Papers reduce the lead thickness by a factor of five for 192 Ir and ten for 60Co. What are the implications of this research? The adaptation of the NCRP 151 methodology proposed in this study works well for conventional bunkers with a door at the end of the maze but fails for bunkers of unusual design. For those facilities, a specific Monte Carlo study is in order for reasons of safety and cost-effectiveness. Since the beam that reaches the door is softer than the primary source beam, the use of transmission data for the real spectra at the door instead of the ones emitted by the source will significantly lighten the door and hence simplify construction and operating requirements for all bunkers. INTRODUCTION GEC-ESTRO MEETINGS EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY EDITORS’ PICKS BRACHYTHERAPY Highlight Brachytherapy Papers Dose to the bladder neck is the most important predictor for acute and late toxicity after low-dose-rate prostate brachytherapy: implications for establishing new dose constraints for treatment planning Hathout L, Folkert MR, Kollmeier MA, Yamada Y, Cohen GN, Zelefsky MJ. Int J Radiat Oncol Biol Phys. 2014 Oct 1;90(2):312-9. doi: 10.1016/j.ijrobp.2014.06.031. Corresponding author: Michael J. Zelefsky Memorial Sloan-Kettering Cancer Center, Weill-Cornell Medical School New York, USA MICHAEL J. ZELEFSKY INTRODUCTION What was your motivation for initiating this study? Our motivation for this study was to attempt to identify an anatomic region or zone of normal tissue, which, after exposure to radiation, may be most associated with urinary-related symptoms commonly observed after prostate brachytherapy. The specific normal tissue responsible for urinary toxicity after brachytherapy has been elusive. Some have focused attention on the prostatic urethra and others on the bladder. We were interested in studying the dose to the bladder neck, which is important in micturition function to see if higher doses to this region were associated with increased urinary toxicities. What were the main challenges during the work? For this study we updated the toxicity in a cohort of 927 patients and retrospectively one of the co-authors contoured the bladder neck region in all cases, which we defined as the 5mm region around the urethra between the catheter balloon and the prostatic urethra. These structures were re-confirmed by a second investigator to further ensure accuracy. The bladder neck doses were then recalculated in all cases and various dose-volume parameters were then analysed. GEC-ESTRO MEETINGS What are the most important findings of your study? We found that the bladder neck dose was an important predictor of acute and late urinary symptoms, after prostate brachytherapy. Specifically we noted that the bladder neck D2cc >50% was the strongest predictor for grade ≥2 acute urinary retention and lower urinary tract symptoms in patients treated with low dose rate brachytherapy. What are the implications of this research? These findings are important as they demonstrate that symptoms after brachytherapy may be more related to bladder neck and detrusor muscle dysfunction rather than prostatic urethra swelling alone. In addition, our data suggest that bladder neck dose rather than simply overall bladder dose should be measured as part of the routine dosimetric evaluation performed after prostate brachytherapy. Efforts to reduce bladder neck dose with brachytherapy may result in reduced treatment related toxicities for patients treated with this modality. These data are also consistent with prior reports from our institution and others that the bladder neck or trigone region may represent a critical anatomic sub-unit of normal tissue where higher doses to this region could be associated with increased urinary toxicities after prostate radiotherapy. EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY The first edition of the GEC-ESTRO Handbook of Brachytherapy was released in 2002. In the meantime major new developments have taken place in the field of radiation oncology and brachytherapy and have been integrated into the growing educational activities of the ESTRO School. BRACHYTHERAPY THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY 2nd edition The GEC-ESTRO Handbook is publicly available. To access the table of contents visit www. estro.org/about-us/governance-organisation/committees-activities/gec-estro-handbook-of-brachytherapy From here select the chapter you would like to view. You will be prompted to login into DOVE using your ESTRO account details. Access is free. INTRODUCTION Furthermore, many recommendations have been designed and published by GEC-ESTRO working groups during the last decade reflecting various aspects of the developing field of brachytherapy, particularly for prostate, cervix, breast and head and neck brachytherapy. Such new insights have demanded the complete revision of the old edition of the GEC-ESTRO Handbook of Brachytherapy (2002), which is now partly outdated. As this task has turned out to be huge, a new template was finally chosen by the editors in agreement with ESTRO and the GEC-ESTRO Committee, taking into account emerging forms of book production and publication. This template also reflects the growing complexity and the continuously changing situation in the field of brachytherapy in general with much diversification, and also the growth of educational activities within the ESTRO School. There are at present four teaching courses dedicated to brachytherapy and there is even wider representation of GEC-ESTRO MEETINGS brachytherapy in other educational activities of the ESTRO School and beyond. Continuous online publication of the book, chapter by chapter, was therefore chosen to allow rapid publication and general availability of the chapter contents, keeping within the overall frame of the GEC-ESTRO Handbook. This internet GEC-ESTRO Handbook of Brachytherapy will grow with time and will become both comprehensive and up to date. This is possible through the DOVE (Dynamic Oncology Virtual ESTRO) platform which was implemented on the new homepage of ESTRO in 2014. Chapters that are considered ready for publication are made available in DOVE. An overview of all planned chapters is provided in the “Table of Contents” which is continuously available in DOVE. Published chapters are in bold letters with the publication date indicated. They are directly accessible through the “Table of Contents”. Editors Erik Van Limbergen Richard Pötter Peter Hoskin Dimos Baltas EDITORS’ PICKS THE GEC-ESTRO HANDBOOK OF BRACHYTHERAPY 2015 ESTRO SCHOOL LIVE COURSE TOPICS • Sources used in brachytherapy • Physics and dose calculation • Clinical radiobiology in brachytherapy: general principles and practical examples • Radioprotection and afterloaders • Optimisation of stepping source brachytherapy • Eye plaque brachytherapy • Permanent seed and HDR prostate implants • Radiobiology of permanent implants • Interstitial brachytherapy • Place of intracavitary brachytherapy in cervix, endometrium and vaginal cancer • Place of endoluminal brachytherapy in oesophageal and bronchus carcinoma • Recommendations for recording and reporting in interstitial, intracavitary and endolumina brachytherapy MODERN BRACHYTHERAPY TECHNIQUES 15-18 March, 2015 | Limassol, Cyprus WWW.ESTRO.ORG RADIOTHERAPY TREATMENT PLANNING AND DELIVERY PHYSICS INTRODUCTION PREDICTIVE MODELS OF TOXICITY EDITORS’ PICKS PHYSICS “With the publication of the QUANTEC reports the work on dose effect models does not end, but is just at the beginning” Dear colleagues, This edition of the Physics Corner features a very nice contribution from Claudio Fiorino on the past, present and future of predictive models of toxicity. Claudio points out clearly that with the publication of the QUANTEC reports the work on dose effect models does not end, but is just at the beginning. The challenges ahead include the distribution of dose inside organs, the integration of dose into multi-variable models and the use of big data. The editor’s pick section features two papers from the United Kingdom. Catharine Clark explains the results of a multiinstitutional dosimetry audit of rotational intensity-modulated radiotherapy and Evangelia Kaza explains how an active breathing coordinator can be used during the acquisition of magnetic resonance images. Mischa Hoogeman ([email protected]) Ludvig Muren ([email protected]), Frank Van den Heuvel ([email protected]), PHYSICS MEMBERS ASSEMBLY Saturday 25 April 2015 at the 3rd ESTRO Forum, Barcelona Room 122/123 at lunchtime INTRODUCTION MISCHA HOOGEMAN Read the interview with Robin Garcia, chair of the biennial physics meeting at the 3rd ESTRO Forum, in the Conference Corner on p139 > PREDICTIVE MODELS OF TOXICITY LUDVIG MUREN FRANK VAN DEN HEUVEL EDITORS’ PICKS PHYSICS PREDICTIVE MODELS OF TOXICITY: AN ALWAYS YOUNG (AND NEW) OLD STORY Claudio Fiorino Medical physics San Raffaele Scientific institute Milano, Italy CLAUDIO FIORINO INTRODUCTION Some history: the impact of the “Emami & Burman” paper More than 20 years ago the milestone publication by Emami et al.  dealt with the first attempt at a systematic quantification of dose-volume effects of organs at risk in fractionated radiotherapy. This work was accomplished within the American Task Group of 3D conformal radiation therapy (3DCRT), which generated an important report regarding the emerging (at that time) field of 3DCRT. The huge merits of the Emami work and of its companion paper dealing with the first NTCP fit estimates for most organs  largely outweighed the evident limitations. The authors tried to quantify with a simple scheme (i.e. assessing the TD5/50 for whole, two/ thirds, one/thirds organ irradiation) the behaviour of most organs when considering the most relevant toxicity end-points. We cannot understand the revolutionary impact of these courageous works if we don’t recall what radiotherapy was in the late 1980s: CT-planning was not universally available and was often dedicated to selected categories of patients. Massive contouring on CT and BEV-based 3DCRT optimisation started to appear in only a few large academic centres in both the USA and in Europe. These experiences helped to inspire the authors to offer a guide for implementing 3DCRT that was seen as visionary and as the “new” radiotherapy paradigm for the 1990s. Also thanks to this document, and probably more to the dramati- PREDICTIVE MODELS OF TOXICITY cally growing field of computer science, medical imaging, and to the evolution of delivery systems (MLC became a reality during those years), 3DCRT quickly became the standard, preparing the way for the next step of intensity-modulated and image-guided radiotherapy. In particular, the work of Burman et al. introduced the idea that the risk of an adverse effect could be quantified starting from the 3D dose-volume information of the organ. This NTCP concept was revolutionary and attractive; however, it was clear, as the same authors underlined, that the published curves fitting “clinical” data with an error-function (the so-called Lyman-Kutcher-Burman, LKB, model) were affected by large uncertainties that related to the “clinical” data being roughly derived by the experience of a very skilled radiation oncologist and not by quantitative, reliable data (i.e. DVH-based information of single patients within a large cohort of patients, carefully scored). The long road to QUANTEC More than 20 years later, a lot remains to be explored, although the situation is drastically different. The easy availability of 3D individual dose-volume information offered the possibility to model the dose-volume effect of many organs on large cohorts of patients. The growing number of publications concerning dose-volume relationships reflects more and more the absolute need to continuously improve and refine our EDITORS’ PICKS knowledge in the field of quantitative modelling of normal tissue effects. Still more, in the era of inverse planning, optimisation is driven by numbers that directly reflect our knowledge (and often our ignorance) around the quantitative assessment of dose-volume effects. In this context, the QUANTEC group and its report  tried to summarise this growing amount of information in a relatively short and usable guide. QUANTEC differed from the Emami work in its recommendations, as it tried to report in a cautious manner what we knew at that moment in time. The document gave clear and exhaustive recommendations only in the few situations where consistent results had been published (for instance, parotids, lungs, spinal cord, rectum). In the case of controversial results or, still more, of lack of results, the document simply discussed in a critical manner the controversial points, often suggesting urgent lines of research (for instance bladder and heart) without avoiding giving some suggestions, but with clear warnings about the uncertainty of the suggested recommendations. New challenges…part I: looking at the 3D dose distributions The organ-based DVH approach to describe quantitatively the relationship between dose and toxicities is clearly a difficult constraint. First, symptoms cannot be linked always to the irradiation of a single organ without looking what happens in the surrounding volume. Second, and INTRODUCTION maybe more importantly, approximating the organs as “homogenous entities” from the point of view of their response to radiation is very useful but it is not true: organs are composed of a complexity of sub-structures and different tissues that are not considered by DVHs. Due to this, much research is oriented to implement methods that try to integrate the spatial information included in the 3D dose distributions to the specific local reactions. Imaging is a good candidate to measure local radiation-induced changes and correlate them to the insurgence of toxicities [5,6]. Another important field concerns the development and the refinement of methods that may permit a direct comparison of the 3D dose distribution in patients with or without toxicities by advanced similarity tests [7,8] with the potential to detect more sensitive regions/organs and de facto overcome the organ-based approach. in most patients. On one hand, the application of dose-volume constraints reduces the incidence and severity of toxicities; on the other hand, it enhances the impact of the individual sensitivity factors. New challenges…part II: integrating the dose into multi-variable models New challenges…part III: the large data-base story: hopes and pitfalls In the hypothetical case that two patients receive the same dose distribution, the development of a toxicity is always modulated by the individual. The fact that dose is not all is clear from the early days of radiobiology and has received stronger support in the current “omics” era ; the availability of any individual information characterising the patients and potentially influencing their reaction to radiation is more and more mandatory, especially nowadays in the era of image-guided IMRT in which organs are spared effectively PREDICTIVE MODELS OF TOXICITY This implies the need to have access to data, including individually assessed clinical, biological and genetic information. This means that our approach has to become more and more “phenomenological”  with the development of robust methods for selecting the most predictive variables (including both dosimetric and non-dosimetric ones) and condensing the information in robust, user-friendly predictive models. The adaptation of statistical methods for data-mining and robust variable selection is a pivotal point of the story that will be written in the next few years. The access to information, previously unknown, is rapidly changing the field of predictive modelling of radiotherapy effects. Platforms that are able to connect large networks of institutes quickly and safely are becoming a reality and it is likely that in the next few years a significant proportion of European centres will be included in these networks. This is also a cultural process, shifting from a “doctor/institutional data” culture to a “pooling data” culture . EDITORS’ PICKS It is likely that this process will be accompanied by a greater radical automation of the processes of data collection, permitting the sharing of data with much less effort compared to now . Although the huge possibilities of this visionary (and more and more real) path to toxicity modelling are more than evident, we should not forget that the possibility of creating large databases is not the aim but is a (powerful) tool. In other words, the outcome of the process in terms of robustness and reliability of the models will depend not only on the numbers (a highly important component) but also, and maybe more importantly, on the quality of data. In contrast to the “easy” measure of the success of a therapy (the patient is dead or alive, is under control or not), toxicity is a much more complex and demanding problem that deserves attention and the prospective and careful collection of patient-reported and physician-reported information for years. Well-assessed, prospective, observational studies focused on specific toxicities seem to be the best choice; this kind of study may largely benefit from the possibilities of advanced data-sharing tools to permit the participation of a larger number of centres. Predicting is a medical physics peculiarity Is there still space for medical physicists to contribute to these challenging developments as they have done over past decades? The question INTRODUCTION is provocative and the answer is obvious since the prediction of what may happen, given some “boundary conditions”, is an innate interest of physicists and, specifically, of medical physicists. Maybe the right question is how much will medical physics contribute? It is hard to answer this question. Personally, I believe that this exciting field of research is a big challenge for medical physicists nowadays and is full of amazing opportunities. We are living in rapidly changing time, in which we are requested to interact more and more, not only with clinicians and radiation biologists, but also with other people outside the field, including those who work in engineering, informatics, mathematics, biology and also other areas of physics. It is certainly a challenge worth meeting!  Marks LB, Yorke ED, Jackson A et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phy. 2010;76 (Suppl 1):S10-S19.  Nijkamp J, Rossi M, Lebesque J et al. Relating acute esophagitis to radiotherapy dose using FDG-PET in concurrent chemo-radiotherapy for locally advanced non-small cell lung cancer. Radiother Oncol. 106:118-123, 2013  Fiorino C, Rizzo G, Scalco E et al. Density variation of parotid glands during IMRT for head–neck cancer: Correlation with treatment and anatomical parameters. Radiother Oncol. 2012;104:224-229.  Acosta O, Drean G, Ospina J. et al. Voxel-based population analysis for correlating local dose and rectal toxicity in prostate cancer radiotherapy. Phys Med Biol. 2013;58:2581-95.  Witte MG, Heemsbergen WD, Bohoslavsky R et al. Relating dose outside the prostate with freedom from failure in the Dutch trial 68Gy vs. 78Gy. Int J Radiat Oncol Biol Phys. 2010;77:131-8.  Bentzen SM. Preventing or reducing late side effects of radiation therapy: radiobiology meets molecular pathology. Nature Rev Cancer. 2006;6:702-713 REFERENCES  Emami B, Lyman J, Brown A et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phy. 1991;21:109-122.  Burman C, Kutcher GJ, Emami B, Goitein M. Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phy. 1991;21:123-135.  Kutcher GJ, Burman C. Calculation of complication probability factors for non-uniform normal tissue irradiation: The effective volume method. Int J Radiat Oncol Biol Phy. 1989;16:1623-1630. PREDICTIVE MODELS OF TOXICITY  van der Schaaf A, Langendijk JA, Fiorino C, Rancati T. Embracing phenomenological approaches to NTCP modeling: a question of method. Int J Radiat Oncol Biol Phys. 91:468-471,2015  Deasy JO, Bentzen SM, Jackson A et al. Improving normal tissue complication probability models: the need to adopt a “data-pooling” culture. Int J Radiat Oncol Biol Phys. 2010; 76 (Suppl 1):S151-S154  Skripcac T, Belka C, Bosch W. Creating a data exchange strategy for radiotherapy research: toward federated databases and anonymised public datasets. Radiother Oncol. 2014; 113:303-309 EDITORS’ PICKS EDITORS’ PICKS PHYSICS Highlight Radiotherapy Physics Papers First MRI application of an active breathing coordinator A multi-institutional dosimetry audit of rotational intensity-modulated radiotherapy Evangelia Kaza Phys. Med. Biol. 60 (2015) 1681-1696 Catharine Clark Radiotherapy and Oncology 113 (2014) 272–278 INTRODUCTION PREDICTIVE MODELS OF TOXICITY EDITORS’ PICKS EDITORS’ PICKS Highlight Radiotherapy Physics Papers PHYSICS First MRI application of an active breathing coordinator Kaza E, Symonds-Tayler R, Collins DJ, McDonald F, McNair HA, Scurr E, Koh D-M, Leach MO. Phys. Med. Biol. 60 (2015) 1681-1696 CORRESPONDING AUTHOR: Evangelia Kaza CR UK Cancer Imaging Centre, Institute of Cancer Research, London, and Royal Marsden Hospital London, UK [email protected] What was your motivation for initiating this study? An Active Breathing Coordinator (ABC, Elekta) is a respiratory control apparatus routinely employed during lung, liver or breast radiotherapy to reduce motion and treatment margins by holding respiration at a specified level for a preset duration. We adapted such a device for MR applications, to acquire MR images with the same patient positioning and lung volume used during conventional treatment planning and radiotherapy, in order to aid planning and treatment response assessment. What where the challenges during the work? EVANGELIA KAZA INTRODUCTION Our intention was to perform minimal technical alterations for successful ABC operation, whilst preserving the main commercial components, software and operational mode and maintaining the patient positioning used in radiotherapy planning. We had to evaluate and take into account the impact of any modifications. As an improvement to the original system, we built a triggering circuit achieving automatic and simultaneous MR acquisition with ABC-controlled breath holds. Moreover, we developed a comprehensive MR-ABC examination protocol compris- PREDICTIVE MODELS OF TOXICITY ing morphological (T1, T2) and functional (diffusion-weighted) sequences with a minimal number and duration of breath holds, applicable on lung cancer patients. What is the most important finding of your study? Volunteer Diffusion-Weighted-MRI (DWI) in ABC-controlled breath holds delivered better image quality than self-sustained breath holding and precise abdominal intra-session organ position reproducibility. Lung cancer patient MRI demonstrated not only very good intra-session tumour and thorax position reproducibility under ABC, but also very good MR-CT inter-modality registration. DWI presented increased contrast and detail in the tumour region, which may reflect structural and biological differences. What are the implications of this research? Reproducing breath holds at a predefined lung volume became possible for MRI, as practiced in radiotherapy. Using identical ABC settings MRI can match CT. The combination of variously weighted MR images can provide a wide range of contrast mechanisms and thus additional diagnostic information compared to CT, which should aid radiotherapy planning. EDITORS’ PICKS EDITORS’ PICKS Highlight Radiotherapy Physics Papers PHYSICS A multi-institutional dosimetry audit of rotational intensitymodulated radiotherapy Catharine H. Clark, Mohammad Hussein, Yatman Tsang, Russell Thomas, Dean Wilkinson, Graham Bass, Julia Snaith, Clare Gouldstone, Steve Bolton, Rebecca Nutbrown, Karen Venables, Andrew Nisbet Radiotherapy and Oncology 113 (2014) 272–278 CORRESPONDING AUTHOR: Catharine Clark Royal Surrey County Hospital Guildford, UK and the National Physical Laboratory Teddington, UK CATHARINE CLARK INTRODUCTION What was your motivation for initiating this study? There has been a rapid uptake of volumetric modulated arc radiotherapy (VMAT) and tomotherapy in the UK since it was introduced commercially, such that by 2010 around 30% of centres were already using it for treatment. This uptake was much quicker than the implementation of intensity modulated radiotherapy (IMRT) and it was felt there was a need for an independent audit to verify the implementation, investigate the capability of the planning and delivery systems and assess whether each planning and delivery system had been optimised uniformly across each institution. What where the challenges during the work? First of all we had to undertake a pilot study to ascertain that the proposed detector array would be suitable to use for an audit. We visited ten centres and made measurements, both with the array and with the standard audit equipment of ion chambers, film and alanine pellets. The correlation of the results was excellent and this gave us the confidence to carry out the whole audit using only the array. Whilst conducting the audit, the main challenges we faced were the practical- PREDICTIVE MODELS OF TOXICITY ities of visiting 34 centres in the UK and driving round the whole country. The team managed to visit five centres in five days in Scotland, which was amazing! What is the most important finding of your study? The main finding is that the majority of the centres have done an excellent job in implementing rotational IMRT. However, we also found some interesting issues, in particular to do with the ability of the treatment planning system (TPS) to model the presence of the couch in the beam, that the minimum leaf gap can have a significant effect on the ability of the TPS to model what the machine actually does, that too high modulation leads to very high monitor units, and also that these are more difficult plans to verify correctly at the machine. We found that the systems where the planning and delivery technology came from the same manufacturer tended to deliver the plan more closely to the planned one. What are the implications of this research? Most of the centres were credentialed to join a clinical trial using their rotational IMRT technique. We have been able to identify some EDITORS’ PICKS EDITORS’ PICKS Highlight Radiotherapy Physics Papers of the issues with the different systems and give the centres quantitative information as to whether they have got the best from the planning and delivery systems. We hope that this will help them, and also allow them to feed back to the manufacturers as to improvements that they would like to see made. ESTRO PHYSICS COMMITTEE View the activities of the Physics Committee: http://www.estro.org/about-us/governance-organisation/committees-activities/ physics-committee-activities > View the members: http://www.estro.org/about-us/governance-organisation/scientific-council/ committees/physics-committee > The committee is contactable through Evelyn Chimfwembe [email protected] at the ESTRO office. RESEARCH MASTERCLASS IN RADIOTHERAPY 3-6 September 2015 Prague, Czech Republic PHYSICS Submit your application form by 1 June 2015 Download the application form: http://www.estro.org/binaries/content/assets/estro/school/2015-general-docs/research-masterclass-in-rp-application-form-2015.pdf > More information: http://www.estro.org/school/items---list-courses-school-main-pages/2015-prague-master-class-physicists > INTRODUCTION PREDICTIVE MODELS OF TOXICITY EDITORS’ PICKS RTT INTRODUCTION PAPER REVIEWS CASE REPORT INTERVIEW WITH YOLANDE LIEVENS RTT “RTTs have submitted a very large number of abstracts for this conference: 197, which is twice as many as for the 2nd ESTRO Forum in 2013!” We welcome you to the second RTT Corner of 2015. This seems to be a really interesting year for the RTT world. Multiple courses are organised for radiation therapists in a discipline specific or an interdisciplinary manner. For us, the peak of 2015 will be the 3rd ESTRO Forum. RTTs have submitted a very large number of abstracts for this conference: 197, which is twice as many as for the 2nd ESTRO Forum in 2013! Another way to be inspired is, of course, by reading the RTT Corner. This time we have three interesting papers to present. First, Philipp Scherer, co-editor of the RTT Corner, will discuss in the paper review some recently submitted articles that are of importance to the RTT community. Second, there is the case report, which is well worth reading, by RTT committee member, Velimir Karadza. Last but not least, Bruno Speleers has interviewed Professor Yolande Lievens, the President-elect of ESTRO. They discussed recent developments in the position of the RTT in the world of radiotherapy. Since there was so much to be discussed, the interview will be published in two parts. For the second part you will have to wait another two months, but we can assure you it’s well worth it. PHILIPP SCHERER MARTIJN KAMPHUIS We hope you will enjoy reading the 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 [email protected] or [email protected] – every input is welcomed. Philipp Scherer and Martijn Kamphuis INTRODUCTION PAPER REVIEWS CASE REPORT INTERVIEW WITH YOLANDE LIEVENS PAPER REVIEWS RTT Absorbable hydrogel spacer use in men undergoing prostate cancer radiotherapy: 12month toxicity and proctoscopy results of a prospective multicentre phase II trial A comparison of patient position displacement from body surface scanning and cone beam CT bone registrations for radiotherapy of pelvic targets Matthias Uhl, Klaus Herfarth, Michael Eble, Michael Pinkawa, Baukelien van Triest, Robin Kalisvaart, Damien C Weber, Raymond Mirabell, Danny Y Song, and Theodore L DeWeese Kenneth Wikström, Kristina Nilsson, Ulf Isacsson, and Anders Ahnesjö Acta Oncologica 2014 53: 268-277 Radiation Oncology 2014, 9:96 INTRODUCTION PAPER REVIEWS CASE REPORT INTERVIEW WITH YOLANDE LIEVENS PAPER REVIEWS RTT BACKGROUND Absorbable hydrogel spacer use in men undergoing prostate cancer radiotherapy: 12-month toxicity and proctoscopy results of a prospective multicentre phase II trial Matthias Uhl, Klaus Herfarth, Michael Eble, Michael Pinkawa, Baukelien van Triest, Robin Kalisvaart, Damien C Weber, Raymond Mirabell, Danny Y Song, and Theodore L DeWeese Rectal toxicity is one of the limiting side-effects mentioned whenever the topic of dose escalation for prostate cancer radiotherapy is discussed. Due to the anatomical situation, achieving a low dose at the rectum as organ at risk, especially at the anterior wall of the rectum is hardly possible. Even the variety of image-guided or adaptive therapy possibilities developed in the last years could not solve this problem. The authors of this article investigate the use of a spacer positioned between rectum and prostate – in this case a polyethylene glycol (PEG) hydrogel-spacer – to reduce the dose delivered to the rectum. Radiation Oncology 2014, 9:96 METHODS In this multi-centre, non-randomised, single arm study the toxicity scores of 52 patients treated with IMRT to a dose of 78 Gy (in 2 Gy fractions with five fractions per week) for localised prostate cancer, who received a PEG hydrogel-spacer (injected transperinal prior to treatment planning), were evaluated. A planning CT-scan was generated, somewhat before and after injection of the spacer, and the plans were compared to analyse the dosimetric impact of the spacer. Gastrointestinal (GI) and genitourinary (GU) toxicity INTRODUCTION PAPER REVIEWS were documented using the RTOG/EORTC grading and recorded weekly during treatment and three, six and 12 months after radiation therapy. Furthermore, Vienna Rectoscopy Scale (VRS) was used to document proctoscopy findings 12 months after irradiation. FINDINGS The comparison of the treatment plans was only mentioned briefly – reduction of the rectal V70 by ≥ 25% in 96% of the patients, with a mean reduction of 8 Gy – because a separate report on the dosimetric comparison was published previously by the same group (Song et al. 2013). In this most recent publication of the trial – preliminary clinical outcomes were published 2013 (Uhl et al. 2013) – the authors concentrate on the acute and late GI and GU toxicity. Grade one or worse GI toxicity scores were 52.1 % acute toxicities and 4.3% late toxicities, and GU toxicities were 79.2% and 19.1 % respectively. This included some patients that were Grade 1 and one Grade 2 at baseline. In the absence of a control arm the authors compared the results with other published data and RTOG/EORTC Grade 2 or more GI toxicity was substantially lower than in other trials. Similarly, a comparison of the VRS with published data showed lower toxicity in the patients CASE REPORT INTERVIEW WITH YOLANDE LIEVENS PAPER REVIEWS treated with a spacer. Comparison with a control arm would have allowed a more rigorous judgement, but nevertheless, it can be concluded that, despite the higher radiation dose, the treatment of the patients with a spacer resulted in a considerably lower rectal toxicity. RELEVANCE TO RADIATION THERAPISTS (RTTS) The implementation of a method to enlarge the space between the prostate and rectum allows the introduction of dose escalation or a change of fractionation with a lower risk of additional toxicity at the rectum and, therefore, influencing the time needed to manage these side-effects. Additionally, this could have an impact on our workload in the treatment units if the number of fractions of one of our biggest patient groups is changed. INTRODUCTION PAPER REVIEWS REFERENCES A multi-institutional clinical trial of rectal dose reduction via injected polyethylene-glycol hydrogel during intensity modulated radiation therapy for prostate cancer: analysis of dosimetric outcomes. Song DY, Herfarth K, Uhl M, Elbe MJ, Pinkawa M, van Triest B, Kalisvaart R, Weber DC, Miralbell R, De Weese TL, Ford EC Int J Radiat Oncol Biol Phys 2013, 87:81-87 Low rectal toxicity after dose escalated IMRT treatment of prostate cancer using an absorbable hydrogel for increasing and maintaining space between the rectum and prostate: results of a multi-institutional phase II trial. Uhl M, van Triest B, Eble MJ, Weber DC, Herfarth K, De Weese TL Radiother Oncol 2013, 106:215-219 CASE REPORT INTERVIEW WITH YOLANDE LIEVENS PAPER REVIEWS RTT BACKGROUND A comparison of patient position displacement from body surface scanning and cone beam CT bone registrations for radiotherapy of pelvic targets Kenneth Wikström, Kristina Nilsson, Ulf Isacsson, and Anders Ahnesjö Acta Oncologica 2014 53: 268-277 In the last few years several optical surface detection devices evolved as a method for image-guided radiotherapy without administering an additional imaging dose. These methods for optical surface scanning offer prosperous features for the verification of patient set-up, but also for monitoring, gating, and patient positioning. In this article the authors evaluate the accuracy of one of these methods, body surface laser scanning (BSLS). They try to achieve this by comparing the set-up errors recorded by the BSLS to displacements recorded using a cone beam computed tomography (CBCT) with bony alignment, in the pelvis region. METHODS Registrations of the set-up for 40 patients were compared, resulting in a total of 170 analysed setups. Surface scans were compared to a reference scan obtained at the first fraction (with the CBCT corrections applied), while CBCT was registered directly to the planning CT. The patient outline derived from the planning CT was used as an additional reference to register the BSLS to. The patients were positioned using a skin mask and the set-up errors evaluated using BSLS and CBCT for the analysis. INTRODUCTION PAPER REVIEWS FINDINGS The authors were able to demonstrate that the surface scan allowed a significantly better setup, especially if a restricted volume (pelvis only, omitting legs and stomach) was used for surface registration. Significantly better meaning that the radial difference was closer to the results of CBCT with 0.26cm (0.24-0.29cm 95%CI) compared to 0.38 (0.34-0.42cm 95%CI) when using skin marks only. Interestingly, these improvements could only be shown when using the reference scan from the first fraction and not the outline derived from the planning CT, which could be due to the surface data derived from different systems or a reduction of a small systematic error that is corrected due to using the CBCT corrections of the first fraction. Adding some information from other publications, the authors conclude, that BSLS offers additional benefits, i.e. detecting changes of body contour due to weight change or tumour pro-/regression, or verifying pose and position, hence a correction of, for example, leg position is possible before acquiring CBCT. CASE REPORT INTERVIEW WITH YOLANDE LIEVENS PAPER REVIEWS RELEVANCE TO RADIATION THERAPISTS (RTTS) The introduction of surface scanners into radiotherapy offers several possibilities that could change the workflow of RTTs, especially at the treatment machines. A surface scan could help position the patient or decide whether additional IGRT-procedures are needed for the actual fraction if a set-up error above a certain threshold is detected. Following the currently used lines of argument, the results published, and the technical possibilities of such devices, surface scanning even has the potential to supplant skin marks. INTRODUCTION PAPER REVIEWS CASE REPORT INTERVIEW WITH YOLANDE LIEVENS INTRODUCTION AND BACKGROUND RTT CASE REPORT Treatment verification and dose distribution in irradiation of chondrosarcoma of cervical spine Velimir Karadza, Timor Grego, Kristijan Galic Radiotherapy Unit, Department of Oncology University Hospital Centre Zagreb, Croatia ACKNOWLEDGEMENTS: Tonko Herceg Radiation Oncologist Department of Oncology University Hospital Centre Zagreb, Croatia VELIMIR KARADZA INTRODUCTION TIMOR GREGO KRISTIJAN GALIC IMRT was recommended, but both IMRT and 3DCRT plans were considered. Treatment verification using Megavoltage Portal Imaging and/or Megavoltage CBCT sometimes can contribute significantly to overall dose delivered to the patient and the planning target volume (PTV). This is usually not the case, or at least not something of a greater significance when treatment verification is used on a weekly basis, every fifth treatment. On the other hand, if verification needs to be done every day prior to treatment, due to geometric uncertainties or OARs that are very close to the PTV, the dose given to the patient during treatment may have a greater impact that needs to be considered carefully. CASE A 22-year-old male patient, diagnosed with chondrosarcoma grade II of the cervical vertebrae causing spinal compression, underwent surgery in December 2013. His status was: laminectomia C5/6, partim C4 and C7, tumour ressection – chondrosarcoma grade II, spinal cord decompression, residual tumour part in the C6 level. Insertion of vertebral prosthesis Harm’s was performed in January 2014. A postoperative CT performed in April 2014 showed a total resection of the bony component of the tumour, except for a small residual part in the level of C6 vertebrae, where the vertebral prosthesis was placed. The radiation oncologist decided that radiotherapy of the residual process was indicated, and PAPER REVIEWS TREATMENT PLAN Medical physicists composed two radiotherapy treatment plans: an IMRT and a 3DCRT plan. The IMRT was calculated with seven fields with step and shoot method. The 3DCRT plan consisted of four oblique wedged fields, with more weight on posterior oblique fields (fig.1). Treatment planning was conducted on an XiO treatment planning system. Dose constraints were D90%>64 Gy and D5%<70.62 Gy for target volumes and for OAR-s QUANTEC(2010.) guidelines were used. DVH comparison of these plans was performed (fig. 2). Although the IMRT plan showed better PTV coverage, OAR sparring (spinal cord and larynx) was better for the 3DCRT plan. The problem with the delivery of these RT plans was the proximity of the spinal cord to PTV (2 mm on some slices). This suggested that a very careful and precisely controlled treatment delivery should be performed, and it implied the usage of CBCTs or portal imaging every day prior to irradiation. kV-imaging was still not available in our department at that time. Therefore, all the imaging had to be done by either Cone Beam or EPID using MV exposure, which, in this case, was considered as an undesired dose contribution. Due to availability of “Port During” option, the choice was made for the 3DCRT plan. CASE REPORT INTERVIEW WITH YOLANDE LIEVENS Figure 1: Beam arrangement for 3DCRT plan Figure 2: DVH comparison between 3DCRT and IMRT plan. 3DCRT plan: solid line, IMRT: dashed line One more thing led to implementation of a “Port During” verification of the patient's position: the fact that the PTV/beam was shaped accordingly to the vertebral prosthesis where the residual tumour was placed. This indicated good visibility and a reliable marker for a position check of the field and the spinal cord. TREATMENT DELIVERY Radiotherapy treatment was delivered on Siemens Primus Plus with 82 MLC. The dose was delivered using the 3DCRT plan and a protocol for INTRODUCTION treatment verification was established. Set up correction was performed with eNAL protocol. “Port During” was performed at every fraction, so that it was possible to check the position of treatment field in accordance to the spinal cord (fig. 3 & 4). This option allows us to use the treatment fields while irradiating the patient for creating Portal images with EPID. In this way, it was possible to maintain continuous control of patient position using the MUs from treatment field, therefore minimising the dose contribution from treatment verification imaging. PAPER REVIEWS Portal images were analysed on a daily basis and even though they occasionally showed smaller shifts, the overall control of the patient position and dose delivered to the spinal cord was in agreement with the initial plan. SUMMARY In the case presented here, a patient diagnosed with chondrosarcoma, radiotherapy treatment of the residual tumour in the cervical spine was prescribed. The original intention was to treat the patient with an IMRT plan. In the process of CASE REPORT INTERVIEW WITH YOLANDE LIEVENS comparison of IMRT and 3DCRT plans, proximity of spinal cord and patient set-up correction were taken into account. Due to absence of kV imaging it was concluded that treatment verification on a daily basis with “Port During” option would better fit the need to keep the minimum dose on the spinal cord. 3DCRT plan was chosen for these reasons, as the overall OAR sparing was better. This example shows us that sometimes less complex treatment plans with conventional portal imaging can give quite satisfactory results. However, in this case usage of portal images derived from treatment fields with MV energy gave enough information, because there was a very good reference structure for image registration - the vertebral prosthesis. Otherwise, decisions about the precise position of the field using “Port During” would have probably been very difficult. Figure 3: DRR from treatment field INTRODUCTION Please note: this work has not been peer reviewed Figure 4: Port during PAPER REVIEWS CASE REPORT INTERVIEW WITH YOLANDE LIEVENS Yolande Lievens is the President-elect of ESTRO. Just like Philip Poortmans, ESTRO’s current President, she has agreed to share with us her vision on the position of the RTTs within the interdisciplinary team and beyond. RTT The second part of the interview will be featured in the next issue of the newsletter in this Corner. Interview with YOLANDE LIEVENS President-elect of ESTRO By Bruno Speleers Member of the ESTRO RTT committee BRUNO SPELEERS INTRODUCTION How did you start your involvement within ESTRO? My career in radiation oncology started about 20 years ago. I was trained in the radiation oncology department of the University Hospital of Leuven. You may remember that one of the co-founders of ESTRO, Emmanuel van der Schueren, was chairman in Leuven at that time. Moreover, ESTRO’s administration was hosted by the Leuven radiotherapy department. As a consequence I came in contact with ESTRO at a very early stage in my career. My active participation started as author of the “Radiotherapy in Public Health Policy” section in the ESTRO newsletter, a column, now the “Health Economics Corner”, where I share the task with Madelon Pijls-Johannesma and Peter Dunscombe. I have been a teacher on the target volume delineation course for a few years and a member of the clinical committee and the professional and memberships council. In 2010 ESTRO launched the HERO (Health Economics in Ra- PAPER REVIEWS diation Oncology) project, which I co-chair with Cai Grau. Last but not least, I have had the great honour to be elected ESTRO President as of April 2016. In the previous interview, Philip Poortmans talked about the many differences in the role of the RTTs between The Netherlands and Belgium in the past. Is this still the case? It is a bit difficult to picture clearly how RTTs function in The Netherlands because I am not working there myself. But the difference in educational background between RTTs in The Netherlands and nurses in Belgium is bound to have an impact on their involvement in daily radiotherapy practice. In The Netherlands they are specifically trained to master the skills of an RTT. Radiotherapy is included from the beginning of their education and during a clinical placement they learn how to deal with the more technical issues such as planning and the image-guided CASE REPORT INTERVIEW WITH YOLANDE LIEVENS approach to radiotherapy. Belgium is one of the few countries in Europe where the professionals working on the radiotherapy treatment machines are nurses. They are trained with a focus on bedside care and only get involved in radiotherapy once they start working in a radiotherapy department. This defers the actual training in radiation oncology to the time they start to work in the radiotherapy department, which, in the context of our rapidly evolving discipline, is quite challenging. Apart from the specific example of Belgium and The Netherlands, it is a fact that there is a large difference in background knowledge of RTTs among the different European countries. What would you advise in order to support optimal patient care? Within the HERO project, for which we have now finalised the first work package, we have made an evaluation of radiotherapy staffing in Europe. For RTTs, as for all radiotherapy professionals for that matter, we observed large variations in the key parameters related to availability of personnel and their workload. One of the dominant factors in that respect is the variability in roles and responsibilities, which are certainly, to some extent, related to the background knowledge they acquired during training. Additionally, there are different national rules and regulations so that their tasks may be determined by the tasks that INTRODUCTION other radiotherapy professionals – radiation oncologists, medical physicists, dosimetrists – perform. Adequate education and training is the first prerequisite to optimise the care delivered by the RTTs. An enormous body of work has already been done in that respect by ESTRO in defining the core curriculum. The next phase in improving standardised education is to implement the core curriculum throughout Europe. But in our vision to build a common platform of knowledge we should not overlook the necessity to take into account the needs of each individual country. Regarding this point we are still lacking important information: ideally we should first come up with a better definition of the staffing requirements based on cancer incidence and population mix, and on the level of technology already implemented in a given country. Only then will we be able to correctly forecast the needs and, in turn, align training and education to meet both the knowledge and clinical need requirements. How has the role of the RTT developed within the interdisciplinary team from the start of your career up to today? There are certainly differences, which is not surprising given the important technological evolution that has taken place in radiotherapy over the last decade. In the past RTTs were almost solely involved with daily treatment delivery and simu- PAPER REVIEWS lation, whereas now they are often also involved in the more technical aspects like planning. As a consequence of the introduction of more hightech treatment machines with on-board imaging capabilities, RTTs have become a driving force in patient-specific quality assurance through online imaging. Moreover, in some departments in Belgium, RTTs have taken up the global role of quality assurance as quality managers. As a matter of fact, about a year ago a Quality Management Board of Experts was installed in Belgium, and it is interesting and pleasing to see how many RTTs are part of this group. What do you consider to be the strengths of RTTs in the interdisciplinary team? RTTs have the advantage of being able to follow the patient more closely during their entire process. Hence, contrary to the other radiotherapy professionals, they have a more global overview of the patient, his/her physical and psychological evolution and needs during treatments, whereas radiation oncologists, physicists and dosimetrists have a more scattered patient contact. This daily contact is certainly an enormous advantage for the RTTs. And within ESTRO? Apart from the more technical and quality-related aspects that RTTs are involved with, it is CASE REPORT INTERVIEW WITH YOLANDE LIEVENS specifically this close interaction between the RTTs and the patient that gives them the possibility to better understand and observe what the patients really need. We are exploring how we can involve patients more closely in our Society, and RTTs will certainly be able to bring us important additional information in that respect. Do you see weaknesses that should be improved? We have already extensively discussed the educational challenges, which are certainly the first important issue to tackle. ESTRO RTT COMMITTEE View the activities of the ESTRO RTT Committee: www.estro.org/about-us/governance-organisation/committees-activities/ rtt-committee-activities > View the members: www.estro.org/about-us/governance-organisation/scientific-council/committees/rtt-committee > The committee is contactable through Viviane Van Egten [email protected] at the ESTRO office. It is, moreover, an understatement that in most countries, and Belgium does not form an exception to that general observation, RTTs are infrequently involved in research. That this is, however, perfectly possible is demonstrated for example by Ireland, where research forms an integrated part of the training of RTTs. Finally, I feel that RTTs are not yet adequately involved in the professional aspects of radiotherapy, be it in organisations at the national or international level. The active participation of RTTs in ESTRO, for example, deserves further endorsement. INTRODUCTION PAPER REVIEWS Read the interview with Martijn Kamphuis, chair of the RTT meeting at the 3rd ESTRO Forum, in the Conference Corner on p143 > CASE REPORT INTERVIEW WITH YOLANDE LIEVENS RADIOBIOLOGY INTRODUCTION SPOTLIGHT RECENT NEWS FROM THE STEM CELL FIELD RADIOBIOLOGY “In this edition of the Radiobiology Corner we put the spotlight on Professor Dr Rob P. Coppes, whose group is dedicated to elucidating the role of stem cells in the radiation responses of tissues and organs” Read the interview with Brad Wouters, chair of the PREVENT and TARGET meetings at the 3rd ESTRO Forum, in the Conference Corner on p144 > INTRODUCTION The loss of dividing cells and its detrimental effect on tissue homeostasis has long been known to be an important mechanism by which normal tissue damage can develop, resulting in complications after radiotherapy. In this edition of the Radiobiology Corner we put the spotlight on Professor Dr Rob P. PETER VAN LUIJK Coppes, whose group is dedicated to elucidating the role of stem cells in the radiation responses of tissues and organs in order to find novel approaches to predict, prevent and treat radiotherapy side-effects. In addition, members of his group discuss four recent publications on this topic. Taken together, these publications highlight the maturation of the field in terms of solving technical issues and a paradigm-shift from “a single type of cell does all” towards the notion that other cell types and processes also contribute to the fate of an organ after irradiation. ANNE KILTIE MARTIN PRUSCHY Peter van Luijk Dept Radiation Oncology University Medical Centre Groningen University of Groningen Groningen, The Netherlands CONCHITA VENS As usual we encourage you to contact Anne Kiltie, Martin Pruschy and Conchita Vens, with comments (good or bad) at our “electronic” mail address [email protected] SPOTLIGHT RECENT NEWS FROM THE STEM CELL FIELD RADIOBIOLOGY SPOTLIGHT Professor Dr Rob P Coppes Departments of Radiation Oncology and Cell Biology Cancer Research Centre Groningen University Medical Centre Groningen University of Groningen Groningen, The Netherlands ROB COPPES INTRODUCTION Rob Coppes is a professor of radiation oncology with a special focus on the radiation biology of normal tissues. His group at the Cancer Research Centre at the University Medical Centre Groningen is currently composed of two assistant professors, two post-docs, four PhD students and five technicians. Rob obtained an MSc degree in Animal Physiology and a PhD on the pre-synaptic regulation of noradrenergic neurotransmission in molecular pharmacology at the University of Groningen. This phenomenon is very closely related to the secretion of granules from the salivary gland. It was the topic of his first post-doc position at the department of radiobiology of the UMCG. Here he studied the pharmacological removal of enzyme-containing granules from the salivary glands, which were thought to release their enzymes in the cells, causing cell death after irradiation. Although many of the tested degranulating drugs protected the salivary glands, no relation was found with the number of remaining granules and radiation response. Instead he found that these drugs induced stem/progenitor cells to proliferate and regenerate the radiation-damaged gland faster. Here, his interest in stem cells was raised. Moreover, the collaboration with Professor Albert van der Kogel and Dr Peter van Luijk on proton irradiation of the spinal cord and the hypothesis that small fields were repaired by (stem) cells from outside the radiation field further stimulated his curiosity. Finally, the movement of the radiobiology lab to a new fa- SPOTLIGHT cility, where the department of stem cell biology of Professor Gerald de Haan was located as well, facilitated this process and soon the idea of developing a stem cell therapy to prevent radiotherapy-induced toxicity was born. Together with several other normal tissue radiobiologist and stem cell biologists, he applied for and coordinated the EU-funded integrated project FIRST (Further improvement of radiotherapy of cancer through side-effect reduction by application of stem cell transplantation). Now, 10 years and several grants later, his group has developed a protocol for adult stem cells therapy for radiation-induced hyposalivation and consequential xerostomia for which a phase I/II clinical trial is planned from 2017-2018. Meanwhile his interest in particle therapy was stimulated. The accurate irradiation possible with protons revealed many novel insights, such as the interaction between organs (heart/lung) and the uneven distribution of stem cells within organs, with the potential for stem cell sparing radiotherapy. Currently, the possibility of growing adult tissue stem cells as tissue resembling organoids, as developed in the laboratories of Professor Hans Clevers (Hubrecht Institute, Utrecht) and Coppes, opens novel avenues for the study of radiation effects on normal tissue and tumours. The potential of this methodology in the development of personalised medicine and the prediction of response is unprecedented and indicates that exciting times lie ahead of us. RECENT NEWS FROM THE STEM CELL FIELD RADIOBIOLOGY RECENT NEWS FROM THE STEM CELL FIELD By various members of Professor Rob Coppes’s group Survival of neural stem cells undergoing DNA damage-induced astrocytic differentiation in selfrenewal-promoting conditions in vitro Lgr5+ stem cells are indispensable for radiationinduced intestinal regeneration Review of Metcalfe et al., Cell Stem Cell. 2014;14:149-59 by Martti Maimets Review of Schneider, PLOS One 2014;9:e87228 by Peter Nagle Transient activation of hedgehog pathway rescued radiation-induced hyposalivation by preserving stem/progenitor cells and parasympathetic innervation Long-term culture of genome-stable bipotent stem cells from adult human liver Review of Hai et al., Clinical Cancer Research 2014;20:140-150 by Sarah Pringle Review of Huch et al. Cell 2014;160:299–312 by Cecilia Rocchi INTRODUCTION SPOTLIGHT RECENT NEWS FROM THE STEM CELL FIELD RECENT NEWS FROM THE STEM CELL FIELD RADIOBIOLOGY Lgr5+ stem cells are indispensable for radiationinduced intestinal regeneration Review of Metcalfe et al., Cell Stem Cell. 2014;14:149-59 Paper review by Martti Maimets PhD student University Medical Centre Groningen Groningen, The Netherlands INTRODUCTION By various members of Professor Rob Coppes’s group Intestinal epithelial cells undergo continual self-renewal, which depends on intestinal stem cell (ISC) activity. At least three crypt cell types have been identified to contain ISCs. These, however, have distinct expression of specific molecular markers, proliferation kinetics and sensitivity to ionising radiation. Lgr5+ columnar cells residing at the crypt base are mitotically active and, therefore, thought to be the “work-horse” stem cell population responsible for intestinal homeostasis. Upon ablation of these Lgr5+ cells, a second population of stem cells (“ position four cells” or “Chris Potten cells”) assumes total ISC function and quickly produces new Lgr5+ ISCs. Additional intestinal populations, including progenitor cells generated by these ISCs, have been shown to acquire plasticity in regards to injury-mediated responses. to the sensitivity to ionising radiation of the “reserve” Lgr5− stem cells. This indicates that, even though stem cell plasticity exists, not all of the distinct stem cell populations are necessarily involved in the radiation response of a tissue. However, recent expression profiling of these distinct ISC populations has demonstrated a robust position four-cell gene expression in Lgr5+ cells, which challenges the current understanding of intestinal homeostasis and post-injury response. In a recent issue of Cell Stem Cell, Metcalfe et al. show that Lrg5+ ISCs are crucial for intestinal regeneration following irradiation but are not required for hyperplastic responses. This is due SPOTLIGHT RECENT NEWS FROM THE STEM CELL FIELD RECENT NEWS FROM THE STEM CELL FIELD RADIOBIOLOGY Transient activation of hedgehog pathway rescued radiation-induced hyposalivation by preserving stem/progenitor cells and parasympathetic innervation Review of Hai et al., Clinical Cancer Research 2014;20:140-150 Paper review by Sarah Pringle Post-doc University Medical Centre Groningen Groningen, The Netherlands INTRODUCTION By various members of Professor Rob Coppes’s group Hyposalivation and consequential xerostomia are deleterious sequelae of salivary gland (SG) damage commonly occurring after radiotherapy for head and neck cancers. In the absence of a durable treatment for this condition, recent efforts have focused on the manipulation of resident stem/progenitor cells within the SG, before, during or after radiotherapy treatment, to prevent hyposalivation. In a recently published study, Hai et al. suggest that homeostasis of radiation-damaged SGs can be recovered by manipulation of the Hedgehog signalling pathway. This pathway has long been implicated in the behaviour of many other stem/ progenitor cell pathways. In a transgenic mouse, transient Hedgehog pathway activation led to functional rescue from radiation-induced hyposalivation, including saliva production and increased expression of the water-channel associated protein AQP-5. Mechanistically, Hai et al. also demonstrate that the stem/progenitor cell pool of the SG, characterised by sca-1+ and c-Kit+ cells, was increased following Hedgehog pathway stimulation. Moreover, functionally more salispheres (floating cultures of SG stem/progenitor cells) were generated from SGs exposed to Hedgehog activation compared to control counterparts. Further exploration showed that stimulation of SPOTLIGHT the Hedgehog pathway exerted the observed effect on SG stem/progenitor cells by boosting or preserving the function of the parasympathetic innervation pathway, represented by measurement of neurotrophic factors bdnf, ngf and nrtn, and the receptor for such factors, Chrm1. As such, this is the first report to link augmentation of parasympathetic innervation to the preservation of the stem/progenitor cell pool and furthermore to the rescue of irradiation damaged SGs from hyposalivation. RECENT NEWS FROM THE STEM CELL FIELD RECENT NEWS FROM THE STEM CELL FIELD RADIOBIOLOGY Survival of neural stem cells undergoing DNA damageinduced astrocytic differentiation in self-renewal-promoting conditions in vitro Review of Schneider, PLOS One 2014;9:e87228 Paper review by Peter Nagle PhD student University Medical Centre Groningen Groningen, The Netherlands INTRODUCTION By various members of Professor Rob Coppes’s group DNA double strand breaks pose a major threat to cells and are potentially lethal if they are not repaired by the DNA damage response. Previous studies from these authors indicated that ionising radiation causes neural stem cells (NSCs) to differentiate. However, although these cells were capable of repairing DNA damage, the transcription of some vital DNA damage response genes was down. Recently, Schneider demonstrated that NSCs that have been irradiated undergo delayed apoptosis, which is caspase-dependent and p53-independent under self-renewal-promoting culturing conditions. Next, by over-expressing BCL2 to inhibit apoptosis, the authors showed that NSCs are pushed towards astrocytic differentiation in response to irradiation, while differentiation towards other cell fates was not detected. To investigate the effect of culturing conditions on apoptosis in NSCs, the cells were seeded in different conditions post-irradiation. Conditions that promote neuronal differentiation resulted in increased levels of apoptosis. However, conditions that induce astrocytic differentiation (addition of BMP2 or FCS to self-renewal media) showed a decrease in apoptosis compared to normal self-renewal media. SPOTLIGHT From this, Schneider concludes that DNA damage itself is not the cause of ionising radiation induced apoptosis in NSCs, but it is, in fact, the post-irradiation culture conditions that are important in terms of apoptosis proneness. If this is indeed true, this paper also raises further questions for stem cell radiation research. For instance, it would be interesting to investigate whether this holds true for other stem cell types and/or for the apoptotic response of stem cells to other forms of irradiation. RECENT NEWS FROM THE STEM CELL FIELD RECENT NEWS FROM THE STEM CELL FIELD RADIOBIOLOGY Long-term culture of genome-stable bipotent stem cells from adult human liver Review of Huch et al., Cell 2014;160:299–312 By various members of Professor Rob Coppes’s group Therapy based on adult stem cells could offer a unique opportunity to rescue the functionality of damaged tissue, both in terms of cell replacement and trophic support to the surrounding tissue. Beside the difficulties of characterising the most potent stem/progenitor cell population, safety issues regarding the risk of genetic and epigenetic aberration during long-term in vitro expansion are a primary concern for the use of cell therapy in regenerative medicine. In a recent study, Huch et al. described the optimisation of a long-term human liver stem cell culture system. They show that Wnt signalling, cAMP activation and inhibition of the Tgf-β pathway are fundamental to assuring the longterm self-renewal (more than six months) of human Lgr5+ liver cells in vitro. Under these conditions, cells expanded in culture maintain the ability to differentiate into functional hepat- ocytes in vitro as well as upon in vivo transplantation into a damaged liver. Moreover, an important feature of this 3D organoid culture is the long-term maintenance of their genomic stability. In fact, the authors observed that the number of base substitutions acquired over the three months of culture was ten-fold lower than that which has been reported previously in cultures derived from induced pluripotent stem (iPS) cells. In addition, when analysed for structural aberration, only two copy number variants were found in the longterm expanded cells, also indicating a higher chromosomal stability during expansion when compared to iPS cells. Taken together these results open up the possibility of using the therapeutic potential of autologous adult stem cells transplantation for treating the adverse side-effects associated with radiation treatment. ESTRO RADIOBIOLOGY COMMITTEE Paper review by Cecilia Rocchi PhD student University Medical Centre Groningen Groningen, The Netherlands INTRODUCTION View the activities of the Radiobiology Committee: www.estro.org/about-us/governance-organisation/committees-activities/radiobiology-committee-activities > View the members: www.estro.org/about-us/governance-organisation/scientific-council/committees/radiobiology-committee > The committee is contactable through Viviane Van Egten [email protected] at the ESTRO office. SPOTLIGHT RECENT NEWS FROM THE STEM CELL FIELD ESTRO SCHOOL INTRODUCTION E-CONTOURING COURSE REPORTS WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE ESTRO SCHOOL “The next examination for ESTRO Fellow candidates will take place during the Barcelona meeting on 24 April” The new calendar year for the ESTRO School has now started. There is a full programme of 35 live courses, covering the core curricula for radiation oncologists, radiation physicists and RTTs, plus seven online delineation workshops. A new development currently being worked on is the concept of blended learning, with a mix of online and live teaching. Several such courses are planned for the coming years. The 3rd ESTRO Forum will offer many educational opportunities, including five pre-meeting courses and four separate online contouring workshops on 24 April. During the main meeting, each day begins with teaching lectures and there are multi-disciplinary tumour board sessions, as well as FALCON contouring workshops. There will also be a “teachers’ retreat” on 23 April, bringing together many of the dedicated people who are involved in teaching activities in the ESTRO School on the 35 ESTRO courses. This will offer the opportunity to discuss common problems and future possibilities and the day will end with an entertaining social event. The next examination for ESTRO Fellow candidates will take place during the Barcelona meeting on 24 April. If you are interested in applying, check out the information under the “Careers & Grants” tab at the top of the website estro.org/careers-grants/estro-fellow/ index. FIONA STEWART Core member, Education and Training Committee CHRISTINE VERFAILLIE ESTRO Chief Operating Officer We are looking forward to seeing you all in Barcelona. Find out about education at the 3rd ESTRO Forum on www.estro.org and in the Conference Corner on p150 > INTRODUCTION E-CONTOURING Richard Pötter, Christine Verfaillie and Fiona Stewart RICHARD PÖTTER Chairman, Education and Training Committee COURSE REPORTS WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE ESTRO SCHOOL E-CONTOURING FALCON* is ESTRO’s web-based contouring platform that offers you the opportunity to practice your delineation skills online and to compare them with those made by delineation experts and with the ESTRO guidelines. With FALCON you can: • practise by yourself online anytime you wish on a database of contouring cases accessible at www.estro.org: head and neck, lymphoma and gynaecological cancer. FALCON cases are freely accessible to ESTRO members. • join a virtual workshop: below is the programme for the coming months. Please note that some of them are in Sydney time (AEDT). * Fellowship in Anatomic deLineation and CONtouring FALCON Fellowship in Anatomic deLineation & CONtouring INTRODUCTION E-CONTOURING COURSE REPORTS WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE 2015 FALCON ONLINE SCHEDULE Workshop Topic Breast cancer Gynaecological cancer External Beam RT Prostate cancer Gynaecological cancer Brachytherapy Paediatric cancer Head and neck cancer Head and neck cancer Dates 25 February 2015 5 March 2015 11 March 2015 1 April 2015 10 April 2015 17 April 2015 14 September 2015 21 September 2015 28 September 2015 September-October* 15 October 2015 22 October 2015 29 October 2015 19 October 2015 26 October 2015 2 November 2015 7 December 2015 14 December 2015 21 December 2015 Time CET 18.00-19.00 hrs 18.00-20.00 hrs 18.00-19.30 hrs 09.00-10.00 (18.00 hrs AEDT) 10.00-12.00 (18.00 hrs AEDT) 10.00-11.30 (18.00 hrs AEDT) 18.00-19.00 hrs 18.00-20.00 hrs 18.00-19.30 hrs 18.00-19.00 hrs 18.00-20.00 hrs 18.00-19.30 hrs 09.00-10.00 hrs (17.00 hrs AEDT) 09.00-11.00 hrs (17.00 hrs AEDT) 09.00-10.30 hrs (18.00 hrs AEDT) 18.00-19.00 hrs 18.00-20.00 hrs 18.00-19.30 hrs 10.00-11.00 hrs (18.00 hrs AEDT) 10.00-12.00 hrs (18.00 hrs AEDT) 10.00-11.30 hrs (18.00 hrs AEDT) Faculty Workshop director: Birgitte Offersen Cancer specialist: Philip Poortmans Workshop director: Ina Jurgenliemk-Schulz Cancer specialist: Umesh Mahantshetty Workshop director: Carl Salembier Cancer specialist: Alberto Bossi Workshop director: Ina Jurgenliemk-Schulz Cancer specialist: Umesh Mahantshetty Workshop director: Umberto Ricardi Cancer specialist: Rolf-Dieter Kortmann Workshop director: Jesper Eriksen Cancer specialist: Vincent Grégoire Workshop director: Jesper Eriksen Cancer specialist: Vincent Gregoire *Dates to be announced CONTOURING SESSIONS AT THE 3RD ESTRO FORUM Eight contouring sessions will take place between 24-28 April in Barcelona (oesophagus, lymphoma, prostate and OAR). Have a look at the programme in the Conferences Corner and on www.estro.org. Also, don’t miss the free FALCON demos on the ESTRO booth in the exhibition area (booth #2000). INTRODUCTION E-CONTOURING COURSE REPORTS WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE COURSE REPORTS ESTRO SCHOOL ESO/ESTRO 3rd masterclass in radiation oncology Quantitative methods in radiation oncology: models, trials and clinical outcomes 8 - 12 November 2014 | Cascais, Portugal 7 - 10 December 2014 | Vienna, Austria Target Volume Determination - from imaging to margins 9 - 13 November 2014 | Vienna, Austria INTRODUCTION E-CONTOURING COURSE REPORTS WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE COURSE REPORTS ESTRO SCHOOL ESO/ESTRO 3RD MASTERCLASS IN RADIATION ONCOLOGY 8 - 12 November 2014 Cascais, Portugal CHAIRMEN: Michael Baumann Jacques Bernier Roberto Orecchia Richard Pötter It is a great pleasure to be able to share the wonderful experience we all had at this unforgettable course. The selection process to be able to attend was thorough. I found this really exciting, because I hoped to be able to meet colleagues with different backgrounds, from all over the world, but with the same great interest in research. And I am happy to say that this masterclass greatly exceeded my expectations. ELEONOR RIVIN DEL CAMPO INTRODUCTION E-CONTOURING COURSE REPORTS The first thing that attracted me about this masterclass was that it covered all aspects of research in radiation oncology, from biology, imaging, technology, multidisciplinarity, without forgetting such important basic aspects such as methodology and statistics. All of the sessions were very well structured. Each day we would focus on a main topic and listen to the lectures from the brilliant faculty such as Daniel Zips, Daniela WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE COURSE REPORTS Thorwarth, Jose Belderbos, Felipe Calvo, Sören Bentzen and our chairs: Richard Pötter, Roberto Orecchia and Jacques Bernier. And after these extensive overviews of the topics, the following morning we presented our own research proposals for that topic. This schedule allowed us to understand the topic better, especially those that were not our main area of research, which helped us interpret our colleagues’ research proposals on the next day. This gave way to very stimulating discussions during the small group workshops where we presented our proposals, which continued and were even more interactive in the general session where we presented some of the most noteworthy proposals. Not only were we able to learn from and interact with such an amazing faculty board, but also with the other colleagues. It was incredible to have such close contact with the faculty. They were very open and eager to get to know us, and even discuss our projects with us directly during coffee breaks or meals. This was an extremely valuable input, which I am sure will help many of us when developing our research projects. On the other hand, we were also able to share the success and the pitfalls of our still short experience in the research field, for most of us, with other young radiation oncologists/physicists from around the INTRODUCTION E-CONTOURING world. This was very enriching because we all have had different experiences, depending on our background and access to grants, technology, mentors, etc. However we all have the same eagerness to discover more about our specialty by trying to answer those research questions that still elude us. Many of us have certain research interests in common, and hopefully will be able to work on projects together in the future. These connections are key in the research field where it is so important to share our knowledge so as to help each other to improve and advance. This is especially true in the era of internet, which allows us to collaborate even though we are miles away. This masterclass is highly recommended, and one of a kind. Eleonor Rivin del Campo Specialist in radiation oncology Gustave Roussy Cancer Campus Villejuif, France [email protected] And last, but definitely not least, the organisation was splendid, thanks to ESO and ESTRO. The venue was outstanding. The ocean views from the breakfast/lunch room, and even from our own rooms, allowed us to completely disconnect from our daily, stressful routine, and focus on learning and interacting during the course. In addition, it was so pleasant that it allowed the group to get to know each other on a personal as well as a professional level. Some colleagues were able to share runs along the beach, and we all went on evening walks where we would compare our day-to-day professional lives, as well as discussing research. COURSE REPORTS WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE COURSE REPORTS ESTRO SCHOOL TARGET VOLUME DETERMINATION - FROM IMAGING TO MARGINS 9 - 13 November 2014 Vienna, Austria COURSE DIRECTOR: Gert De Meerleer Radiation oncologist Ghent University Hospital Gent, Belgium As a trainee in radiation oncology I was looking for a course covering the scope of radiation oncology from image registration to the delineation process. This course titled “Target Volume Delineation - From imaging to margins” suited that purpose very well, so I travelled to the beautiful city of Vienna to enjoy a fruitful course. ROBIN WIJSMAN INTRODUCTION E-CONTOURING COURSE REPORTS The confirmation letter mentioned the “highly interactive character” of this course, which was true as we started the first day with useful group discussions upon the homework exercises: the delineation of a brain, a lung and a head and neck tumour. With these discussions, the need for a course like this became quite clear, as it was sometimes hard to find consensus upon the WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE COURSE REPORTS delineation of the target volumes. This introduction formed the basis of the course, since the different, scheduled topics worked towards solving the cases. By the use of different imaging modalities such as computed tomography and positron emission tomography, every tumour site (from CNS to prostate) was separately discussed, starting with a review of the anatomical structures involved. We discussed the strengths and weaknesses of every imaging modality, together with the pitfalls in image registration and position verification. Subsequently, the evidence for target volume delineation practices was discussed, leading to useful recommendations concerning, for example, target volume margins and elective lymph node irradiation. Finally, we discussed the consensus-based delineations of the target volumes of the cases and compared the group results with those of the teachers. dence-based) principles of target volume delineation of the most common tumour sites. Robin Wijsman Resident in radiation oncology Radboud UMC afdeling Radiotherapie Nijmegen The Netherlands During the course there was plenty of time for interesting discussions supported by the very enthusiastic teaching staff, even during the coffee and lunch breaks (while enjoying the tasty food). I would highly recommend this well organised course for those who want to learn the basic (evi- INTRODUCTION E-CONTOURING COURSE REPORTS WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE COURSE REPORTS ESTRO SCHOOL QUANTITATIVE METHODS IN RADIATION ONCOLOGY: MODELS, TRIALS AND CLINICAL OUTCOMES 7 - 10 December 2014 Vienna, Austria COURSE DIRECTOR: Sören Bentzen Biologist University of Maryland School of Medicine Baltimore, USA It was my pleasure to attend the recent ESTRO teaching course on “Quantitative methods in radiation oncology: Models, trials and clinical outcomes” held in Vienna. The excellent faculty was lead by Sören Bentzen and the meeting organised most efficiently by Gabriella Axelsson. The title was rather daunting but the course was in fact a quick, wide-ranging introduction to many are- MICHAEL JACKSON INTRODUCTION E-CONTOURING COURSE REPORTS as of numerical data analysis. The participants included medical physicists and radiation oncologists covering a broad range of experience and location. The schedule was quite intense over four days, and arriving from Australia at 9.30pm Saturday evening to start work at 8.00am Sunday morning was stressful, but the interesting programme kept us all awake and involved. Sören WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE COURSE REPORTS Bentzen, in particular, was very stimulating and the largely Dutch and Danish faculty members, Francesca Buffa, Philippe Lambin, Johannes Langendijk, Peter van Luijk and Ivan Vogelius were all good speakers. Richard Pötter and Dietmar Georg from the Medical University of Vienna came as guest speakers. The programme began with an introduction to statistics and clinical trials and went on to cover much else, including the selection of endpoints, meta-analyses, modelling and technology assessment. The clinical examples were a general overview of hot topics in radiation oncology and beyond. My favourite topic, proton therapy, was mentioned several times, although not always favourably given the cost and lack of evidence. The fragile rationale for several other expensive treatments and diagnostic tests was also exposed. I found the sessions on NTCP models and alternatives to conventional RCTs for technology assessment particularly helpful. Monte Carlo methods, which are familiar to most in treatment planning, were extended to several other interesting applications. A noble attempt was made to explain bootstrapping but I am still rather unclear on the details and will stick to slip-on shoes to avoid tripping up. More on health economics and INTRODUCTION E-CONTOURING Bayesian methods may be included in the future. I suspect it was a difficult course to run because of the wide range of audience experience but the discussion was well moderated by Sören Bentzen who always has a good anecdote to stimulate discussion. Participants, and especially the faculty, were challenged to defend their positions. Having more pre-course reading material might have been useful to give a more even knowledge base but the course slides were excellent. and the whole faculty were always approachable at other times. Dr Michael Jackson Radiation oncologist Prince of Wales Hospital Sydney, Australia [email protected] Vienna is a wonderful city, even in winter, and the dinner on the first night helped everyone to get to know one another. The venue was a small hotel on the edge of the city centre but easy to access by public transport. I can confidently recommend this course to young oncologists, physicists, RTTs and others who want to learn more about quantitative methods and controversies in radiation oncology and also as a refreshing overview for the more experienced. Mathematical ability is not required. It will not equip you for a career as a statistician but will help you understand papers and to ask tricky questions at Journal Clubs and other meetings. For those wanting advice on a particular project, the meet-the-professor sessions were very useful COURSE REPORTS WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE ESTRO SCHOOL WHO’S WHO? Sofia Rivera BIOGRAPHY Head of radiation oncology breast unit at the Gustave Roussy institute, Villejuif, France Sofia Rivera studied medicine in Paris and Madrid. She undertook a specialisation in radiation oncology in Dijon and her doctoral degree in 2008 was on the evaluation of quality insurance procedure by dummy run in phase III trials. During her training she was charmed by the multidisciplinary nature of radiation oncology and the enormous potential for innovation within this field. In addition to her clinical work, she undertook a masters degree in science in radiobiology and is currently working on her PhD on a translational topic evaluating the combination of HDAC inhibitors and radiation in preclinical NSCLC models at Gustave Roussy radiobiology laboratory (INSERM1030 unit). Following her studies, she worked as an assistant professor in radiation oncology at the Hôpital Saint-Louis in Paris where she became senior radiation oncologist. She was then approached by the Gustave Roussy cancer centre to take over the position of head of the breast cancer radiation unit. SOFIA RIVERA INTRODUCTION In this new section of the ESTRO School Corner, we will highlight in every issue a person who is very active in education at ESTRO. For this first time, we have invited Sofia Rivera, a radiation oncologist at Gustave Roussy Institute, Villejuif, France, since January 2013. At only 38 years old, she has already accumulated several years of experience and involvement with ESTRO: she joined the young group in 2006, she is a teacher for the ESTRO course on advanced skills in modern radiotherapy, she is co-chair of FALCON workshops and has been a member of the ETC (Education and Training Committee) for six years, just to name a few of her activities within the Society… E-CONTOURING COURSE REPORTS Currently her areas of focus are: ∙ Breast cancer where, as principal investigator, she is involved in various clinical trials including preoperative radiotherapy and accelerated hypo-fractionated partial breast irradiation. ∙ Combination of new drugs with radiotherapy, which is strongly linked to her PhD research topic, her involvement in phase I trials and her position as co-chair of the Synergy for Targeted Agents and Radiotherapy (STAR) group in the EORTC Radiation Oncology Group (ROG). Her heart is in research, patient care and training and she strongly believes that in these three fields the room for improvement in radiation oncology can only be filled in by sharing and spreading our expertise, knowledge and interrogations. That is why at a local, national and international level she is involved in training programmes for radiation oncology residents, RTTs and physicists. WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE INTERVIEW What is your current role within the ESTRO School? I’m a member of the core Educational and Training Committee (ETC) where we discuss pedagogical, strategic, organisational and financial aspects of education in ESTRO, namely within the ESTRO School. I’m a member of the core FALCON group where we work on pedagogical, strategic, organisational and financial aspects of the contouring tool and activities developed in ESTRO for pedagogical and scientific purposes. Besides that I’m the cochair of the FALCON online workshops group in which we have an exponentially growing activity developing online contouring workshops for radiation oncologists, RTTs, and every professional involved in contouring all over the world . I am a teacher of “advanced skills in modern radiotherapy” , which is an annual ESTRO course that started in 2014. I’ve been teaching in two pre-meeting courses (one on contouring and one in radiobiology) and in live contouring workshops on thoracic organs at risk in ESTRO meetings for two years now. Last but not least I’m part of the evaluation group for the ESTRO mobility grants  where twice a year we assess, score and discuss the applications from RTTs, biologists, physicists and radiation oncologists. INTRODUCTION E-CONTOURING How and when did you enter the ESTRO School? I didn’t realise it because time is running so fast and being part of the ESTRO School is so interesting that you don’t count, but in fact I entered the ETC six years ago. At that time I was the co-chair of the young scientific committee for the ESTRO meeting and Professor Guy Kantor approached me saying he would retire soon from the ETC and he thought it would be great to be replaced by a young ESTRO member. Soon after, I was invited by Professor Richard Pötter, chair of the ETC to attend an ETC meeting. I came to a few meetings with Prof Kantor and got involved in ETC activities, so I took over his position smoothly when he left the ETC. What was your previous ESTRO involvement before becoming a course teacher? My first ESTRO involvement was in the young ESTRO group in 2006-2007. Supported by the ESTRO Board, the scientific committee of the ESTRO meeting and the ETC, we reinitiated a young scientific session at ESTRO meetings and that was a fantastic experience. Then I was involved in the young ESTRO group up to 2013 and in the ETC up to now with various activities, among which two of the most exiting were being an editor of the Young Corner of the ESTRO newsletter and launching FALCON within the core FALCON group. COURSE REPORTS We imagine that you are very busy with your position at the Institute. What are your motivations for taking on additional responsibility with the ESTRO School and what gives you most satisfaction? ESTRO has clearly broadened my vision of radiation oncology and has brought me valuable professional, scientific and human experiences that confirmed for me that I had made the right choice by choosing radiation oncology as a specialty. Being involved in ESTRO activities in close contact with brilliant and highly motivated people willing to openly share their experience and knowledge has been a source of motivation and energy. I strongly believe the progress we need in radiation oncology for our patients can only come from sharing and spreading our expertise, knowledge and interrogations. Joining forces in our community across specialties is essential to me. In ESTRO and in the ESTRO School I’ve found a spirit that goes completely along with that and makes me feel part of this Society. I sincerely think that teaching and being taught within the ESTRO School brought as much knowledge as satisfaction, and it’s clearly one of the most fantastic experiences of my professional life that I’m willing to continue even with the increasing burden and responsibilities of my position at the Institute. WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE LINKS ESTRO EDUCATION AND TRAINING COMMITTEE  Online worshops: http://estro.org/school/articles/onlineworkshops/2015-online-workshops View the members: www.estro.org/about-us/governance-organisation/scientific-council/committees/education-and-training-committee >  ESTRO teaching course on Advanced skills in modern radiotherapy, 28 June - 2 July 2015 Copenhagen, Denmark http://estro.org/school/items---list-courses-school-main-pages/2015-copenhagen--advanced-skills-in-modern-radiotherapy The committee is contactable through Christine Verfaillie [email protected] and Viviane Van Egten [email protected] at the ESTRO office.  ESTRO mobility grants Next dealine on 30 April 2015 http://estro.org/school/articles/grants/ estro-mobility-grants INTRODUCTION E-CONTOURING COURSE REPORTS WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE ESTRO SCHOOL UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE RESTRUCTURING OF THE EDUCATION AND TRAINING COMMITTEE At the June strategy review it was agreed that the Core Education Committee would become a full ESTRO Council, with direct links to the Board. The new Council will become effective at the 3rd ESTRO Forum in April in Barcelona. The Educational Council will: • Define the strategy for education within the framework of the overall ESTRO strategy • Delegate tasks to implement this strategy to Task Forces within the broader Education and Training Committee or other Standing Committees and Task Forces • Follow up on the implementation of these tasks • Oversee the daily management of the School by the ESTRO staff • Monitor the budget of the School • Facilitate relations with other oncology (related) societies regarding education • Approve appointments related to the implementation of the educational strategy (e.g. course directors). Composition of the Educational Council: The Council will consist of an Educational Executive (Chair/School Director, Administrative Director, Presidential Representative), plus approximately nine other members who will be selected to represent all subspecialties and to link to all ESTRO committees and Task Forces. The Board INTRODUCTION E-CONTOURING COURSE REPORTS will appoint the Chair of the Council, based on open solicitation and selection of the most appropriate candidates. The Board will appoint other Council members, based on recommendations by Standing Committees and existing Council members. INTERNAL REVIEW OF ESTRO SCHOOL An internal review of the ESTRO School is currently underway, based on the guidelines for postgraduate medical education models developed by the World Federation for Medical Education (WFME). The existing structure and performance of the School scored very well on the majority of important issues. However, a few areas for improvement have been identified and are currently being investigated: • Support for teachers and faculties • Mechanism for robust evaluation of the efficacy of educational programmes • Professional and pedagogical expertise • Trainee representation on educational programmes • Administrative structure of the School to support programme implementation WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE 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 (postponed) 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 - 25 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 INTRODUCTION E-CONTOURING COURSE REPORTS WHO’S WHO? UPDATES ON THE EDUCATIONAL TRAINING COMMITTEE YOUNG ESTRO INTRODUCTION YESTRO MOBILITY REPORTS YOUNG PROGRAMME YOUNG ESTRO “The young task force has officially become a standing committee in ESTRO” We have some great news to share with you: the young task force has officially become a standing committee in ESTRO. It will allow us to support the needs and create initiatives for young members, provide the structure for continued input, organisation and network for young activities already in place and to have a structure to launch new ideas with proper consistency and efficiency. CATHARINE CLARK In this issue, we publish two mobility reports. Lucas Persoon from The Netherlands wrote the first one after he visited the Aarhus University Hospital in Denmark. Dr Sayan Paul from India wrote the second mobility report in this issue after he visited Vienna General Hospital to learn more about brachytherapy techniques. Don’t forget to renew your membership for 2015 and to register for ESTRO’s 3rd Forum in Barcelona. We have added at the end of this Corner the young programme that the scientific advisory group of young ESTRO members has prepared for you. We look forward to meeting you in Barcelona! JEAN-EMMANUEL BIBAULT Catharine Clark and Jean-Emmanuel Bibault Read the interview with Laura Mullaney and Kasper Rouschop, chairs of the young programme at the 3rd ESTRO Forum, in the Conference Corner on p145 > INTRODUCTION YESTRO MOBILITY REPORTS YOUNG PROGRAMME YOUNG ESTRO THE YOUNG TASK FORCE HAS BECOME A STANDING COMMITTEE The young task force (YTF) has the pleasure to inform you that ESTRO now has a standing committee to represent the young. The ESTRO Board approved the creation of this new committee, yESTRO, at their meeting on 17 November 2014. The committee will officially start at the 3rd ESTRO Forum, although work continues on all fronts on the issues started by the YTF, while articulating the activities the new committee should tackle. activities and supporting young members. The first task given by the Board to the committee is to investigate and come up with a way to involve young national societies more in ESTRO. Come and toast a glass to the new committee at the Young reception at the 3rd Forum on Monday 27 April at 16.45-17.45 hrs. This has been a long process for the young members in ESTRO. Everything began in 2011 at the ESTRO 30th Anniversary congress when the first YTF was formed based on efforts of few young ESTRO members who started to lobby for a specific young element in ESTRO in early 2009. These pioneers created and managed the young track and the young Corner in the newsletter between 2009-2011 until the YTF took over these activities. We thank them for their innovation and persistency and are proud that their ultimate goal has finally been realised, with the creation of the yESTRO. This committee will be an integral part of the ESTRO governance, contributing to INTRODUCTION YESTRO MOBILITY REPORTS YOUNG PROGRAMME MOBILITY REPORT S YOUNG ESTRO Adaptive radiotherapy using portal dosimetry for clinical decision-making Lucas C.G.G. Persoon Image based gynaecological brachytherapy, the ultimate dose painting: treat the disease you see Paul Sayan INTRODUCTION YESTRO MOBILITY REPORTS YOUNG PROGRAMME MOBILITY REPORT YOUNG ESTRO MOBILITY REPORT Adaptive radiotherapy using portal dosimetry for clinical decision-making Lucas C.G.G. Persoon HOST INSTITUTE: Aarhus University Hospital Aarhus University Aarhus, Denmark DATE OF VISIT: 31 August 2014 – 19 September 2014 LUCAS PERSOON INTRODUCTION The aim of the visit was to familiarise myself with clinical procedures developed for adaptive radiotherapy developed at Aarhus University Hospital (AUH). Secondly, we wanted to set up a collaboration between our institutes to share knowledge to analyse large groups of patients and develop adaptive radiotherapy decision-support aids for informed decision-making. AUH has a long track record in applying adaptive radiotherapy strategies for several treatment sites and, therefore, was an excellent choice to learn more about the strategies so that we can combine this with our EPID dosimetry method to apply adaptive radiotherapy in a better way. During the visit we focused mainly on three treatment sites: head and neck, lung and bladder cancer, where AUH has a lot of experience with adaptive radiotherapy. In lung cancer treatments AUH has considerable experience and they have analysed a large patient group. They observed in a study published in ESTRO’s Green Journal that in approximately 20% of the patients, a clinical relevant anatomy change emerged during treatment. In this study reduction of lung atelectasis, tumour regression and base-line shifts of the tumour frequently occurred. During the visit they showed how they apply this procedure and the way they can adapt a treatment within one day. YESTRO For head and neck the focus was on contour propagation. Contour propagation is necessary for an accurate assessment of the dose based on dose recalculations using Cone Beam CT (CBCT) images. One of the main disadvantages is that re-delineations are necessary in order to get accurate Dose Volume Histogram (DVH) results, especially for head and neck re-delineations, which are time-consuming. AUH has explored some methods to perform contour propagation and dose accumulation. Besides the methods developed for lung and head and neck, AUH uses an adaptive radiotherapy protocol for bladder cancer patients with a planof-the-day where, based on the CBCT, a plan is selected according to the bladder filling when the patients come for treatment. I had the opportunity to follow the entire treatment adaptation process at the treatment machine. Furthermore AUH has a lot of experience in motion assessment and tracking while MAASTRO clinic has a lot experience with time-resolved EPID dosimetry, and this was one of the topics where our two institutes plan to collaborate for radiotherapy treatments. During the two-week visit I was also introduced MOBILITY REPORTS YOUNG PROGRAMME MOBILITY REPORT to many of the other research areas AUH is working on and I happened to see their new facilities at the Skejby location. The visit surpassed my expectations and I learned a lot and was able to set up a collaboration project. Finally, I would like to thank ESTRO for providing the opportunity to visit AUH. From AUH I would like to thank Professor Ludvig Paul Muren and his whole team for arranging the visit and the hospitality. I also would like to thank Lone Hoffmann, PhD; Ulrik Vindelev Elstrøm, PhD and Anne Vestergaard, MSc for the very pleasant discussions and collaborations we have set up. Lucas C.G.G. Persoon, Msc Computer scientist and PhD student MAASTRO clinic Maastricht, The Netherlands [email protected] INTRODUCTION YESTRO MOBILITY REPORTS YOUNG PROGRAMME MOBILITY REPORT YOUNG ESTRO MOBILITY REPORT Image based gynaecological brachytherapy, the ultimate dose painting: treat the disease you see Paul Sayan HOST INSTITUTE: AKH, Vienna General Hospital Medical University Vienna. Austria Dr Sayan Paul and Mrs Kanan with Prof Richard Pötter, the pioneer in image based gynaecological brachytherapy, in AKH, Vienna DATE OF VISIT: 13 - 23 October 2014 AIM OF THE VISIT PAUL SAYAN INTRODUCTION Brachytherapy plays an integral role in treatment of gynaecological cancers. There has been much development in image-based technology for external beam radiation and these technologies are available in most of the radiotherapy centres, but the skill and training needed for image-based brachytherapy are still lacking even in many advanced radiotherapy facilities. In spite of having equal importance in treatment of gynaecological cancers, most of the centres are still using con- YESTRO ventional treatment planning in brachytherapy for this reason. Being a state-of-the-art radiotherapy facility in India, where cervical cancer is the leading cancer in females, we planned to start image-based brachytherapy in our centre. In order to get trained we visited AKH, Vienna, which has been the pioneer in this field and where Professor Richard Pötter has been teaching and guiding the radiotherapy fraternity of the world this technique for more than a decade. MOBILITY REPORTS YOUNG PROGRAMME MOBILITY REPORT DETAILS OF THE SCIENTIFIC CONTENT OF THE VISIT There was extensive preplanning by the host institute for our visit. A detailed schedule was prepared taking a holistic approach to train us not only in the technique but also in patient care as a whole. There was balanced allocation of time for clinical exposure, technical training, physics training, research work and didactic lectures. There regular morning meeting and tumour boards were organised in English for our better understanding. Lectures on image-based brachytherapy technique, clinical results and trial outcomes were delivered. Various cases with imaging and pathology were also discussed in these meetings. The most useful and exciting part of the training was Prof Pötter’s personal involvement in teaching the technique we had gone to learn about. Starting from the pre-planning he explained the imaging clinical findings, desired plan of treatment, prescription dose to various target areas, expected outcome and toxicities and also how to reduce toxicities and enhance gain. In the operation room we were shown the application of compatible brachytherapy applicators (Vienna 1 and 2 applicators) and the tricks and areas of caution during application and post application care. A detailed training on image INTRODUCTION acquisition and hands-on training on contouring and planning were the most useful part of this whole exercise. We were allowed to contour and plan real time and were checked and corrected by Prof Pötter himself and their excellent physicist, Dr Daniel Berger. Their friendly nature never allowed this technically demanding task to become boring for a second. The team explained their meticulous plan evaluation and we witnessed the plan’s execution as well. It was our good luck that there were a good number of patients and applications during our visit. The rest of our time was devoted to exposure to clinical research. We attended the EMBRACE trial meetings and learned the trial data collection, data evaluation, screening and analysis methods. The joyful and cooperative environment of the department made this whole learning process exciting and enjoyable. We had good times with other international fellows from different parts of the world and making a few new friends among them was the icing on the cake. in the process of implementing image-based techniques, this visit gave us immense confidence on this subject. The skill we acquired will be of great use in our day-to-day practice. Our successful implementation of this technique has the potential to change the pattern of practice in this part of the world where it can yield best results. Lastly we express our heartiest thanks and gratitude to ESTRO, Mrs Viviane van Egten, Prof Pötter, Dr Berger and the whole AKH team for this wonderful training, which has not only enriched us but also will benefit millions of gynaecological cancer patients in south east Asia. Dr Sayan Paul Radiation Oncologist Fortis Memorial Research Institute Gurgaon, Haryana, India [email protected] RESULTS FROM THE VISIT Being a tertiary referral centre in India we get a good number of patients with gynaecological malignancies who need brachytherapy. As we are YESTRO MOBILITY REPORTS YOUNG PROGRAMME YOUNG ESTRO YOUNG PROGRAMME 3rd ESTRO Forum Monday 27 April 2014 08.00 - 08.40 | ROOM 114 TEACHING LECTURE Co-chair: S. Rivera (FR) Initiating and maintaining meaningful collaborations: A requirement for good sciences! – A guide for dummies Chair: P. Kelly (IE) Speaker: P. Lambin (NL) Learning Objectives: This session will look at what are the important factors to consider when initiating collaborations with more experienced colleagues and once these collaborations have been formed how to ensure that they remain active and mutually beneficial. 08.45 - 10.00 | ROOM 114 SYMPOSIUM Integrating health economics in research Chair: L. Fokdal (DK) INTRODUCTION YESTRO > Why health economics matters in radiation oncology research Y. Lievens (BE) > How to incorporate cost calculation into our research? N. Defourny (BE) > How to calculate cost-effectiveness? J. Grutters (NL) 10.30 - 11.30 | ROOM 114 MOVING POSTER SESSION I AND II > Head and neck cancer > Lung cancer > Breast cancer > Gynaecological cancer > Dosimetry and dose measurements > Treatment planning calculation, optimisation, MOBILITY REPORTS YOUNG PROGRAMME radiobiological planning, predictive models of outcome > Radiobiology imaging and physics imaging > Intrafraction motion management > RTT Pre-treatment imaging; adaptive radiotherapy; geometric uncertainties and margins 14.45 - 16.15 | ROOM 114 SYMPOSIUM Chair: K. Rouschop (NL) Working smarter to create ‘my dream career’ Learning Objectives: In this symposium a report on the current and ongoing young ESTRO activities will be provided, including experiences of ESTRO fellows and exchange programmes. This session will promote engagement in the young ESTRO community and the exchange of ideas on future activities. Chair: L. Fog (DK) Co-chair: W. Van Elmpt (NL) > Physicist: K. Tanderup (DK) 13.15 - 14.15 BROWN BAG LUNCH: MEET THE PROFESSORS - YOUNG ESTRO MEMBERS Radiation Oncology: D. de Ruysscher (BE), D. Zips (DE) Chair: J-E Bibault (France) Physics: D. Low (US), L. Muren (DK) Chair: D. Thorwarth (DE) RTT: M. Coffey (IE), H. McNair (GB) Chair: E. Forde (IE) Radiobiology: F. Stewart (NL), B. Wouters (CA) Chair: K. Røe (NO) Learning Objectives: This session is designed to provide an opportunity for young ESTRO members to meet a number of preselected professors/ experts over lunch to ask questions and generate discussion, putting some of the teaching lecture lessons into practice. > Clinician: S. Combs (DE) > Radiobiologist: M. Koritzinsky (CA) > RTT: M. Leech (IE) Learning Objectives: In this session, four outstanding young researchers will explore the steps they consider key to building the career of their dreams. Our expert panel, which boasts a biophysicist, a radiation therapist, a doctor and a physicist, will explore goal-setting, branding, creating and exploiting opportunities, the usefulness of networking inside and outside your own institution, finding your place within your team and the role of mentorship. We hope to leave you inspired, enthused and well-equipped to build your dream career. 16.45 - 17.45 SYMPOSIUM Report from the Young Task Force and Young reception Chair: V. Valentini (IT) INTRODUCTION Feedback / brainstorm from audience for YTF YESTRO YOUNG RECEPTION AT THE 3RD FORUM Monday 27 April at 16.45-17.45 hrs Room 114 MOBILITY REPORTS YOUNG PROGRAMME HEALTH ECONOMICS INTRODUCTION STEREOTACTIC BODY RADIOTHERAPY: WHAT DOES IT REALLY COST? HEALTH ECONOMICS “Stereotactic body radiotherapy: what does it really cost?” Before being able to launch their product on the market, manufacturers of new radiotherapy equipment only have to prove that their product does what it is designed to do: to deliver radiation, and to do it safely. But health care payers want evidence that goes beyond this requirement. They want evidence that innovative treatments are of clinical benefit to patients, and that these treatments deliver sufficient additional value for the typically higher cost. Unfortunately, this evidence is not always readily available, and research often needs to be performed after novel equipment has been purchased by the health care provider. This shifts the financial risk from the health care payer to the provider, often delays reimbursement, and, as a consequence, may result in a situation where innovations disseminate slowly into general practice due to financial disincentives. Coverage with evidence development (CED) has been proposed as a means to overcome this potential barrier, as is described in a paper on the cost of stereotactic body radiotherapy (SBRT) for early stage non-small cell lung cancer (ES-NSCLC) . YOLANDE LIEVENS PETER DUNSCOMBE Yolande Lievens, Peter Dunscombe and Madelon Pijls MADELON PIJLS INTRODUCTION STEREOTACTIC BODY RADIOTHERAPY: WHAT DOES IT REALLY COST? HEALTH ECONOMICS STEREOTACTIC BODY RADIOTHERAPY: WHAT DOES IT REALLY COST? YOLANDE LIEVENS INTRODUCTION As level 1 evidence for (lung) SBRT is lacking, the Belgian obligatory health care insurance organisation has, to date, not agreed to endorse reimbursement. However, in order not to withhold this promising treatment modality from patients, a CED programme has been launched for SBRT in well-defined clinical indications. In return for the financing, health care providers have to commit themselves to collect effectiveness data that are gathered in a central database, monitored by the Belgian cancer registry and the health care insurance organisation. To provide input for this cost-based coverage programme, a comprehensive cost calculation study of standard and innovative radiotherapy was performed in ten Belgian radiotherapy centres, representative of all 25 centres in Belgium. The choice for the costing methodology was time-driven activity-based costing (TD-ABC). This method has been described previously and was selected for its usefulness in the context of situations where high treatment complexity goes hand in hand with a rapidly evolving technology, as is the case in radiotherapy. In short, ABC tackles the problem of resources that cannot be directly traced to a single product (so-called indirect costs, such as equipment or personnel) in a stepwise approach: resource costs are first allocated to activities using “resource drivers”, and the calculated activity costs are further assigned to the products (services or treatments) through “activity drivers”. The product cost is calculated by simply adding together all costs assigned to that product. Whereas the original ABC-methodology typically required a large number of diverse cost drivers, TD-ABC reduces the necessary parameters at each process step to only two: the cost, per time unit, of each of the resources used in the process and the time spent by each resource. We will not focus on the specificity of this model’s parameters; the interested reader will find it in much detail in the paper, as well as in the full report of the Belgian Knowledge Centre, which is available online . The analysis in the paper focuses on the cost of SBRT for ES-NSCLC, put in the context of curative intent treatments for lung cancer. In the ten participating departments, the overall yearly number of lung radiotherapy treatments delivered with curative intent varied from 46 to 252, the lung SBRT treatments from 7 to 73 (mean 40). The average cost (in 2011 in Euros) of lung SBRT was computed at €6,221, with an average by centre ranging between €3,104 and €12,649; compared to a cost of €5,919 (€4,557-€6,564) for standard fractionated 3D-CRT and of €7,379 (€5,054-€8,733) for IMRT. This shows that in spite of fewer fractions, the average lung SBRT cost is close to that of standard fractionated radiotherapy, due to the high demand on machine and personnel time per fraction. On the contrary, the cost of SBRT treatments decreased with a decreasing number of fractions. Similar conclusions hold true for more standard treatment techniques, where, in line with the STEREOTACTIC BODY RADIOTHERAPY: WHAT DOES IT REALLY COST? lower resource needs, the costs of hypofractionated schedules came out about 30-35% lower than those of standard fractionated schedules. new treatment to the patient at an early stage of technology development. Lastly, as can also be deduced from the figures above, the average cost amongst the different centres varies more for SBRT than for conventional radiotherapy techniques, with 3D-CRT having the smallest variability in cost. This reflects the impact of differences in the equipment and technologies used, in stages of the learning curve and related personnel demands, in the utilisation of the various resources, and, by extension, in a lack of clear guidance and planning in this field. Yolande Lievens Ghent University Hospital Ghent, Belgium REFERENCES  Lievens Y, Obyn C, Mertens A-S et al. “Stereotactic body radiotherapy for lung cancer: what does it really cost?” J Thorac Oncol. 2014 Nov 7. [Epub ahead of print].  Hulstaert F, Mertens A-S, Obyn C, et al. “Innovative radiotherapy techniques: a multicentre time-driven activity-based costing study.” Health Technology Assessment (HTA) Brussels: Belgian Health Care Knowledge Centre (KCE) KCE Reports. Brussels: Belgian Health Care Knowledge. One should be aware that the costs presented above might not be entirely generalisable to other jurisdictions, as the input figures, in terms of resource costs and use, may diverge from one country to another. However, this study does demonstrate that it is feasible to compute resource costs with TD-ABC in a multicentre context, resulting in real-life cost data that can support reimbursement negotiations. As a matter of fact, based on these computations, the Belgian obligatory health insurance organisation initiated a CED project with provisional financing for innovative radiotherapy, including SBRT amongst others, for ES-NSCLC. The ultimate goal is to make a blueprint of the Belgian SBRT landscape, showing the national distribution of indications, techniques and practice patterns, and their evolution over time. Thanks to the financial coverage, it allows health care providers to deliver this promising INTRODUCTION STEREOTACTIC BODY RADIOTHERAPY: WHAT DOES IT REALLY COST? INSTITUTIONAL MEMBERSHIP INTRODUCTION UZ BRUSSEL 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 three 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 some feedback on their experiences and their institute. UZ Brussel is featured in this issue. Contact: [email protected] INTRODUCTION UZ BRUSSEL INSTITUTIONAL MEMBERSHIP UZ BRUSSEL, VRIJE UNIVERSITEIT BRUSSEL (VUB) Brussels, Belgium Number of ESTRO institutional members: 27 Spokesperson: Professor Mark De Ridder, Head of the radiation oncology department www.uzbrussel.be/u/view/nl/127896-Radiotherapie. html The radiation oncology department at UZ Brussel How would you describe the radiation oncology department of your institute? MARK DE RIDDER INTRODUCTION From the launch of the Vrije Universiteit Brussel, the need was identified for a proprietary hospital. Its foundations have remained relevant to this day as they relate to the university’s mission not only to provide a platform for the education of students in the (para)medical professions, the development of new medical techniques or innovative treatments, but also for the best possi- ble accessible medicine governed by the right of self-determination. In view of its location in the Brussels region, the VUB has also taken it upon itself to provide an answer to the failed language policy in Brussels’ public hospitals. The radiation oncology department of the UZ Brussel treats approximately 1,500 patients per year. Our staff consist of 12 radiotherapists (of which three are physicians in training), 29 UZ BRUSSEL nurses and technologists, two social nurses, a dietician, a psychologist, two logisticians, seven clinical physicists, two dosimetrists, five service engineers, two radiobiologists, a lab technician, a team of six administrative staff, a data manager, four post-doc scientists and six PhD students. Our mission is “to offer the optimal and most efficient radiation therapy tailored to the individual patient, through development and clinical implementation of novel irradiation techniques and radiobiological concepts”. The department is on two sites, applying a multi-vendor philosophy with dedicated technology to optimise an individualised treatment approach. What are the main areas of specialisation in your department? The UZ Brussel’s clinical research programme is currently built around four strategic clusters: a) diagnosis and treatment of colorectal cancer, b) treatment of oligometastasis, c) frameless stereotactic radiosurgery, and d) biological modulated radiotherapy with special emphasis on the tumour microenvironment. Research activities are largely focused on safe implementation of 3D conformal radiation therapy in all its aspects, more particularly Intensity-Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT). From the start, research has been based on the concept INTRODUCTION that conformal radiotherapy requires real-time and accurate knowledge of the patient’s anatomy during dose delivery. As such, the UZ Brussel has always advocated the need for real-time image-guidance to warrant safe administration of dose when applying sophisticated dose delivery techniques. In 1992 the centre was one of the first centres worldwide to report on on-line patient set-up procedures using an electronic portal imaging device mounted to the gantry of the linac combined with a tele-controlled treatment couch. These developments gradually evolved in the combination of a real-time infrared tracking device with stereoscopic X-ray imaging and a (6 degrees-of-freedom) robotic treatment couch for high precision localisation of tumours prior to, and during treatment, such as respiratory gated delivery of irradiation (in use clinically since 2006). In 2009, this expertise emanated in the exploration of real-time tumour tracking with the co-development and clinical implementation of the VERO-system for stereotactic body radiotherapy. In parallel to the development of IGRT, the UZ Brussel recognised the need for rotational irradiation in combination with intensity-modulation and was the first European centre to introduce IMRT by means of sequential tomotherapy into the clinic in 1995. Research in this field focuses on volumetric approaches in arc therapy to increase efficiency in dose delivery, and it resulted in the clinical introduction of two units for helical tomotherapy in 2005 and 2006, and VMAT in 2011. In addition, the UZ Brussel has been active in the validation of both frame-based and frameless linac-based stereotactic radiosurgery using dynamic arc therapy with circular cones or micro-multileaf collimators since 1992. In addition, these technological developments aim at integrating research in high precision radiotherapy with radiobiology. The radiobiological research unit of the department is focused on hypoxic tumour cell radiosensitisation and the role of the pro-inflammatory tumour infiltrate in radioresponse. Clinical trials on this synergy are currently on-going. Special programmes for patient safety and treatment quality are continuously adapted and implemented to monitor and improve the care programme within the department. What are the main achievements so far and the main challenges on your daily work and for the future? Our focus is the translation, integration and clinical implementation of new biological concepts and innovative radiation techniques in phase I/ II clinical trials. We implemented IMRT/IGRT in the pre-operative treatment of rectal cancer and dynamic tumour tracking by the Vero SBRT system in oligometastatic and lung cancer. The implementation of biological imaging UZ BRUSSEL modalities for patient individualised treatment strategies is our future challenge. Is your department currently undertaking some studies or clinical trials that you would like to share with the ESTRO community? The radiotherapy department of the UZ Brussel offers high quality and academic-based patient care. The department acts as the principal or participating investigator in several clinical studies. The focus of our research is on radiobiology, colorectal cancer, oligometastatic cancer and stereotactic radiosurgery. We would like to invite the ESTRO community to join the RECTUMSIB trial, evaluating a simultaneous integrated radiation boost as an alternative to concomitant chemotherapy in pre-operative radiation treatment of rectal cancer (NCT 01224392). 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 main feature of the concept “institutional membership” is the obvious answer, in that it mirrors the department’s philosophy of multidisciplinary team-work. Promoting ESTRO from within the institute, as opposed to individual initiatives, lowers the threshold for attending INTRODUCTION courses and meetings. As such, we see ESTRO as an additional and important contribution to the educational programme of the department. Moreover, an institutional approach opens doors for benchmarking, networking and collaboration on different levels. the entire team. We encourage people interested in visiting the department for a medium or long term visiting project to contact us any time at [email protected] In your opinion, what additional benefits would be useful as part of the institutional membership package? Tools to facilitate inter-departmental collaborations and exchanges of not only researchers but also clinical personnel might help to strengthen the ESTRO network with a view to creating a uniform, high quality radiotherapy service throughout Europe. Is there anything particular about your institute that you would like to promote and share with the ESTRO community? We organise weekly seminars, doctoral school and clinical training programmes for residents in radiation oncology, medical physics and RTTs within certified academic programmes. The department has an open-house policy in that it accepts external visitors and fellows from all disciplines related to radiation oncology (radiation oncologists, medical physicists and RTTs) on a regular basis. Exchange of experience with trainees and visiting experts is considered to be mutually fruitful and is highly appreciated by UZ BRUSSEL NATIONAL SOCIETIES INTRODUCTION TURKISH SOCIETY FOR RADIATION ONCOLOGY NATIONAL SOCIETIES “This edition of the Corner hosts TROD, the Turkish Society for Radiation Oncology” Welcome to the National Societies Committee (NSC) Corner. Continuing to offer national societies the opportunity to present their views on issues of general interest (such as education, mobility and expectations towards ESTRO), this edition of the Corner hosts TROD, the Turkish Society for Radiation Oncology. TROD representatives introduce their society, report on its approach to continuous medical education and update us on the current state of the national radiation oncology services field. The conclusion of this concise, yet informative interview serves as a reminder to the NSC of its main responsibility: to promote the open discussion on radiation therapy in the broader European area as a means of highlighting issues requiring concerted action and promoting inclusive approaches drafted from the synthesis of views. PANAGIOTIS PAPAGIANNIS It is in this regard that we’d like to remind you of our next meeting on 24 April at the 3rd ESTRO Forum in Barcelona. We are looking forward to your active participation, recommendations, experience sharing, as well as comments and criticism regarding our progress on further promoting the role of ESTRO as a melting pot of national societies and their concerns. Panagiotis Papagiannis Member of the ESTRO national societies committee Medical School, University of Athens Athens, Greece National societies half-day meetings at the 3rd ESTRO Forum: • National Associations Day Joint Meeting for ALATRO, SEOR, SPRO: 24 April • National Associations Day, Polish Society of Radiation Oncology: 24 April View the full programmes in the Conference Corner on p153 > INTRODUCTION ESTRO NATIONAL SOCIETIES COMMITTEE View the members and the activities: www.estro.org/about-us/governance-organisation/professional--membership-council/committees/national-societies-committee-nsc > The committee is contactable through Chiara Gasparotto [email protected] at the ESTRO office. TURKISH SOCIETY FOR RADIATION ONCOLOGY NATIONAL SOCIETIES TURKISH SOCIETY FOR RADIATION ONCOLOGY Interview with Professor Yavuz Anacak, Representative of TROD to ESTRO and Professor Serdar Özkök, President of TROD Ege University Hospital, Izmir, Turkey When was your society founded, and how many members does it have at present? The history of radiotherapy in Turkey goes back to beginning of 20th century, when the first documented radiotherapy applications were published in 1904 (1). Radiotherapy was a branch of radiology until 1987 when it was accepted as a separate medical specialty and referred to as “radiation oncology” in Turkish law. The Turkish Society for Radiation Oncology (TROD) was founded in Istanbul in 1993, spread out to the whole country quickly and became a national society within a few years. TROD is the only society for radiation oncologists in Turkey; all radiation oncologists and radiation oncology residents are considered to be natural members. Medical physicists are also eligible for membership by application. Currently TROD has more than 700 members, including 450 radiation oncologists, 200 medical physicists and 50 radiation oncology residents. What would you refer to as the major strength of your national society? SERDAR ÖZKÖK INTRODUCTION YAVUZ ANACAK The aim of the TROD is to enhance capacity and standards of knowledge among Turkish radiation oncologists by organising regional and national meetings and training courses, developing certification standards and executing board exams, developing national guidelines for radiotherapy applications, providing fellowships abroad and grants for ESTRO school courses. TROD has several working groups which organise coordinated clinical research projects to enhance the science of radiation oncology in Turkey. TROD represents Turkish radiation oncologists at various levels on governmental issues, including lobbying for the rights of radiation oncologists, advising on manpower and infrastructure planning, and contributing to national cancer control plans and health policies. How does your society work towards addressing the need for continuous professional development of its members? As we all know radiation oncology is a rapidly evolving medical speciality, which means there need to be frequent updates of individuals’ knowledge. TROD has organised the National Radiation Oncology Congress (UROK) biennially since 1994. The last meeting was held in 2014 with more than 700 participants. Almost all topics and issues related to radiation oncology are usually discussed at UROK. TROD also organises a National Cancer Congress (UKK) jointly with the Turkish Medical Oncology Society and the Turkish Paediatric Oncology Society. Several training courses are organised annually by TROD in different Turkish towns. These courses range from basic radiation physics and radiobiology to hands-on training for advanced contouring, or they are specific to certain TURKISH SOCIETY FOR RADIATION ONCOLOGY situations such as sarcomas, head and neck, and secondary cancers. In 2015, 250-300 people are expected to participate in these courses. Every year TROD provides fellowships abroad lasting for three months to one year for three young members, and also supports the participation of its members in the ESTRO School courses by covering the expenses of 25-30 participants each year. Other activities of the Society include grants for research projects, awards for the three papers each year with the highest impact, and awards for the best presentations at the meetings. Since 2008, TROD has organised two-step board exams. The first step is a multiple choice text exam, where the questions are selected from an online question bank provided by university professors. Those who are successful in the written exam are required to participate in an Objective Structured Clinical Examination (OSCE) to test their clinical skills. The OSCE takes place in a clinical skills lab where the participants should complete 10 tasks, including target definition, contouring, DVH evaluation, patient communication etc. Currently 160 members are board certified. Re-certification exams are planned every 10 years. What is the situation with health professional mobility in Turkey and how would you comment on the national training/accreditation programme in your specialty with regard to professional INTRODUCTION mobility as a sending/receiving country? Radiation oncology is booming in Turkey. Until recently there were few public radiotherapy centres located in the country’s main towns. However, in the last decade we have witnessed a huge amount of investment in radiotherapy, both from public and private sectors. Currently there are around 120 radiotherapy centres in the country, which require a well-trained workforce at all levels; thus, the employment rate is very high within Turkey and, to the best of our knowledge, currently fewer than ten colleagues are working abroad. Almost all radiotherapy professionals studied and received their diplomas and certificates from Turkish institutions, while many colleagues visited centers in North America and Western Europe for fellowships of variable durations. Given its population and the above mentioned investment increase, Turkey has the largest radiotherapy infrastructure in its broader region, attracting cancer patients and students from abroad. Many colleagues from Turkic countries of the Caucasus and Central Asia, and neighboring Middle Eastern countries received full academic training in Turkish institutions, and many get additional training provided by IAEA fellowships and bilateral agreements. Is there a particular topic that you think the NS committee should target in the future? Although ESTRO represents the whole of Europe, there is much heterogeneity between regions and countries, including infrastructure and manpower, education and training, laws and legal issues and practices of radiotherapy. As a middle-income country Turkey has a number of problems in the development of a nationwide radiotherapy infrastructure that would be easily accessible by all cancer patients in the country. We think ESTRO did a very good job in establishing the National Societies Committee, which brings together the member societies and provides a common ground to share and discuss the issues and problems within countries, regions and the whole continent. We hope the National Societies Committee will continue working to document and define the strong and weak points of European radiotherapy, propose and execute solutions to enhance the radiotherapy capacity in Europe and help to close the gap between East and West, North and South. REFERENCE (1) (Rasih Emin: “Le Cancer et les rayons X à l’Hôpital Hamidie”, Hamidiye Etfal Hastahane-i Âlisinin İstatistik Mecmua-i Tıbbiyesi, 113-114, 1904) If your national societies would like to share views on topics of common interest, please contact the National Societies Committee via Chiara Gasparotto: [email protected] TURKISH SOCIETY FOR RADIATION ONCOLOGY CONFERENCES INTRODUCTION FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES CONFERENCES “Together we’ll show that quality of life can be maintained during and after treatment and we count on you to help us spread this positive message” It’s always a special time of year at ESTRO: spring seems to be on its way and buds are slowly emerging after a cold winter… However, in the ESTRO office the atmosphere is far from bucolic; we are on the starting blocks to make our annual congress the best European platform for radiation oncology. As this is the newsletter you will receive just before the congress, we have gathered here all the practical details you will need onsite. However, don’t panic if you don’t have your newsletter with you in Barcelona: we will launch an app shortly before the congress. It will provide you with information on all the sessions, floor plans, maps, access to social media, etc. You will find details in the following pages. AGOSTINO BARRASSO ESTRO Congress manager The ESTRO Forum is the place to share science and knowledge between disciplines. The chairs of the five meetings have reviewed all the abstracts and here they tell us about some of the science that will be presented. Besides top science, we have created some new events, which we recommend you don’t miss. These include the ESTRO Job Fair, where participants will have the opportunity to meet companies and institutes for job interviews, and the Super Run. ESTRO is encouraging all Forum participants and also patients, former patients and their families to join us for a five-kilometre run on the Barcelona beach. Together we’ll show that quality of life can be maintained during and after treatment and we count on you to help us spread this positive message. ERALDA AZIZAJ ESTRO Programme manager We look forward to meeting you in sunny Barcelona for an outstanding scientific meeting that can definitely compete with Barcelona’s sun. Despite the beautiful weather we can expect, we are confident that no sunscreen will be needed! Agostino Barrasso and Eralda Azizaj INTRODUCTION FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES CONFERENCES FOCUS ON NEXT CONGRESSES WORLD CONGRESS ON LARYNX CANCER 3RD ESTRO FORUM 24 - 28 April 2015 Barcelona, Spain 26 - 30 July 2015 Cairns, Queensland, Australia EUROPEAN CANCER CONGRESS 25 - 29 September 2015 Vienna, Austria INTRODUCTION FOCUS ON NEXT ESTRO CONGRESSES FOCUS ON PAST CONGRESSES CLINICAL 24 - 28 April 2015 Barcelona, Spain PHYSICS BRACHYTHERAPY RADIOBIOLOGY RTT INTRODUCTION FOCUS ON NEXT ESTRO CONGRESSES FOCUS ON PAST CONGRESSES 3RD ESTRO FORUM CONFERENCES INTRODUCTION MARK YOUR CALENDAR By Philip Poortmans, ESTRO President Clinical and translational meeting - Philip Poortmans > Physics Biennial meeting - Robin Garcia > GEC-ESTRO-ISIORT meeting - Jacob Lindegaard > RTT meeting - Martijn Kamphuis > PREVENT and TARGET meetings - Brad Wouters > Social activities > Young programme > Rendez-vous with colleagues > Education > Awards > Exhibition > Wifi > Luncheons and refreshments > YOUNG TRACK OF THE 3RD ESTRO FORUM NATIONAL SOCIETIES HALF-DAY MEETINGS Interview with Laura Mullaney and Kasper Rouschop, Chairs of the Young programme KEYNOTE LECTURE 3RD ESTRO FORUM IN FIGURES ESTRO JOB FAIR FREE 3RD ESTRO FORUM APP THE SUPER RUN INTERVIEWS WITH THE CHAIRS LOCAL ORGANISING COMMITTEE Interview with Ismael Sancho, Chair INTRODUCTION FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES Dear colleagues, INTRODUCTION Philip Poortmans ESTRO President The 3rd ESTRO Forum is now just around the corner and I’m very pleased to announce that we have received a lot of abstracts for the congress. And a big increase on the previous Forum: in 2013 we received 1,175 abstracts and this year it has risen to 1,637 abstracts. The Physics Biennial meeting got the record number of submitted abstracts (630), followed by the Clinical and translational meeting with 594. I would also like to underline that the number of abstracts submitted for the RTT meeting have almost doubled from 99 in 2013 to 197 in 2015. Although the Forum is a young event, the overall number of abstracts received is only eight percent below that of our numbered meetings like ESTRO 33. This growth definitely suggests a promising future for the ESTRO fora to come. Forum is growing thanks to the mosaic of different profiles, skills, knowledge and competencies of radiation oncology professionals. In an area where it’s always difficult to fit our professions into boxes labelled such as “radiation oncologist” or “RTT”, the success of the Forum relies on this diversity, which fosters an exchange of our experience and knowledge. This is why I recommend you warmly to join us in the interdisciplinary track, in addition to the sessions for your own discipline. I look forward to welcoming you in Barcelona to share knowledge and to develop networks for the benefit of our patients. With warm regards, Philip Poortmans ESTRO President On the following pages all the chairs of the various meetings unveil a bit more about the top science to be presented onsite and especially in their meetings: clinical and translational, the physics biennial meeting, GEC-ESTRO-ISIORT, RTT, PREVENT and TARGET meetings. PHILIP POORTMANS INTRODUCTION Finally, I would like to say that the ESTRO FOCUS ON NEXT ESTRO CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES CLINICAL AND TRANSLATIONAL MEETING Interview with Philip Poortmans, Chair Which topics attracted the largest number of abstracts and why do you think these subjects are so well represented? Among the 594 abstracts that were submitted to the clinical and interdisciplinary tracks, breast, gastrointestinal, genitourinary, head and neck and lung have definitely been the most popular topics. That could be explained simply by the fact that there is currently a lot of research going on in these radiation oncology topics, as well as from the interdisciplinary perspective. Moreover, these tumour sites are an important area in daily practice for all of us. Are there any dominant emerging trends that are expressed in these abstracts? PHILIP POORTMANS INTRODUCTION gramme consisting of teaching lectures, scientific symposia, oral presentations and debates. What about international collaboration at the ESTRO Forum? A lot of partners are participating in the programme. I want to underline the very visible presence of the International Atomic Energy Agency (IAEA) who submitted seven very good abstracts (see text box next page) that will be presented altogether in a dedicated proffered paper session; the Forum is also the platform for international joint activities with ASTRO, CARO, JASTRO… just to name a few who are part of the scientific programme again this year. The submitted abstracts reflect the complexity of our discipline, the tremendous continuous development in the field of research as well as inter- and multidisciplinary aspects of oncology as a whole. Many current efforts focus on the optimisation of treatment, building as much on technical developments specific to imaging and radiation therapy, as on optimising combined modality approaches and on quality of life. Our knowledge of tumour biology continues to evolve tremendously. All of these aspects, and several more, will be covered by the scientific pro- FOCUS ON NEXT ESTRO CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum RANDOMISED TRIALS Several randomised trials are part of the scientific programme and Professor Philip Poortmans highlights some of them: IAEA randomised trials number of common indications that are highly relevant for daily practice. In this session, we included two IAEA-supported studies on the availability and utilisation of radiation oncology as well. The IAEA submitted seven abstracts, to which we have dedicated a separate session. They focus on various topics: • Nimorazole with accelerated radiotherapy in head and neck squamous cell carcinomas (report of an incomplete trial); • Optimisation of treatment of locally advanced non-small cell lung cancer using radiotherapy and chemotherapy; • Irradiation of the supraclavicular nodal region in post-mastectomy radiotherapy; • Short-course radiotherapy for locally advanced rectal cancer; • Optimal single dose radiotherapy in the treatment of painful bone metastases. • Current radiotherapy capacity in post-Soviet countries; • Optimal radiotherapy utilisation rate in developing countries. These show that developing countries, with the help of the IAEA, can contribute significantly to increasing the level of evidence and they underline the contribution of radiation oncology for a The same trial shows interesting survival results (LDR Brachytherapy is Superior to 78 Gy of EBRT for Unfavourable Risk Prostate Cancer), as does the trial presented in the abstract “The INTRODUCTION role of induction chemotherapy with TPF and radio-chemotherapy for head and neck cancer: a meta-analysis”. Toxicity and survival Very interesting results on toxicity endpoints from one of the highlighted randomised trials will be presented: “GU and GI toxicity in ASCENDE-RT*: a multicentre randomised trial of dose-escalated radiation for prostate cancer”. This shows that the treatment can be more effective, with less toxicity, and that many toxicity events are only temporary. FOCUS ON NEXT ESTRO CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES PHYSICS BIENNIAL MEETING Interview with Robin Garcia, Chair Which topics attracted the largest number of abstracts? More than 600 abstracts, from all around the world, were submitted with the help of the ESTRO website. The authors had to select the domain closest to their work. The topic that attracted the largest number of abstracts concerned all the studies and developments in planning and dose calculation. After that, there were fairly equal numbers on: dose measurements, inter and intra fractions, clinical and quality assurance imaging and new technologies. Why do you think these subjects are so well represented? ROBIN GARCIA INTRODUCTION Planning and dose calculation are often placed at the centre of all our activities. Many issues need to be simulated, whether for the source of variation or to display dose effects. All radiotherapy improvements have their part in such simulations. Many imaging modalities contribute to improving the radiotherapy procedure and are included in this preparation phase. The use of light ions, previously limited to expert departments, can now be more accessible. The current, very sophisticated irradiation techniques, that need a lot of investigations before being used for treatments, are studied with the help of impressive software. FOCUS ON NEXT ESTRO CONGRESSES The continuity of treatment simulation is found in the numerous outcome evaluations that use all the planning data. This domain should continue to provide implementations and research activities, with the regular appearance of new options. Are there any dominant emerging trends that were expressed in these abstracts? The future of radiotherapy is already contained within current planning investigations. The domain of adaptive radiotherapy focuses on improvements coming from imaging, calculation and automatic processes. Before reaching the daily adaptation, many investigations are based on these new options, which help to manage 3D image and dose deformations. Other, more complex studies tend to apply the adaptive method to the most important variation sources due to breathing. These evolutions will obviously need clinical trials to prevent any decreased quality of outcomes. The powerful source of simulations will help the correlations with outcome evaluations. So the variety of the abstracts received reflect the diversity of topics covered by the programme? Planning and dose calculation benefit from FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum research and improvement in a large number of clinical activities and cover multimodalities, real time, automatic and robust processes, models, MC simulations, functional imaging and radiobiology. This multidisciplinarity is reflected in the meeting programme, which will satisfy all the professionals. Is there any other aspect of the Physics Biennial meeting that you would like to draw attention to? There are an increasing number of abstracts that relate to multi-centre studies. These concern dose measurements, modalities evaluations and the contributions to clinical trials. These audits may be based on two institutions, multiple national centres or European collaborations. The conclusions of these abstracts are often compelling and contribute to better knowledge worldwide. The managers of these audits should to be thanked for their important personal investment for the benefit of the community. INTRODUCTION FOCUS ON NEXT ESTRO CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES GEC-ESTRO-ISIORT MEETING Interview with Jacob Lindegaard, Chair Which topics attracted the largest number of abstracts? We received a lot of abstracts for gynaecology and prostate cancers. Why do you think these subjects are so well represented? First of all, these subjects are very well established indications for brachytherapy. However, for both subjects major new improvements have been made in the recent years with image-guided adaptive target and treatment planning concepts now being employed clinically. These data are now maturing and clearly show that the therapeutic index has been significantly improved with higher levels of tumour control and a significant decrease in radiation-induced morbidity. Are there any dominant emerging trends in these abstracts? Individualisation of radiotherapy coined to the morphology and biology of the patients at the time of brachytherapy. As brachytherapy delivers a very significant dose within a short overall treatment time with a very steep dose gradient (even steeper than for protons!) this is the ultimate in adaptive radiotherapy. JACOB LINDEGAARD INTRODUCTION FOCUS ON NEXT CONGRESSES Do the chosen abstracts advance new and interesting areas within radiotherapy, and if so, in which particular areas? In vivo dosimetry in brachytherapy is a fast emerging subject with a significant clinical potential for improving treatment delivery so that we can ensure that what we plan is also what the patient is getting. This new research area is becoming even more important as we strive to individualise brachytherapy for each patient since in vivo dosimetry has the capability to record in 4D (time and space) how our advanced adaptive brachytherapy treatment plans are delivered on line as the treatment is carried out in the patient. Are there any randomised trials? A major Canadian trial showing that low dose rate brachytherapy is superior to external beam radiotherapy in prostate cancer. This abstract has been selected as a highlight paper. Is there any other aspect of the GECESTRO-ISIORT meeting that you would like to draw attention to? It is very encouraging to see more and more departments taking up the new concepts of adaptive brachytherapy. This is reflected in abstracts on this subject coming from new departments FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum showing that the guidelines of the GEC-ESTRO work in the clinics around the world. Also, this emphasises our choice to have a pre-meeting workshop before the 3rd ESTRO Forum on adaptive brachytherapy strategies. INTRODUCTION FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES Did you receive a lot of abstracts? RTT MEETING Interview with Martijn Kamphuis, Chair First of all it’s worth mentioning that the total number of abstracts for the RTT track increased dramatically; 99 abstracts were submitted for the 2nd ESTRO Forum in 2013. For the 3rd ESTRO Forum we received 197 abstracts. This seems to show that research, as well as active participation in conferences, is increasing among radiation therapists. I really hope that this trend persists. In my opinion this will not only improve the knowledge of the individual, but also the quality of radiotherapy on a departmental or even higher level. I’m glad to say that this opinion is also shared by other disciplines within ESTRO. Which topics attracted the largest number of abstracts? Within the topic “image guided radiotherapy and adaptive radiotherapy” we received the largest number of abstracts (59). This was closely followed by “treatment planning” (57). The overall quality in these topics was very high. Why do you think these subjects are so well represented? MARTIJN KAMPHUIS INTRODUCTION have spent a lot of effort on these topics in recent years. Nowadays, image-guided adaptive radiation therapy is very often performed by the RTTs, which enables them to do research on this topic. The same goes for treatment planning. In many departments efforts are made to switch from conformal radiation therapy to intensity-modulated radiation therapy or directly to volumetric modulated arc radiotherapy or even intensity-modulated particle therapy. This is an interesting subject for research. Do the chosen abstracts provide new and interesting advances in radiotherapy, and if so, in which particular areas? One of the highest scoring abstracts was on the use of 3D printing for creating immobilisation devices. I guess we will see much more of that. It’s really nice to see that in this sub-area, in which there has not been a lot of development over the past few years, new techniques might improve this important part of radiotherapy. Both topics are still very much evolving. With regard to image guided and adaptive radiotherapy, people working in the medical and physics areas FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES PREVENT AND TARGET MEETINGS Interview with Brad Wouters, Chair Which topics attracted the largest number of abstracts? The Forum this year has two sub-meetings. In the PREVENT meeting the largest number of abstracts addressed genetic variation and its contribution to risk of normal tissue toxicity. In the TARGET meeting the largest number of abstracts were focused on novel agents used in combination with radiotherapy. Are there any dominant emerging trends in these abstracts? The selected abstracts highlight the progress in these emerging areas, and identify several new approaches to personalised therapy. Why do you think these subjects are so well represented? PREVENT There is still intense interest in the genetic determinants of risk and the use of such information for personalising therapy. It remains unclear how important this contribution will be, and the approaches for answering this question are important issues in the field. TARGET Our increased understanding of the biological changes in cancer continue to open new opportunities for development of targeted agents that could increase the efficacy of radiotherapy. BRAD WOUTERS INTRODUCTION FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES YOUNG TRACK OF THE 3RD ESTRO FORUM Interview with the two chairs of the Young programme: Laura Mullaney and Kasper Rouschop View the programme of the young track in the Young Corner on p116 > Why wouldn’t you miss the young track as a young ESTRO member? When designing the young ESTRO track for the 3rd ESTRO Forum, the scientific advisory committee focused on what we, as young members would like to gain most from the day. With this in mind, we decided to focus the track on the theme of “Career Development”. Distinguished speakers from all disciplines will join us on the day to discuss their experiences of building successful careers and developing meaningful collaborations. There will also be an opportunity to participate in an informal “Brown Bag” lunch seminar with experts from the different disciplines to discuss your own career. The track will include several moving poster sessions, facilitating informal discussion of pre-selected posters with their respective authors. An emerging theme in many aspects of research is health economics. To support this aspect of our research endeavours, we have a morning session dedicated to the integration of health economics into research. The track will close with a reception, providing an opportunity for discussion and networking with other young ESTRO members. LAURA MULLANEY INTRODUCTION The young track promises to be a beneficial day for all those aspiring to advance their career, so don’t miss out! What outcomes can the participants expect? Through attendance at this track, you can expect to: • Gain insights into the initiation of meaningful collaborations • Appreciate the importance of health economics and its implementation in research • Meet over lunch with experts in your discipline, to discuss your career and potential research opportunities • Learn from the shared experiences of successful individuals about how to progress your career • Participate in topic-specific moving poster sessions • Engage with the young ESTRO committee and exchange ideas on future activities. Who can attend? The young track is open to all delegates. It may be of particular interest to those of you interested in progressing your careers, initiating collaborations, developing research networks or considering a health economics component to your research. KASPER ROUSCHOP FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES 557 3RD FORUM IN FIGURES 557 E-POSTERS POSTERS 10,000 m 2 3,500 249 INVITED SPEAKERS DELEGATES 255 ORAL PRESENTATIONS INTRODUCTION 8 CONTOURING WORKSHOPS EXHIBITION 9 JOINT SESSIONS 73 POSTER DISCUSSIONS FOCUS ON NEXT CONGRESSES 5 PRE-MEETING COURSES 1,637 SUBMITTED ABSTRACTS > Clinical & Translational : 594 > Biennial Physics: 630 > GEC-ESTRO-ISIORT: 164 > RTT: 197 > PREVENT & TARGET: 52 FOCUS ON PAST CONGRESSES FREE ESTRO FORUM APP Maximise your time at the congress Download the free ESTRO Forum mobile and tablet app and take advantage of the full event schedule, as well as the personalised agenda, networking function and exhibition listings. Sessions You can check out the sessions you wish to attend, view their summary and add them to your personal agenda. Speakers You can view biographies, select congress speakers, send them messages and add them to your own personal agenda. My event This is your personal agenda, displaying your selected sessions, speakers, exhibitors and much more. Exhibition Thanks to the interactive floor plan, you can easily access the information on the booths and exhibitors you wish to visit and save them to your personal agenda. FREE DOWNLOAD STATION Networking You can create your own profile, which gives you the opportunity to interact with other attendees at the event via the messaging service. You can send messages privately and arrange meetings that will be scheduled in your personal agenda. Social media Stay up-to-date with the latest congress news by using Twitter (#ESTRO3F) and Facebook. Abstract book The abstract book will be directly downloadable from the app. Download the app from www.estro.org Come to the stand next to the registration area to download the app. However, we recommend you download it prior to the congress. FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES SOCIAL ACTIVITIES MARK YOUR CALENDAR Opening ceremony Friday 24 April | 18.00 – 19.15 hrs | Main auditorium All participants and company delegates are invited to the official opening ceremony. The opening ceremony will be followed by the welcome reception, which will take place in the exhibition area. Check out the latest available information on www.estro.org On the ESTRO website, you will be able to access one month prior to the congress: • the searchable programme • the programme book • the abstract book And, of course, follow us on Facebook and Twitter (#ESTRO3F) to be informed of the latest developments. INTRODUCTION Opening remarks Philip Poortmans (NL), President of ESTRO and Chair of the 3rd Forum Scientific Programme Committee Krzysztof Skladowski (PL), Chair of Host Society Committee Krzysztof Slosarek (PL), Chair of Host Society Committee Jose Lopez Torrecilla (ES), Chair of Local Organising Committee Ismael Sancho Kolster (ES), Chair of Local Organising Committee Keynote speaker Prof Dr Turgut Durduran (ES) Topic: The promise of diffuse optical methods for non-invasive diagnosis, therapy monitoring and prediction in oncology FOCUS ON NEXT CONGRESSES Entertainment Concert with the award-winning Catalan guitar player, Pedro Javier González. During his career, Pedro Javier González has collaborated with a number of different artists and performed at major festivals with musicians such as the “King of Blues”, B.B. King, who, according to legend, gave him the thumbs up on numerous occasions while watching him play. Definitely not to be missed…. Welcome reception Friday 24 April | 19.15 hrs | Exhibition area All registered participants and all company delegates are invited to the welcome reception which will take place in the exhibition area. Poster reception & poster awards Saturday 25 April | 18.00 hrs | Poster area All participants and company delegates are invited to the poster reception and poster awards. Canapés and drinks will be served while participants view more than 500 posters of the best posters. During the reception, three ESTRO awards of €1,000 each will be handed out to the best scored posters. FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum Social event Monday 27 April | 22.00 hrs The after-dinner party will take place at Teatre Principal. Patients Day Monday 27 April | 17.30-20.00 hrs | Room 122/123 Cancer patients have their own session dedicated to their needs with professionals answering their questions. The session will be held in Spanish. YOUNG PROGRAMME Monday 27 April | 08.00-18.00 hrs | Room 114 & poster area Lunch in the 'Meet the professor' area View the full programme in the Young Corner of this newsletter and read the interview of the chairs of the young programme. The young scientists reception will take place from 16.45 to 17.45 hrs. Visit to Synchrotron Alba Tuesday 28 April | 14.00 hrs Synchrotron Alba is a modern facility that was inaugurated in 2010 and located at Cerdanyola del Vallès, a town 15 kms from Barcelona city centre. It is a great opportunity to learn about the use of cutting-edge technology in Spain and to see how other radiation applications are implemented. Departure from the CCIB will be at 13.00. A lunchbox will be provided for all participants. Busses will return at approximately 17.00 to CCIB. A stop at the airport will also be foreseen. Participation fee: €35/person Register > INTRODUCTION RENDEZ-VOUS WITH COLLEAGUES GEC-ESTRO assembly Sunday 26 April | 13.30 - 14.30 hrs | Room 122/123 The GEC-ESTRO assembly is open to anyone with an interest in GEC-ESTRO activities. Physics members’ assembly Saturday 25 April | 13.30 - 14.30 hrs | Room 122/123 The annual Physics assembly is open to any physicist and will offer the opportunity to exchange ideas on current issues for the radiation physics community. ESTRO general assembly WRITE YOURSELF INTO THE STORY #ESTRO3F By connecting to ESTRO’s social media channels on Twitter and Facebook, you can: • Find the latest updates from the Forum and reminders on the events not to be missed onsite • Interact with attendees you meet face to face • Join discussions • Share pictures FOCUS ON NEXT CONGRESSES Monday 27 April | 18.00 hrs | Room 118/119 An agenda will be sent to full members, however all the ESTRO members are welcomed to participate as long as they have renewed their membership by 22 April. FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum EDUCATION Five pre-meeting courses Friday 24 April Interdisciplinary pre-meeting course 08.30 - 17.00 hrs | Room 116 Joint ESTRO-EIBIR-EANM Incorporating imaging in radiation oncology treatment delivery Course directors: V. Valentini (IT) - ESTRO, G. Krestin (NL) - EIBIR, V. Lewington (GB) EANM Clinical pre-meeting course 08.30 - 17.00 hrs | Room 115 Data management Course directors: G. Jones (CA) and A. Dekker (NL) Physics pre-meeting course 08.30 - 17.00 hrs | Room 111 4D radiotherapy – from 4D-imaging to 4D dose delivery and verification Course directors: P. Poulsen (DK) and U. Oelfke (GB) RTT pre-meeting course 08.30-17.00 hrs | Room 118/119 Implementation of SBRT: a review of current practice Course directors: P. Scherer (AT) and F. Moura (PT) INTRODUCTION GEC-ESTRO workshop 08.30 - 17.00 hrs | Room 114 Adaptive brachytherapy strategies Course director: J.C. Lindegaard (DK) Eight contouring sessions OAR - upper abdomen Friday 24 April | 16.00 – 18.00 hrs Repeated on Tuesday 28 April | 08.30 – 10.30 hrs Chair: A. Morganti (IT)) Panellists: T. Brunner (UK) and A. Mendez Romero (NL) Administrator: D. Pasini (IT) Room 131/132 Oesophagus Friday 24 April | 08.00 - 10.00 hrs Repeated on Saturday 25 April | 08.00 - 10.00 hrs Chair: O. Matzinger (CH) Panellists: M. Hulshof (NL) and B. de Bari (IT) Administrator: B. de Bari (IT) Joint ESTRO – ILROG on Lymphoma Friday 24 April | 10.30 - 12.30 hrs Repeated on Sunday 26 April | 08.00 - 10.00 hrs Chair: L. Specht (DK) Panellists: S. Terezakis (US) and A.K. Berthelsen (DK) Administrator: B. de Bari (IT) Prostate cancer in the post-prostatectomy setting Friday 24 April | 13.30 - 15.30 hrs Repeated on Monday 27 April | 08.00 – 10.00 hrs Chairs: P. Ost (BE) Panellists: C. Salembier (BE) and A. Henry (UK) Administrator: D. Pasini (IT) FOCUS ON NEXT CONGRESSES Educational aims of the workshops • Provide attendees with the opportunity for interactive training on contouring CTV, GTV and, when relevant, OAR and to discuss their results with international experts in the field, • Provide the participants with knowledge on how contouring is performed in different institutions and on the existing recommendations and guidelines, • Provide the participants with consistent information to validate or modify/improve their daily contouring practice. Methodology for the workshops • Clinical case presentation, • Delineation tool presentation, • Delineation with maximum two participants per computer, • Presentation of the contouring guidelines recommended by the experts for the delineation of the CTV, GTV +/- OAR + bibliographic refer- FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum ences for the therapeutic strategy chosen, • Inter-comparison of the contours by the participants and by the experts, • Justification and comments. Participants are required to bring their own computer for contouring. More information on the contouring sessions > FALCON demos ESTRO booth (#2000) The eight contouring sessions will use FALCON*, the multifunctional ESTRO platform for contouring and delineation. Free short demos of 15 minutes take place everyday at lunch time and coffee breaks on the ESTRO booth (#2000): • 10.10 – 10.25 hrs • 13.30 – 13.45 hrs • 14.15 – 14.30 hrs • 16.25 – 16.40 hrs *Fellowship in Anatomic delineation and CONtouring Multidisciplinary tumour board sessions Multidisciplinary tumour board (MTB) Upper GI Saturday 25 April | 10.30-11.30 hrs Case 1: Oesophageal AEG Case 2: Mid-oesophageal squamous cell INTRODUCTION Chair: C. Rödel (DE) Panellists: 1. ESTRO fellow – F. Cellini (IT) 2. Surgeon – C. Balagué (ES) 3. Medical oncologist – D. Páez (ES) 4. Imaging – R. Mast (ES) Multidisciplinary tumour board (MTB) Prostate Sunday 26 April | 10.30-11.30 hrs Case 1: Locally advanced resectable RT or surgery Case 2: Limited pN+ Chair: M. Hoyer (DK) Panellists: 1. ESTRO fellow – M. Pinkawa (DE) 2. Urologist - M. José Ribal (ES) 3. Pathologist – F. Algaba (ES) Multidisciplinary tumour board (MTB) - Lung Monday 27 April | 10.30-11.30 hrs Case 1: Early stage operable Case 2: Early stage medically inoperable Chair: E. Lartigau (FR) Panellists: 1. Young ESTRO member – J.-E. Bibault (FR) 2. Surgeon - R. Rami Porta (ES) 3. Radiologist - A. Hidalgo (ES) FOCUS ON NEXT CONGRESSES AWARDS Lifetime Achievement Award Friday 24 April 2015 | 20.00 hrs Harry Bartelink (NL) Tommy Knöös (SE) John Yarnold (GB) ESTRO Award Lectures Emmanuel van der Schueren Award Saturday 25 April | 11.40 - 12.20 hrs | Main auditorium Access to evidence-based radiotherapy in Europe 2020 – are we on the right track? Cai Grau (DK) Donal Hollywood Award Monday 27 April | 11.40 - 11.50 hrs Rescanning measurements in a 4D anthropomorphic phantom for evaluation of motion-mitigated, PBS proton therapy Rosalin Perrin (CH) GEC-ESTRO Iridium 192 Award Saturday 25 April | 12.20 - 13.00 hrs Peter Levendag (NL) FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum Klaas Breur Award Monday 27 April | 12.20 - 13.00 hrs Radiation oncology and technological innovation: a fish desperately looking for a bicycle? Dirk Verellen (BE) Honorary Physicist Award Sunday 26 April | 12.10 - 12.30 hrs | Main auditorium Vincent Grégoire (BE) University Award ESTRO-Jack Fowler University of Wisconsin Award Sunday 26 April | 12.30-12.40 hrs | Main auditorium Time dependent verification techniques and doserate evaluation of external beam treatments Mark Podesta (NL) Company Awards ESTRO-Accuray Award Sunday 26 April | 12.40-13.00 hrs | Main auditorium Considerable intra-breath-hold motion and inter-breath-hold position variation of pancreatic INTRODUCTION tumours Eelco Lens (NL) ESTRO-Varian Award Sunday 26 April | 12.40-13.00 hrs | Main auditorium Quantification of coronary artery motion: Analysis from ECG gated radiotherapy planning scan Shyam Bisht (IN) ESTRO- Elekta Brachytherapy Award Saturday 25 April | 16.45-18.00 hrs | Main auditorium Clinical implementation of in vivo source position verification in high dose rate prostate brachytherapy Ryan Smith (AU) GEC-ESTRO Best Junior Presentation - sponsored by Elekta Brachytherapy Sunday 26 April | 10.30-11.30 hrs | Main auditorium Brachytherapy improves survival for inoperable stage I endometrial adenocarcinoma: a population-based analysis Sahaja Acharya (USA) FOCUS ON NEXT CONGRESSES EXHIBITION An exhibition featuring equipment and medical publishers will be held in the exhibition area. The opening of the exhibition will be on Friday 24 April 2015 at 19.15 hrs. The exhibition will remain open from Friday 24 April to Monday 27 April between 9.30 and 17.00 hrs. Entrance is free for all registered participants. Visit the ESTRO booth #2000! WIFI Wireless internet will be available in designated areas at the congress centre. LUNCHEONS AND REFRESHMENTS The registration fee for the conference includes coffee breaks to all participants wearing their conference badges. Lunch will be available for purchase in the exhibition area and is not included in the registration fee. FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES NATIONAL SOCIETIES HALF-DAY MEETINGS National Day Joint Meeting ALATRO, SEOR, SPRO - 24 April Session will be conducted in Spanish/ Portuguese. SYMPOSIUM Breast Cancer and Proffered Papers from Young Radiation Oncologists 13.00-13.15 hrs Welcome Address by the President of ESTRO Symposium Breast Cancer Chairs: Dr Marcela de la Torre and Dr José López Torrecilla 13.30-13.55 hrs Is the "boost" necessary in breast carcinoma in situ? Speaker: Dr Lourdes Trigo (SPRO) 13.55-14.20 hrs Partial irradiation, can we consider it like usual treatment in some cases? What technique? Speaker: Dr Silvia Zunino (ALATRO) 14.20- 14.45hrs Nodal irradiation after the Z0011. What we do? Speaker: Dr Manuel Algara (SEOR) 14.45-15.15 hrs Discussion 15.15-15.45 hrs Break Proffered Papers from Young Radiation Oncologists on breast, prostate, lung cancer Chairs: Dr Alfredo Ramos and Dr Jose Luis López Guerra 15.45-17.15 hrs 1. Low-kilovoltage single dose intraoperative radiation therapy for breast cancer Presenter: C. Flores-Balcazar (MX) 2. Early toxicity outcomes: A single 15Gy fraction HDR INTRODUCTION 17.15-17.30 FOCUS ON NEXT CONGRESSES brachytherapy as pre-treatment EBRT boost in prostate cancer Presenter: R. Chicas Sett (ES) 3. APBI single-centre experience over a decade – risk estimates and indication variations within current guidelines Presenter: A. Aguiar (PT) 4. Role of 3T multiparametric MRI in the detection of local recurrent prostate cancer after radical prostatectomy Presenter: C. Felipe (ES) 5. Dosimetric impact to organs at risk when the internal mammary node chain is included in irradiation of left breast Presenter: G. Gómez de Segura Melcón (ES) 6. Evaluation of image guided radiotherapy (IGRT) in lung cancer. Is weekly cone beam CT (CBCT) enough? Presenter: J. Luna Tirado (ES) 7. Training for RTTs in image verification in breast cancer: from portal imaging to IGRT Presenter: E. Rivin (FR) 8. Stereotactic body radiation therapy for localized prostate cancer: institutional experience Presenter: G. Heinrich (AR) Conclusions and close session: Organisers of the National day, Presidents of SEOR, ALATRO and SPRO FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum National Day Polish Society of Radiation Oncology - 24 April Session will be conducted in Polish. 08.30-08.45hrs Opening: Biology of high radiation doses Speaker: Krzysztof Składowski Session I (Physics): Stereotactic Radiation Treatment Planning Chairs: Krzysztof Ślosarek and Marzena Janiszewska 08.45-09.00 hrs Review of delivery systems and techniques of SRT in Poland Speaker: Krzysztof Ślosarek 09.00-09.15 hrs Linac SBRT planning of lung tumours Speaker: Marzena Janiszewska 09.15-09.30hrs Specific aspects of Tomotherapy and CyberKnife planning Speaker: Tomasz Piotrowski 09.30-09.45hrs GammaKnife SRT planning Speaker: Aneta Iwanicka 09.45-09.55hrs Best physics original paper: Ga-68 DOTATATE PET/CT imaging for robotic radiotherapy in patients with meningiomas Presenter: Małgorzata Fudzińska 09.55-10.10 hrs Coffee Break 10.40-10.55 hrs SBRT of liver neoplasms Speaker: Rafał Suwiński 10.55-11.10 hrs CyberKnife for prostate cancer patients – preliminary results of 200 patients irradiation Speaker: Leszek Miszczyk 11.10-11.20 hrs Best clinical original paper: Can SRT preserve TCP of HNC patient when standard therapy is not compliant? Presenter: Łukasz Michalecki 11.20-12.20 hrs Panel discussion: Will SRT be a standard method of malignant tumours? Speakers and chairs 12.20-12.25 hrs Symposium Conclusions Krzysztof Składowski Session II (Clinical): Clinical Advances of SBRT Chairs: Rafał Dziadziuszko and Bogusław Maciejewski 10.10-10.25 hrs Oligometastatic tumours Speaker: Krzysztof Konopa 10.25-10.40hrs Oligo- and hypofractionated SRT of lung cancer Speaker: Rafał Dziadziuszko INTRODUCTION FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES KEYNOTE LECTURE The promise of diffuse optical methods for non-invasive diagnosis, therapy monitoring and prediction in oncology Turgut Durduran ICFO - The Institute of Photonic Sciences, Spain Diffuse optical methods using near-infrared light are promising methods for diagnosis, therapy monitoring and prediction in oncology. They utilise near-infrared light in ~600-1000nm range which allows effective penetration into tissues up to several centimetres deep. By utilising multiple wavelengths, they can estimate the concentration of oxy- and deoxy-haemoglobins, blood volume, blood oxygen saturation, water and lipid content and tissues scattering. Furthermore, the use of coherent light allows these methods to estimate microvascular blood flow. Professor Turgut Durduran will describe the basis of these technologies, instrumentation and state-of-the-art results. Professor Turgut Durduran trained at University of Pennsylvania (USA). In 2009 he moved to ICFO - The Institute of Photonic Sciences (SPAIN) where he leads the "Medical Optics group". His research interests revolve around the use of diffuse light to non-invasively probe tissue function. The group develops new technologies and algorithms and translates them routinely to pre-clinical and clinical applications, as well as for industries. TURGUT DURDURAN INTRODUCTION FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES WHAT? ESTRO JOB FAIR Two days where participants at the 3rd ESTRO Forum will have the opportunity to meet the industry and institutes for job interviews in a separate area within the congress centre. pants will have free access to the Job Fair. • Employers: exhibiting companies at the 3rd ESTRO Forum and all the 2015 ESTRO institutional members (institutes). HOW? WHERE? Interviews will be held in the Job Fair area, located in the registration hall. Each participating company will have a specific booth designed to welcome participants and job seekers from the radiation oncology field. In addition, all employers with a booth in the Job Fair will have the opportunity to rent a meeting room in the congress centre for half a day or more, in order to conduct on-the-spot interviews in a more confidential environment. • Candidates: entrance to the Job Fair is free to all the 3rd ESTRO Forum participants. No pre-registration is needed. • Employers will need to book a specific Job Fair booth: • Interested companies should contact Valérie Cremades, [email protected] • Interested institutes should contact Myriam Lybeer, [email protected] WHEN? ESTRO JOB FAIR Saturday 25 April 2015 from 13.00-18.00 hrs Sunday 26 April 2015 from 8.00-14.45 hrs WHO? 2015 INTRODUCTION Participating in the Job Fair are: • Candidates: all the 3rd ESTRO Forum partici- FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES ESTRO JOB FAIR Meet with David Egan, his recruiting team and hiring managers from Varian Medical Systems, USA and EMEIA You have booked a booth at the Job Fair. What is your motivation? Was it an initiative that you had been expecting for a long time? Varian sees ESTRO as an opportunity to meet the best and brightest people in radiation oncology. This Job Fair affords ESTRO attendees the opportunity to understand more about Varian as an employer and the career opportunities we have to offer. What is the added value of the Job Fair compared to the more traditional recruitment channels? ny, whose mission, culture, values and business goals align with yours. What is for you the ideal candidate? Experienced, innovative professionals, who have passion for their work, serving others and saving lives. Is the sector of radiation oncology actively recruiting? Yes, very much so. Varian utilises many channels to meet potential candidates. The ability to meet face-to-face in this type of casual setting is an opportunity we value. What are the profiles that will draw your attention onsite? Radiation therapists, medical physicists, engineers with medical device backgrounds, research and development. What advice would you give to a young ESTRO member looking for a position in the radiation oncology sector? DAVID EGAN INTRODUCTION Find a career opportunity with the right compa- FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES THE SUPER RUN Patients and doctors against cancer Sunday 26 April, Barcelona The Super Run is a five-kilometres run organised by ESTRO and taking place in the scenic surroundings of the Barcelona beach. The Society is inviting the 3,000 Forum participating scientists, carers and doctors to join patients in the run against cancer. The participation fee of €10 will go directly to the ESTRO Cancer Foundation. The ultimate goal of the Super Run is to make people aware that it is possible to enjoy a healthy life during and after radiotherapy treatment; staying physically active has become a reality for the majority of cancer patients undergoing radiotherapy. So join us in Barcelona on the Super Run! How will the funds raised be used? • The ESTRO Cancer Foundation The not-for-profit ESTRO Cancer Foundation (ECF) was launched in 2012 and aims to foster research and to improve the perception of radiation oncology among target audiences such as patients and decision-makers. • HERO, Health Economics in Radiation Oncology HERO is a project supported by the ECF. It was INTRODUCTION FOCUS ON NEXT CONGRESSES launched in 2010 to assess the availability of radiotherapy resources within Europe. Through the collection and analysis of relevant data, the HERO project will be used to advocate for radiotherapy to European governments and other healthcare stakeholders, whose decisions ultimately affect the care of patients. • Patients at the heart of the 2020 ESTRO vision In 2012 ESTRO’s new vision was established, looking at the 2020 horizon. Resolutely centred on high quality patient care, the mission statement reads: Every cancer patient in Europe will have access to state of the art radiation therapy as part of a multidisciplinary approach where treatment is individualised for the specific patient’s cancer, taking account of the patient’s personal circumstances. Subsequently, ESTRO determined several key priorities and the HERO project is one of them. Sunday 26 April - 19.00 CEM Marbella. Av. del Litoral, 86 08005 Barcelona FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum CONFERENCES LOCAL ORGANISING COMMITTEE Interview with Ismael Sancho, Chair of the local organising committee What have been the main tasks for the members of the local organising committee (LOC)? The LOC has eight members from different parts of Spain. So far we have concentrated our efforts on organising some of the social events such as the opening ceremony, and we have organised a programme of grants towards registration fees for young local people through collaboration with Spanish companies. Work is ongoing and will come to fruition at the congress. We are also involved in some press activities and promotion of the congress. For most of the LOC members, this is the first time that we have participated in a committee for such a big event, and we are finding it a challenging but great experience. A visit to Synchrotron Alba is being organised for participants. Why will this be interesting for radiation oncology professionals? ISMAEL SANCHO INTRODUCTION Synchrotron Alba is a modern facility that was inaugurated in 2010 after four years of construction. With a diameter of 140 metres and the shape of a snail shell, it is located at Cerdanyola del Vallés, a town 15 kms from Barcelona city centre. Nowadays, it has seven different beamlines; each of them is used to carry out experi- FOCUS ON NEXT CONGRESSES ments, mainly in the fields of biology, nanoscience and materials. Although not directly related to radiation oncology, it is a great opportunity to learn about the use of this cutting-edge technology in Spain and to see how other radiation applications are implemented. What can we expect at the opening ceremony? Although I do not want to reveal too much about the opening ceremony, I can say that a prestigious researcher is going to talk about different applications of light in science and oncology in particular. This will be a novel and different point of view to what we are used to seeing in our day-today work. After this talk, we will see a very fine and intimate music show, with a touch of both Spanish and more local culture. The combination of the talk and show will be a perfect introduction to the congress and a nice way to prepare participants for the busy programme of the following days. Can you tell us more about the social event on Monday 27 April? The social event will take place at the Teatre Principal. This old theatre was built in 1600 and was the city’s main theatre for many years. Opera, FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES 3rd ESTRO Forum comedy but also circus, magic and costume balls were, performed during this time. However, 250 years later it began to decline as most companies moved to the more popular, stunning and recently inaugurated Teatre del Liceu, also on Las Ramblas and very close to the Teatre Principal. Moreover, several fires destroyed its interior completely and although it was renovated, only the beautiful, slightly curved façade still remains from the old building. With this amazing history, it will be a fantastic place to relax, have fun and meet other participants. rest of the towers and the third façade (the Glory) are being constructed very fast and changes are clearly visible from one month to the next. It is better to buy tickets online in advance to avoid long queues. But there are so many other places to enjoy while visiting Barcelona. The best way to discover them is walking and getting lost in the city centre (ending, for example, with a refreshing drink at one of the nice terraces along the beach). Despite a busy meeting programme, what should not to be missed by participants while visiting Barcelona? Barcelona has a lot to offer to visitors and many participants may have been to the city before. However, every visit is different and a vibrant city like Barcelona changes from year to year. I recently visited the Sagrada Familia and was surprised by the frenetic construction rate. As Gaudí wanted, construction of the cathedral is a dynamic work and each generation makes a contribution in its own style. For example, some months ago, the green and leafy doors of the Nativity façade were installed – a nice work by the Japanese sculptor, Etsuro Sotoo. Moreover, the INTRODUCTION FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES ESTRO 29 April - 3 May 2016 Turin, Italy INTRODUCTION FOCUS ON NEXT ESTRO CONGRESSES FOCUS ON PAST CONGRESSES INTRODUCTION FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES European Cancer Congress CONFERENCES 18th ECCO - 40th ESMO EUROPEAN CANCER CONGRESS Reinforcing Multidisciplinarity 25 - 29 September 2015 Vienna, Austria In collaboration with ESTRO 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 • 7 April 2015: Early rate registration deadline • 28 April 2015: Abstract submission 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 ECC2015 ADVANCED PROGRAMME NOW AVAILABLE The ECC2015 Advanced Programme provides a clear pathway and a definitive supplement for all attendees to discover all the information concerning the Congress. It is a detailed programme showing all the special, integrated and teaching sessions as well as Oxford-styles debates and much more. More information: www.europeancancercongress.org > Registration: www.europeancancercongress.org/ Registration > INTRODUCTION Read/download to discover at a glance all the tracks, chairs and experts that will be part of the event as well as useful practicalities: www.ecco-org.eu/sitecore/RedirectUrlPage.aspx?ec_camp=7D9BC2EDC0084CC2A0DB50B05663823B&ec_as=C4910921A3F74869A72F38A9BD93CA17&ec_url=%2f~%2fmedia%2fDocuments%2fVienna+2015%2fECC2015+Advance+Programme.pdf > ESTRO members will benefit from a discount on the registration fee. FOCUS ON NEXT ESTRO CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES European Cancer Congress ESTRO AWARDS ESTRO - VARIAN AWARD A prize of €2,500 will be given to a radiation oncology professional for research in the field of radiobiology, radiation physics, clinical radiotherapy or radiation technology. Criteria for Eligibility 1. Candidates should be ESTRO members, having completed the submitted work in the previous year. 2. Submissions should be brought forward by the candidates or their department heads and may be work done as an individual piece of research or as a thesis complete in the field of biological, physical and clinical research. 3. Candidates should be younger than 36. Exceptions will be made for female applicants who had to interrupt their research for pregnancy/maternity reasons; for them the maximum age is fixed at 40. 4. Candidates should submit: • A curriculum vitae and a list of publications • A copy of the abstract on the project which should have been submitted for the European Cancer Congress (indicate abstract title and submitting author with your application) • An English summary of their work (max two pages). Applications for the above listed awards are to be addressed to: Eralda Azizaj, ESTRO Programme Manager Rue Martin V 40, 1200 Brussels, Belgium INTRODUCTION ESTRO - ACCURAY AWARD A prize of €2,500 will be given to a radiation oncology professional for research in the field of “High Precision Radiotherapy”. Awardees may be qualified in the field of clinical radiotherapy, radiation physics, radiation technology or radiobiology. Criteria for Eligibility 1. Candidates should be ESTRO Members, having completed the submitted work in the previous or current year. 2. Submissions should be brought forward by the candidates and may be work done as an individual piece of research or as a thesis completed in the field of biological, physical or clinical research. 3. Candidates should be younger than 36. Exceptions will be made for female applicants who had to interrupt their research for pregnancy/maternity reasons; for them the maximum age is fixed at 40. 4. Candidates should submit: • A curriculum vitae and a list of publications, • A copy of the abstract on the project which should have been submitted for the European Cancer Congress (indicate abstract title and submitting author with your application) • An English summary of their work (max two pages). Tel: +32 2 775 93 40 E-mail: [email protected] Deadline for submission: 1 April 2015 FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON NEXT CONGRESSES European Cancer Congress CONFERENCES WORLD CONGRESS ON LARYNX CANCER 26-30 July 2015 Cairns, Queensland, Australia In collaboration with ESTRO Hosted by the Australian and New Zealand Head & Neck Cancer Society, the World Congress on Larynx Cancer 2015 will include over 100 local and international faculties involved in the care of patients with larynx cancer, not only at presentation, but also in the years afterwards. The congress will be held from Sunday 26 to Thursday 30 July 2015 at the Cairns Convention Centre. An impressive four-day multidisciplinary programme has been developed. In excess of 500 local and international delegates, including surgeons, radiation oncologists, medical oncologists, speech pathologists, nurses, dieticians and other health professionals, are expected to attend. Early registration fees apply until Sunday 14 June 2015. Register online at www.wclc2015.org For any enquiries, please contact the congress organisers, telephone +61 3 9249 1260 or email: [email protected] Associate Professor Robert Smee FRANZCR Convener, World Congress on Larynx Cancer 2015 The Cairns Convention Centre was recently awarded the World’s Best Congress Centre 2014 / AIPC Apex Award. Several domestic and international airlines fly direct to Cairns, making the venue very accessible for delegates. More information and registration: www.wclc2015.org > INTRODUCTION The provisional programme can be viewed on the congress website: www.wclc2015.org. Free paper sessions have also been incorporated into the programme. Health professionals are encouraged to submit an abstract for the free paper sessions, which can be completed via the congress website. FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES CONFERENCES FOCUS ON PAST CONGRESSES HADRONS IN THERAPY AND SPACE III Course of the International School of Heavy Ions, Ettore Majorana Foundation 1 - 4 October 2014 Erice, Italy INTRODUCTION FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES FOCUS ON PAST CONGRESSES Hadrons in therapy and space CONFERENCES HADRONS IN THERAPY AND SPACE III Course of the International School of Heavy Ions, Ettore Majorana Foundation 1 - 4 October 2014 Erice, Italy School directors: Roberto Battiston (Italian Space Agency, Italy) and Marco Durante (GSI Helmholtzzentrum für Schwerionenforschung, Director of the Biophysics Department, Darmstadt, Germany) MARCO DURANTE INTRODUCTION Introduction The human mission to Mars is a major enterprise for mankind in the 21st century. Space agencies consider Mars the ultimate goal of exploration, and the recent Inspiration Mars project propose a flyby in 2018. The Mars Science Laboratory (MSL) [1-2], carrying the Curiosity Rover (Fig. 1), and the Alpha Magnetic Spectrometer (AMS)  are now in space and provide careful measurements of the radiation field on the route to Mars and on the planet, supporting previous simulations pointing to radiation as a major showstopper for the mission. However, health risks related to exposure to energetic protons are affected by large uncertainties, due to the unique radia- FOCUS ON NEXT CONGRESSES tion field experienced in space compared to the background radiation on earth . Nevertheless, medicine has experience on the effects of charged particles in humans, gathered by treating over 100,000 patients worldwide with high-energy protons and heavy ions . The success of this therapy has been made possible by the past, present and future contribution of physicists: accelerators, detectors, beam delivery, treatment-planning software are typical examples. The course was a unique attempt to bring together the top world experts in particle therapy and space travel to discuss the problems related to the exposure of humans to high-energy protons FOCUS ON PAST CONGRESSES FOCUS ON PAST CONGRESSES Hadrons in therapy and space co-sponsored by GSI (Germany), INFN (Italy), IARR, ENLIGHT, ESA, ASI (Italy), Verein zur Förderung der Tumortherapie mit schweren Ionen e.V. (Darmstadt), and the Universities of Darmstadt (Germany) and Trento (Italy). All lectures were held in the ancient San Domenico Monastery (Fig.2), now the Patrick M.S. Blackett Institute with the "Paul A.M. Dirac" Lecture Hall. More information on the school is available at: events.unitn.it/en/ishi2014 Particle therapy session Figure 1. This image was acquired on November 2, 2014, by the Mast Camera (Mastcam) on NASA's Curiosity Mars rover, at a target called "Whale Rock" in the basal geological unit of Mount Sharp on Mars. Cross-bedding seen in the layers of this Martian rock is evidence of movement of water recorded by waves or ripples of loose sediment the water passed over. Curiosity landed on Mars on 6 August 2012, following a 253-day, 560-million-kilometre space trip. The Curiosity rover, with the Radiation Assessment Detector (RAD) mounted to its top deck, was inside the MSL spacecraft. RAD measured the space radiation doses during the cruise in deep space  and on the Mars surface . Image Credit: NASA/JPL-Caltech/MSSS. and heavy ions. The current status of particle therapy for cancer worldwide was described with emphasis on side-effects, including second cancers. Recent data from space missions were presented, along with simulations of the radiation INTRODUCTION risk for the Mars mission and possible countermeasures for risk mitigation. The school was attended by 40 students and 18 speakers. It was endorsed by ESTRO and FOCUS ON NEXT CONGRESSES The meeting was opened by Marco Durante (GSI, Germany), who discussed the many common research issues relevant for both particle therapy in oncology and radiation protection in space. Late risk of cancers, biomarkers of sensitivity, normal tissue damage, radiogenomics, mixed radiation fields, shielding, radioprotectors are only some of the topics shared by the two communities. The main issues of this school are dose limits for the Mars mission, gathering on the experience on late morbidity and second cancers in particle therapy (Fig. 3). The session on therapy was chaired by Karin Haustermans, as ESTRO representative, and it had both medical and physics lectures. Hak FOCUS ON PAST CONGRESSES FOCUS ON PAST CONGRESSES Hadrons in therapy and space Choy (UT Southwestern, USA) (Fig. 4), Jürgen Debus (HIT, Germany) and Jay Loeffler (MGH, USA) gave an overview of the clinical results in cancer therapy using protons and heavier ions. Medical physics and facilities were discussed by Marco Schwarz (APSS, Italy), Reinhard Schulte (LLUMC, USA), Piero Giubilato (INFN-LNL, Italy), and Manjit Dosanjh (CERN, Switzerland). Nancy Tarbell (MGH, USA) presented the risk of second cancers in paediatric patients treated with protons versus X-rays based on the experience at MassGeneral Hospital in Boston, MA, USA (Fig. 5). The epidemiological studies [5-6] show that the risk is lower for protons compared to photons, as expected  due to the lower integral dose in proton therapy, and give no evidence of a high RBE for carcinogenesis induced by protons. Figure 3. Opening session with the main questions for this workshop presented by Marco Durante. Space radiation protection session Figure 2. San Domenico Monastery in Erice, now the Patrick M.S. Blackett Institute with the "Paul A.M. Dirac" Lecture Hall. INTRODUCTION The information on secondary tumours in paediatric patients is very relevant for space radiation protection, where cancer is the main late risk related to exposure to protons and heavier ions. Günther Reitz (DLR, Germany) presented (Fig. 6) the first measurements of the radiation dose during the cruise to Mars  and on the surface of the planet  by the RAD instrument on MSL (Fig. 1). The dose during the cruise is FOCUS ON NEXT CONGRESSES Figure 4. Karin Haustermans and Hak Choy. FOCUS ON PAST CONGRESSES FOCUS ON PAST CONGRESSES Hadrons in therapy and space Figure 5. Nancy Tarbell presented the risk of second cancers in paediatric patients treated with protons versus X-rays based on the experience at MassGeneral Hospital in Boston, MA, USA. 1.8 mSv/day, and 0.4 mSv/day on Mars. This should be compared with 1-3 mSv/year on Earth. A long-term mission to Mars will expose the astronauts to an excess cancer risk higher than three percent, and Frank Cucinotta (NASA, USA) presented the current model for risk estimation. The flight surgeon, Ulrich Straube (ESA, Germany), discussed the eradiation risk in the more general framework of space medicine. The problems related to radiation hardness of the electronic components were discussed by Eamonn Daly (ESA, The Netherlands), while Chiara La Tessa (BNL, USA) and Lembit Sihver (Chalmers University, Sweden) presented nuclear physics measurements and codes with applications to both therapy and space. Space radiation protections by passive and active shielding were summarised by Martina Giraudo (TAS, Italy), William Burger (TIFPA-INFN, Italy), and Piero Spillantini (University of Florence, Italy). Conclusions Figure 6. Günther Reitz’s first slide on MSL. INTRODUCTION In the last session, chaired by the ASI President Roberto Battiston, the lecturers and students had a lively discussion on the topic. In general, it was re-affirmed that dose limits for interplanetary missions are required, but that they should be based on risk rather than on dose, or perhaps FOCUS ON NEXT CONGRESSES on life loss in months. This effort would require more research on the biological effects of charged particles, research that can be at least in part performed at the clinical centres where charged particles are used for cancer treatment. Given the importance of the topic and the success of the school it was decided to open a research topic in “Frontiers in oncology” on “charged particles in oncology”. In this research topic we will aim to gather the experiences and opinions of scientists dealing with high-energy charged particles either for cancer treatment or for space radiation protection. Clinical results with protons and heavy ions, as well as ongoing and planned clinical trials will be described. In addition, ground-based and spaceflight studies on the effects of space radiation will be reported. Particularly relevant for space studies are the clinical results on normal tissue complications and second cancers. Physics, biology, and medical contributions in this field are welcome. Physics manuscripts should focus on contributions of nuclear and medical physics to particle therapy, and measurements or calculations of the dose to normal tissues. They should also include mitigation strategies for spaceflight, such as passive and active shielding. Biology contributions should focus on charged particle carcinogenesis or cancer FOCUS ON PAST CONGRESSES FOCUS ON PAST CONGRESSES Hadrons in therapy and space radiobiology with heavy ions. Medical studies should describe clinical outcomes in patients or impact on astronauts’ health. Authors can submit manuscripts on journal.frontiersin.org/ResearchTopic/3520 Marco Durante GSI Helmholtzzentrum für Schwerionenforschung, Director of the Biophysics Department, Darmstadt, Germany REFERENCES 1. Zeitlin C et al. Measurements of energetic particle radiation in transit to Mars on the Mars Science Laboratory. Science. 2013;340:1080-1084. 2. Hassler DM et al. Mars' surface radiation environment measured with the Mars Science Laboratory's Curiosity rover. Science. 2014;343:1244797. 3. Durante M, Cucinotta FA. Heavy ion carcinogenesis and human space exploration. Nat Rev Cancer. 2008;8:465-472. 4. Loeffler JS, Durante M. Charged particle therapy--optimization, challenges and future directions. Nat Rev Clin Oncol. 2013;10:411-424. 5. Chung CS et al. Incidence of second malignancies among patients treated with proton versus photon radiation. Int J Radiat Oncol Biol Phys. 2013;87:46-452. 6. Sethi RV et al. Second nonocular tumors among survivors of retinoblastoma treated with contemporary photon and proton radiotherapy. Cancer. 2014;120:126-133. 7. Newhauser WD, Durante M. Assessing the risk of second malignancies after modern radiotherapy. Nat Rev Cancer. 2011;11:438-448. A LITTLE BIT OF IMAGINATION… Bart Van Daele, one of the participants, was very inspired by the course and came up with a fictional story with a typical Sicilian flavour… Michael Corleone was invited as a guest of honour and sponsor to the congress on proton therapy and cosmic radiation that took place in the Sicilian city, Erice. After the murder of his daughter, the former godfather, overwhelmed by feelings of regret and guilt, had sunk into a continuous depressive state. His short visit to Western Sicily confronted him with the cultural roots of his family and the mafia, and brought back memories of his exile and marriage to a Sicilian woman when he was in his twenties. At a moment when he had become prey to despair, the conference offered him an opportunity to escape… Read the full story: turimm.blogspot.com/2015/02/with-mafia-tomars.html > INTRODUCTION FOCUS ON NEXT CONGRESSES FOCUS ON PAST CONGRESSES CALENDAR OF EVENTS MARCH 2015 6 - 7 MARCH 2015 | TURIN, ITALY ESTRO ENDORSED EVENT Perspectives in Lung cancer medex.com/lung-cancer-congress-europe/ > 12 - 14 MARCH 2015 | ST. GALLEN, SWITZERLAND Advanced prostate cancer consensus conference 2015 www.prostatecancerconsensus.org/ > 22 - 26 MARCH 2015 | PORT SUNLIGHT, WIRRAL, UK Radiobiology & radiobiological modelling in radiotherapy course www.estro.org/binaries/content/assets/estro/school/supported-courses/ccc_rblgy_flyer_2015.pdf > ESTRO RECOMMENDED EVENT ESTRO SUPPORTED COURSE 27 - 28 MARCH 2015 | ISTANBUL, TURKEY Trends in Central Nervous System Malignancies EORTC-EANO-ESMO Conference ESTRO ENDORSED EVENT www.ecco-org.eu/EEE2015 > APRIL 2015 14 - 15 APRIL 2015 | GENEVA, SWITZERLAND ELCC - 5th European Lung Cancer Conference IN COLLABORATION WITH ESTRO www.esmo.org/Conferences/ELCC-2015-Lung-Cancer > 20 - 22 APRIL 2015 | MAASTRICHT, THE NETHERLANDS 10th International Conference on Carbonic Anhydrases www.carbonicanhydrasemaastricht.info/ > 22 - 23 APRIL 2015 | BARCELONA, SPAIN Towards biologically relevant dosimetry workshop www.ptb.de/emrp/bioquart_2015.html > ESTRO RECOMMENDED EVENT ESTRO RECOMMENDED EVENT 24 - 28 APRIL 2015 | BARCELONA, SPAIN 3rd ESTRO Forum www.estro.org/congresses-meetings/items/3rd-estro-forum > 29 APRIL - 1 MAY 2015 | ATHENS, GREECE EMSOS - 28th Annual meeting of the European Musculo-Skeletal Oncology Society www.emsos.org/ > ESTRO INTERDISCIPLINARY CONGRESS ESTRO ENDORSED EVENT MAY 2015 8 - 9 MAY 2015 | NEW YORK, USA Modern Radiation For Lymphoma www.mskcc.org/events/cme/modern-radiation-lymphoma-updated-role-and-new-rules/form > 18 - 22 MAY 2015 | ROME, ITALY 25th Advanced Multichannel Teaching Course www.gemelli-art.it/course2015 > ESTRO ENDORSED EVENT ESTRO ENDORSED EVENT 25 - 29 MAY 2015 | KYOTO, JAPAN ICRR 2015 - 15th International Congress of Radiation Research www.congre.co.jp/icrr2015/ > IN COLLABORATION WITH ESTRO JUNE 2015 16 - 17 JUNE 2015 | LUND, SWEDEN 3rd International Symposium on Magnetic Resonance in Radiation Therapy mrinrt.com/ > 17 - 20 JUNE 2015 | LUGANO, SWITZERLAND 13th International Conference on Malignant Lymphoma www.lymphcon.ch/imcl/index.php > ESTRO RECOMMENDED EVENT ESTRO ENDORSED EVENT 20 - 22 JUNE 2015 | WOLFSBERG, SWITZERLAND Wolfsberg Meeting IN COLLABORATION WITH ESTRO www.wolfsberg-meeting.com/ > 24 - 27 JUNE 2015 | LJUBLJANA, SLOVENIA PROS Congress - Congress of the Paediatric Radiation Oncology Society www.intpros.org/pros-congress/congress.php > ESTRO RECOMMENDED EVENT JULY 2015 26 - 30 JULY 2015 | CAIRNS, AUSTRALIA ESTRO ENDORSED EVENT World Congress on Larynx Cancer www.wclc2015.org/home/ > SEPTEMBER 2015 25 - 29 SEPTEMBER 2015 | VIENNA, AUSTRIA ECC2015 - European Cancer Congress 2015 www.ecco-org.eu/Events/ECC2015.aspx > 18 18th ECCO - 40th ESMO European Cancer Congress Reinforcing multidisciplinarity VIENNA, AUSTRIA, 25 - 29 SEPTEMBER 2015 OCTOBER 2015 18 OCTOBER 2015 | SAN ANTONIO, TEXAS, USA Joint ESTRO-ASTRO session at the 57th ASTRO’s annual meeting 35 SIOP SIOP Europe www.astro.org/Meetings-and-Events/2015-Annual-Meeting/Index.aspx > the European Society for Paediatric Oncology www.ecco-org.eu 24 - 27 OCTOBER 2015 | NICE, FRANCE Joint ESTRO-ESGO session at the European Gynaecological Oncology Congress esgo2015.esgo.org/ > ESTRO JOINT EVENT NOVEMBER 2015 5 - 7 NOVEMBER 2015 | STOCKHOLM, SWEDEN ESDE Congress - Congress of the European Society for Diseases of the Esophagus esde2015.axacoevent.com/sv/ > 12 - 15 NOVEMBER 2015 | BARCELONA, SPAIN EMUC - 7th European Multidisciplinary Meeting on Urological Cancers ESTRO ENDORSED EVENT JOINT EAU, ESTRO AND ESMO CONFERENCE emuc15.uroweb.org/ > APRIL 2016 29 APRIL - 4 MAY 2016 | TURIN, ITALY ESTRO 35 ESTRO CONGRESS CREDITS ESTRO Bimonthly newsletter N° 99 | March - April 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 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: [email protected] For advertising, please contact: [email protected] ARCHIVE Latest issues of the newsletter can be found on the ESTRO website under www.estro.org/about and older issues are accessible on DOVE, from the home page of www.estro.org. Opinions expressed in the ESTRO newsletter do not necessary reflect those of the Society or of its officers.
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