newsletter january - february

Transcrição

NEWSLETTER JANUARY - FEBRUARY
ESTRO | EUROPEAN SOCIETY FOR RADIOTHERAPY & ONCOLOGY
SOCIETY LIFE
ELECTION
Interview with the two candidates for
ESTRO President
N° 92 | BIMONTHLY | JANUARY - FEBRUARY 2014
CONTENTS
NEWSLETTER N° 92
JANUARY - FEBRUARY 2014
Editorial
Society Life
Clinical
Read it before your patients
Brachytherapy
Radiobiology
Physics
RTT
ESTRO School
Young ESTRO
Health Economics
ESTRO Conferences
Calendar of events
ESTRO | EUROPEAN SOCIETY FOR RADIOTHERAPY & ONCOLOGY
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EDITORIAL
“The NewYear
looks very bright
for all ESTRO
members as we
have many events
and opportunities
planned.”
Dear Members,
I hope you all had a relaxing and joyful Christmas and
that the New Year has started well for you. The New
Year looks very bright for all ESTRO members as we
have many events and opportunities planned that will
allow us to come together to learn, share experiences
and have fun during 2014.
From 4th to 8th April we will be meeting in Vienna,
Austria at our annual congress: ESTRO 33. As usual
the scientific programme will be outstanding. The
programme is in the final stages of preparation and
there is plenty to do with more than 1800 abstracts
submitted by the November 2013 deadline. In addition
to the scientific programme the ESTRO congress will
continue to be the place for professionals to network
with colleagues from different countries, to share ideas
and be inspired.
ESTRO School has finalised another exciting annual
programme for 2014 with the support of the faculty,
committee and ESTRO office. In addition to the
traditional courses, the number of ESTRO’s online
services has grown too. You should check out our
EDITORIAL
“The NewYear
looks very bright
for all ESTRO
members as we
have many events
and opportunities
planned.”
services has grown too. You should check out our
online FALCON delineation workshops and DOVE,
the ESTRO treasury of information, to mention but a
few.
In 2014 ESTRO will continue to strengthen its
collaboration with national societies through the
National Societies Committee established at the 2nd
ESTRO Forum in 2014. The Committee will function
as the contact point for national societies and ESTRO
to work together and share ideas. Over the course
of 2014, the HERO programme will deliver the first
outcomes from its work. Working both independently
and with ECCO, the ESTRO Board will continue
to identify priorities and communication channels
for oncopolicy actions to improve support for our
professional needs.
I look forward to hearing your views and working
with you. I wish you all a prosperous New Year.
Vincenzo Valentini
ESTRO President
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SEASON’S GREETINGS
The President & Board of Directors of ESTRO
send their very best wishes for 2014
to all members and friends of ESTRO.
ESTRO
4 - 8 April 2014
Vienna, Austria
WWW.ESTRO.ORG
SOCIETY LIFE
“Express yourself
by choosing and
voting on the
direction in which
you want our
Society to go”
WE COUNT ON YOUR VOTE!
I’m very happy to welcome you to the Society Life Corner which,
in this issue, is dedicated to the election of our ESTRO President.
I am very pleased to introduce two high calibre candidates:
Prof Dr Yolande Lievens, from Ghent, Belgium and Prof Dr Daniel Zips,
from Tübingen, Germany.
In the following pages they share their enthusiasm and views about
our Society and the discipline of radiation oncology. Importantly,
they detail how they envisage the direction of ESTRO developing
in several dimensions and the need to help shape the breadth and
depth of the multidisciplinary, pure and clinical sciences that play
such a critical role in the field of oncology today and in the future.
The candidates discuss the essential contributions that ESTRO must
make if this is to be successful in helping young scientists develop
their talents and skills in the coming years so that the patients, who
are at the heart of what we all do, will be able to reap the greatest
benefit.
VINCENZO
VALENTINI
The voting process will start end of February and will last one
month. All the information you need to be able to vote is set out at
the end of this Corner. The most important thing to remember is
that you need to be a 2013 and 2014 ESTRO member in order to be
eligible to vote, so please ensure that your membership is up to date.
During the year my colleagues and I work to develop congresses,
educational courses and a myriad of projects for the benefit of our
profession, your career and our patients. Now it is your turn to help
shape the future strategic direction of our Society by electing our
new President. The future is in your hands.
Vincenzo Valentini
In this Corner
SOCIETY LIFE
ELECTION OF
THE NEW ESTRO
PRESIDENT
Learn more about the two
candidates and their vision
for the future of ESTRO
YOLANDE LIEVENS
DANIEL ZIPS
Prof Dr Yolande Lievens,
MD, PhD
Radiation Oncologist
Prof Dr Daniel Zips,
MD, PhD
University Hospital Ghent
Ghent, Belgium
Medical Faculty & University
Hospital Tübingen
Tübingen, Germany
In this Corner
ELECTION OF THE NEW ESTRO PRESIDENT
SOCIETY LIFE
YOLANDE
LIEVENS
University Hospital Ghent
Ghent, Belgium
BIOGRAPHY
YOLANDE LIEVENS
Education and professional career
Educated at the Leuven University, Yolande
Lievens became a staff member at the Leuven
University Hospital Radiation Oncology Department in 1996. Early in her career she pursued
additional non-clinical education in Hospital and
Health Care Management, which laid the foundation for the award of a PhD in 2002 by Leuven
University. Yolande’s PhD was titled: “Cost and
Economic Evaluation of Radiotherapy. Activity
Based Costing and Modeling Techniques”. As
of March 2012, she was appointed Chair of the
Radiation Oncology Department of the Ghent
University Hospital.
Academic career
Yolande was Professor in Radiation Oncology at
the University of Leuven from 2002 and took up
her current appointment as Professor at the University of Ghent in October 2012. She takes an
active part in educational activities in Belgium
and internationally.
Yolande’s clinical interests in pulmonary oncology, haematology and breast cancer are
reflected in her research projects, which
In this Corner
largely take place within the interdisciplinary
oncology groups of the hospitals where she
works and through EORTC collaborations.
Besides her clinical research, Yolande has a
keen interest in the economic aspects of radiotherapy and oncology. She has collaborated in
numerous projects with various groups and
organisations, such as ESTRO, the International Atomic Energy Agency, the Belgian Hadron
Therapy Center Foundation and the Belgian
Health Care Knowledge Centre.
Organisational aspects
As a result of her involvement in financial
programmes and interest in healthcare management, she was appointed President of the
Belgian Professional Association for Radiotherapy in 2007, a position she held until early
2013. In February 2013, she was appointed to
the Presidency of the Belgian College of
Radiotherapy, which is an advisory body for
the quality aspects of radiotherapy. Yolande
also acts as an auditor of radiotherapy departments for the Belgian Cancer Plan and for the
IAEA QUATRO programme. Yolande also
finds time in her busy professional life to be
closely involved in working groups that deal
with the financial and organisational aspects
of radiotherapy in Belgium and across Europe.
INTERVIEW WITH
YOLANDE LIEVENS
The ESTRO vision says: 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.
Why did you decide to get involved and campaign
as President-Elect?
Although we are all convinced that radiotherapy
is a key player in oncology, our vital contribution is frequently overlooked by the public and
the media, the wider health care community
and, yes, even by our direct partners in oncology. For many, radiotherapy appears to be a costly and risky treatment modality that will become obsolete as soon as the right code for the
specific anti-cancer drugs has been unravelled.
Leaving such perceptions unchecked is not in
the best interest of the patients we all serve.
For the important contributions that our profession makes to high quality cancer care to be
properly acknowledged by policy-makers and
healthcare managers, we must learn to understand their needs and speak their language.
In this era of budgetary restrictions, the discussion about value for money has become an
INVOLVEMENTS WITHIN ESTRO
Reviewer for “Radiotherapy and Oncology”
2003-2005:
Scientific collaborator ENLIGHT-project
(European Network for LIGht Ion Hadron Therapy)
2002-2005:
Scientific collaborator QUARTS-project
(Radiotherapy for Cancer: Quantification
of Infrastructure and Staffing Needs)
2005 to date:
Author of the Health Economics Corner
in the ESTRO newsletter
2010 to date:
Co-chair of the Health Economics in
Radiation Oncology (HERO) project
2011 to date:
Member of the Professional and Membership Council
2012 to date:
Faculty member of the ESTRO teaching
course on target volume delineation
2012 to date:
Member of the Clinical Committee
Member of the Scientific Advisory Group
of ESTRO 33
In this Corner
unavoidable part of this conversation.
ESTRO has a tremendous track record of education and dissemination of knowledge about the
important aspects of radio-therapeutic sciences
and benefits to clinical medicine. More recently, ESTRO has started to focus on the professional aspects of radiation oncology. With my
long-standing interest in health economics and
my activities in the professional organisations
of Belgium, I want to have the opportunity to
strengthen the good works of ESTRO by fostering and building further health services research within ESTRO. We must address this
area with increased vigour right now if we are to
realise ESTRO’s vision of providing individualised, state of the art radiotherapy to the patients
in Europe who have cancer.
As ESTRO President, what would be your first
three priorities to meet the statement? What concrete actions would you implement to reach these
objectives?
ESTRO has done a great job in the last few
years in restructuring the Society, establishing
new committees and initiating new projects to
drive the organisation forward. My aim is not
to dilute these good works by starting radically
new initiatives, but rather to strengthen those
that have already started and are showing such
promise.
In my view, the first prerequisite for making the
Society successful and relevant to individual
care-givers is to explore what they really want
and need within their specific professional context. The National Societies Council has recently
been established to enhance the interaction with
and between the different radiation societies in
Europe. Through this channel, the specific expectations of our members from ESTRO can be
explored and activities tailored to their specific
needs.
Secondly, I feel that besides well-organised “inward” communication – boosted by our new
members’ website – we must emphasise our
“outward” communication. External communication is a key part of the mission of the ESTRO
Cancer Foundation. Radiation oncology as a
whole has been too modest and low key when
communicating to the outside world the considerable benefits that it brings. We must not waste
the opportunity we now have to engage with the
public in ways that they want. We must do this
through balanced education and explain in clear
and easily understandable terms the value of radiation oncology for cancer patients and society
as a whole. The public needs to be armed with
the information to influence healthcare managers and governmental bodies so that every
cancer patient who would benefit from such
treatment can properly demand and receive, evidence-based, high quality, safe radiotherapy.
Lastly, many European countries are faced with
restrictions on the introduction of new technologies that are not only of a monetary nature but
are also related to incomplete evidence base. As
a result there is an urgent need for a global approach that fosters stronger radiotherapy technology research. Examples of approaches that
can make the use of novel technologies available
to the patients at an earlier phase in their development include coverage with evidence development and better public-private partnerships. This
should ideally be achieved at the European level
and ESTRO must play a leading role in this.
The ESTRO vision at the 2020 horizon was defined in 2011, three years ago now. Do you think
it is still going in the same direction or has it
evolved in the meantime?
Globally, it still holds true. But, in my view,
what has been insufficiently addressed in the
document is the wide variability encountered in
Europe: variability in population density,
In this Corner
socio-economic structure, healthcare services
and cancer incidence. Besides being one of Europe’s strengths and appeals, this diversity places an extra burden on attaining ESTRO’s vision.
Our own experience within HERO, and from
others such as IAEA-DIRAC, has shown that
apart from the demographic variability mentioned above, radiotherapy-specific parameters
such as infrastructure, equipment and staffing
are also very diverse. Therefore, to my mind,
there cannot be a “one size fits all” solution. Instead of striving immediately for a homogeneous
approach in all European countries, we must
first understand the unique assets and needs of
every individual country. This should be done
using a bottom-up approach by working closely
with the relevant national representatives and
societies as HERO is currently doing.
What is your vision of the multidisciplinary approach and how would you position ESTRO and
radiation oncology in this arena?
First I want to stress how much I appreciate the
cohesive “internal” multi-disciplinary nature
of our profession, where the competencies of all
radiation oncology staff converge towards our
common goal, namely: to provide the best treatment for the individual patient. It follows that
within our Society we must also work hard to
ensure that we always have the optimal balance
and collaboration between all sub-disciplines.
Similarly, at the global oncology level, a strong
multi-disciplinary approach is a vital asset, not
a threat. We are all bound by our common endeavour to cure and care for patients with cancer. For this reason, mutual respect, frequent
dialogue and development of a common language must be the aim of all oncology key-players, fostered by ESTRO, for example, through its
collaboration within ECCO.
Education is the essence of ESTRO. Which direction should the ESTRO School follow to remain
the leading educational force in RO at the European and international level?
Without doubt, education is one of the strongest
pillars of our Society. This great achievement
has not come about by accident but is thanks to
the selfless effort of all those participating in our
many educational programmes. To my mind,
we must continue along the same track, using
the unique mixture of live meetings and interactions in combination with the opportunities that
novel online applications also bring.
We can all see that the field of radiotherapy is
rapidly evolving. This rate of change requires us
to review, update and adapt our educational programmes frequently so that we avoid unneces-
sary overlap and redundancy in the courses and
educational materials we provide. The content
dimensions must also be continually assessed
and expanded with the inclusion of new courses
that focus on soft skill development and topics
such as organisational dynamics and leadership,
or even a primer course in health technology
assessment. Finally, when exporting these courses to other continents, we must be cautious not
to simply transport our European point of view,
but ensure that the content is tailored to the realities and environment of the people we aim to
help with these courses.
What should be the priorities for young members?
The young generation is unquestionably the future of our Society. Speaking from my own experience, I can only confirm the positive impact
on me at the start of my career of being an integral part of a larger, broader based organisation,
such as ESTRO. It is very important for personal
and professional development to participate in
activities that are at a level beyond our normal
day to day department or institution. We should
encourage and give our young professionals the
room to develop themselves and find a place
within our Society where they feel comfortable
and have the chance to meet others with
In this Corner
common interests, share experiences and stimulate each other’s thoughts and project plans.
Thinking back to your previous question on
education, one opportunity may be to introduce
one or two young lecturers into each teaching
course, so that they can profit from the experience of the older generation while providing
continuity into the future.
What has been your involvement within ESTRO
that you would particularly like to highlight ?
Of my involvements within ESTRO, it is my
co-chairing of the HERO-project (Health Economics in Radiation Oncology) that is closest to
my heart. Together with an enthusiastic group
of HEROes, we are working on the creation of a
knowledge base and economic model for radiation oncology in Europe that is second to none.
We are a multidisciplinary group of radiation
oncologists, medical physicists, an RTT, an epidemiologist and a health economist and whilst
we come from across Europe we have common
goals. Our overriding aim is to help individual
countries and national societies in their quest
for better radiotherapy and to strengthen the
position of radiation oncology within the global
oncology landscape. This goal perfectly characterises my own ambition as I put myself forward
for election to become ESTRO President and
endeavour to further develop ESTRO and our
profession.
In this Corner
SOCIETY LIFE
DANIEL ZIPS
Medical Faculty and University
Hospital Tübingen
Tübingen, Germany
BIOGRAPHY
DANIEL ZIPS
Daniel Zips was born and raised in Dresden in
East Germany. From 1991 to 1997 he studied
medicine in Berlin and Dresden. He was then a
resident in radiation oncology at the University
of Dresden and research fellow in experimental
radiotherapy in the group led by Michael Baumann. After spending 2003 as visiting scientist
in the departments of Experimental Radiation
Oncology and Cancer Genetics at MD Anderson he was appointed as a consultant radiation
oncologist in Dresden.
Building on his clinical scientist career, Daniel
established a new translational research group
at the OncoRay Center Dresden in 2006. The
group focused on biologically individualised
radiotherapy. His particular interests and areas
of work are: radiobiological mechanisms of
tumour radiation sensitivity, hypoxia and imaging together with novel molecular targeting
strategies. Daniel was also a driving force in
the establishment of the new Comprehensive
Cancer Centre in Dresden where he worked as
leading physician for radiation oncology. In 2007
Daniel was awarded the Holthusen Award from
the German Society for Radiation Oncology
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INVOLVEMENTS WITHIN ESTRO
and the ESTRO Varian Clinical Research Award
for his scientific contributions to translational
radiation oncology.
Since 2008 Daniel has worked and taken responsibility for several ESTRO initiatives such
as the Young ESTRO initiative, Clinical Committee membership, as well as the organisation
and teaching at scientific conferences. In 2012 he
was appointed Professor and Chair of Radiation
Oncology at the University of Tübingen. This
year he was elected Director of the Comprehensive Cancer Centre.
Daniel has published more than 90 scientific
papers and book chapters. As principal investigator he has secured more than €4M of study
funding. In his spare time, away from his passion for radiation oncology, Daniel enjoys travelling, classical music, opera and football. In 2012
he played as a midfielder for the ESTRO Clinical
and Radiobiology Team at the ESTRO conference in Barcelona.
INTERVIEW WITH
DANIEL ZIPS
The ESTRO vision says: 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.
Why did you decide to get involved and campaign
as President-Elect?
I have been involved with ESTRO activities for
15 years and during this time I have personally
experienced the fact that our Society is a powerful driver of change with a significant impact
on, and responsibility for, radiation oncology
and multidisciplinary cancer medicine. This has
strongly motivated me to take a leading role and
campaign as President-Elect to ensure that this
important role of ESTRO is continued and expanded.
My first contact with ESTRO was as a participant at the meeting in Edinburgh in 1998. Since
that time my professional career and personal
development have been strongly influenced by
people who are active in our Society. In addition, I now have many colleagues and friends
in different European countries because of
ESTRO. I have been fortunate to visit many
2008:
Director ESTRO Pre-Meeting Course
on Stem Cells
2008-2010:
Member Task Force Quality Assurance
2008-2012:
Member Clinical Committee
2008 and 2010:
Course teacher ESO/ESTRO Masterclass
2008-2012:
Course teacher ESTRO course Molecular
Oncology for the Radiation Oncologist
2010-2012:
Board Member FALCON
2010-2012:
Member Young ESTRO Taskforce
2011:
Co-Chair Radiotherapy Track
ECCO/ESTRO/ESMO Conference
2012 and 2013:
Course teacher ESOR/ESTRO course Multidisciplinary Approach of Cancer Imaging
2012 to date:
Chair Clinical Committee 2013,
Track Chair, Head and Neck Cancer
ECCO/ESTRO/ESMO Conference
2013 to date:
Scientific Chair ESTRO 33 Conference
Vienna 2014
In this Corner
institutes and I always enjoy meeting people,
hearing their perspectives and experiences from
within the wider radiation oncology community. All this has had a huge impact on my professional development. I could learn from others,
compare the work in other centres to my own
environment, exchange ideas and initiate joint
activities. This is something I think should be a
guiding principle for everyone, not only young
professionals. Through my involvement in a
large number of ESTRO activities I have come
to know our Society well and gained valuable
experiences which I believe will be very helpful for a presidency. For example, I will be able
to draw on my experience organising scientific
conferences, managing projects that promote
radiation oncology, supporting young members during the early years of their career and
developing and delivering education through
both teaching and policy creation. I believe the
combination of my ESTRO experiences coupled
with my professional work, has prepared me
well so that I can help strengthen and promote
ESTRO as the scientific society for all professional groups active in radiation oncology.
As ESTRO President, what would be your three
top priorities to meet the ESTRO vision statement? What concrete actions would you imple-
ment to reach these objectives?
I consider the top three priorities for ESTRO
are:
First, we need to build further on the successful work that ESTRO has already done collecting and disseminating knowledge of what
‘state of the art radiation therapy’ actually is.
This sounds rather simple but it is really a key
role of ESTRO. Only scientifically sound, evidence-based knowledge will provide the reliable
basis which will ensure that we get the resources
to provide each cancer patient in Europe with
the optimal radiation therapy they need. The
question of how that can be achieved is best addressed through professional discussion, debate
and dissemination during ESTRO conferences,
teaching courses and participation in multidisciplinary events that lead to the publication of
expert guidelines. To achieve this it is essential
to draw on the knowledge and experience of
all radiation oncology professionals: clinicians,
physicists, biologists, RTTs and nurses. Having
done this we then need to make sure that political policy makers, patients and the public are
well informed so they can make clear decisions
based on sound information that they understand.
If the success of radiation oncology is to con-
tinue it will naturally depend on technology
advances. But we cannot only focus on radiation
technology alone. Modern drug treatment is
also an essential component of future successful
radiation oncology treatments. Therefore ESTRO needs to be very involved in the collection
and communication of tailored drug / radiotherapy combination therapies. ESTRO can do
this by developing new ways of knowledge accumulation by, for example, research using large
radiation-dose-plan-outcome databases coupled
with new formats of knowledge dissemination
such as electronic books and papers.
Second, radiation therapy is an essential part of
most cancer treatment. We have the responsibility to ensure that cancer patients get access to
radiation therapy according to evidence based
medical standards. This is only possible when
we are fully recognised partners in the multidisciplinary team. Clearly radiation oncology
already has a strong track record in multidisciplinary oncology. However, having had personal
experience of two comprehensive cancer centres
I am not naïve when it comes to the provision
of seamless, multidisciplinary co-operation.
Regrettably, sometimes there are hidden interests that may take precedence over more patientoriented evidence. Therefore, I see ESTRO’s
In this Corner
role as the provider of the knowledge, training,
support and professional networks that will put
radiation oncology professionals in their rightful position within the multidisciplinary setting.
ESTRO must maintain its authoritative voice as
the reference and backbone to support radiation
oncology in its interactions with other disciplines, societies and decision makers.
Third, make individualisation a major topic
for ESTRO. What do I mean by this? Radiation
oncology has been enormously successful in anatomical individualisation through higher conformality. However, in my opinion there is still
room for considerable improvement through,
for example, adaptive treatments. An equally
important area of individualisation for the immediate future is ‘biological conformality’, i.e.
taking into account the individual biology of
tumours and normal tissues in dose prescription, fractionation and combined therapies. This
perspective is based on my experience in translational and clinical radiation therapy in areas
such as research into hypoxia dose painting. I
strongly believe that biologically individualised
radiation therapy will bring substantial changes
to the whole of cancer medicine with the potential to significantly improve outcomes for
patients with cancer. To realise this potential we
must be technologically innovative and biologically orientated in our radiation research. Importantly, we cannot directly use the knowledge
from medical oncology, e.g. on biomarkers or on
molecular mechanisms, but must use and develop further our own specific approaches.
A priority for ESTRO must be to help facilitate
basic, translational and clinical research towards individualised radiotherapy. This could
be achieved by the organisation of think-tank
platform meetings, encouraging out-of-the-box
thinking and avant-garde approaches to trigger
innovative research and technological developments.
The ESTRO vision at the 2020 horizon was defined in 2011, three years ago now. According to
you, is it still going in the same direction or has in
evolved in the meantime?
I think the direction is still valid, and writing
down what we think will be important in the
next ten years was a big achievement for us.
Having said that, looking at the document now,
almost three years later and considering how
quickly time passes, many statements appear too
ambitious to me. I believe we are moving in the
right direction, but that we have to continuously
review aims, expectations and adjust our time
horizons to provide a visionary and scientifically
sound strategy.
What is your vision of the multidisciplinary approach and how would you position ESTRO and
radiation oncology in this arena?
In addition to the priorities discussed above,
I would promote continuation of ESTRO’s involvement in multidisciplinary conferences,
teaching courses and guidelines. For example,
ESTRO must encourage professionals working
in the field of radiation oncology to attend the
multidisciplinary ECCO conferences and present the results from their studies and research
there. I think this is important because we
must not only talk to ourselves at our meetings,
but use the ECCO conference as a platform to
demonstrate our achievements at the multidisciplinary and political level. This will help
ESTRO maintain its role as an equal partner in
the multidisciplinary setting. I also see an opportunity for ESTRO to be more intense and
have a more direct liaison with patient groups
and policy makers within the multidisciplinary
environment.
Education is the essence of ESTRO. Which direction should the ESTRO School follow to remain
the leading educational force in RO at the
In this Corner
European and international level?
ESTRO is the world leader in education related
to radiation oncology. The portfolio is outstanding, the ETC (Education and Training Committee) and the many teachers are doing a wonderful job. To be honest, it is not an easy matter
to improve on such excellence. With an everchanging environment we must maintain flexibility in order to integrate new trends quickly
and be open minded to ‘pilot experiments’. We
need to try new things and new formats with
new people.
What should be the priorities for the young
members?
It was not all that long ago that I was a young
member and active in the Young ESTRO initi-
ative. ESTRO has established a large network
and secured the representation of young professionals in the various ESTRO committees
to ensure their specific interests and needs
are taken into account. ESTRO must maintain consideration of young professionals and
their specific needs as a priority. For example,
they need excellent training, opportunities to
exchange thoughts and ideas, and support in
their career development. All this needs to be
achieved with consideration for work-life-balance, which can be a particular challenge for
female professionals. A lot of things are already
in place, but we must continue to ask and then
listen to young professionals in order to make
sure that what we are doing is right for them
and the profession.
What have been your involvements within
ESTRO that you would like to highlight more
particularly?
Besides being an ESTRO football player (clearly an area for future improvement!), I have
been most influenced by my experiences in the
Young ESTRO member initiative, as an organiser of ESTRO scientific meetings and working
with colleagues in the Clinical Committee. In
the Clinical Committee we recently started an
initiative working with patient organisations
to provide reliable information about modern
radiation oncology and to further involve patients in ESTRO activities. Making sure that
patients understand their treatment options and
can make informed decisions about their lives is
very important.
In this Corner
SOCIETY LIFE
WHAT YOU NEED
TO KNOW TO
TAKE PART IN
THE VOTE
ELECTIONS WILL TAKE PLACE
24 FEBRUARY – 23 MARCH 2014
TO BE ELIGIBLE TO VOTE
YOU MUST:
• renew your ESTRO membership
for 2014 as a Full Member
(supporting ambassador or active
member) by 31 January 2014
• have been a member of ESTRO
in 2013
THE BALLOT FOR THE
PRESIDENT-ELECT AND FOR
BOARD MEMBERS WILL TAKE
PLACE AT THE SAME TIME
VOTING WILL BE ELECTRONIC
ALL MEMBERS ELIGIBLE TO VOTE
WILL BE SENT AN EMAIL WITH
ALL THE INFORMATION NEEDED
TO CAST THEIR VOTE, INCLUDING LOGIN DETAILS
In this Corner
2014 ESTRO MEMBERSHIP
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CLINICAL
“Only by active
participation will
we be able to
maintain and
further develop our
position as a fully
recognised partner
in the multidisciplinary setting.”
The ESTRO report on the ECC 2013 in
Amsterdam was published in the previous issue
of the newsletter. In this Corner, Mechthild
Krause from the Clinical Committee, who
attended the congress, shares with us her
comments on the sessions she attended.
As Co-track Chair for the radiotherapy track,
Mechthild was actively involved in setting-up
the scientific programme for ECC 2013. In her
report she gives examples of the high quality of
science that radiation oncology contributes to
multidisciplinary cancer care. She concludes with
her experience from ECC 2013 that only by active
participation will we be able to maintain and
further develop our position as a fully recognised
partner in the multidisciplinary setting. No need
to say that I deeply share this vision.
DANIEL ZIPS
Daniel Zips
In this Corner
CLINICAL
17TH ECCO- 38TH ESMO - 32ND ESTRO
EUROPEAN
CANCER CONGRESS
(ECC 2013)
27 September - 1 October 2013
Amsterdam, The Netherlands
MECHTHILD KRAUSE
www.ecco-org.eu
The 17th ECCO – 38th ESMO – 32nd ESTRO
European Cancer Congress (ECC 2013) took
place between 27 September and 1 October in
Amsterdam and was the largest in the history of
ECC conferences. More than 18,000 participants
from 125 countries attended the sessions in 17
parallel rooms. More than 3000 abstracts were
submitted, more than 2000 posters were presented.
From the viewpoint of a clinician, however, the
major success of the conference was not the record
number of participants, posters and abstracts, but
the extremely high quality of science presented
at the meeting. Radiation oncology topics were
included in a high number of interdisciplinary
organ sessions, whereas pure radiation oncology
sessions were restricted to very specific topics.
This is exactly the way in which disciplines can
be brought together, fostering interdisciplinary
discussions and bringing forward interdisciplinary
treatment strategies. The field of radiation oncology
profited from this approach. The amount of highquality clinical data from the field of radiation
oncology, including a substantial number of
prospective and randomised clinical trials, was
higher than ever before at ECC meetings and could
be presented to a large interdisciplinary audience,
in several cases within plenary sessions. The size
of the conference prevented attending all the
important presentations and so the following list
of highlights from our field is not intended to be
exhaustive:
Philip Poortmans presented the results of the
EORTC 22922-10925 randomised phase III trial
on the value of internal mammary and medial
supraclavicular chain irradiation in breast cancer.
4004 patients with either medial tumour location
or axillary lymph node involvement were included.
The main conclusion is that internal mammary
and medial supraclavicular irradiation significantly
improves overall survival and distant metastasesfree survival at 10 years after radiotherapy.
Although the difference between the arms, 1.6 or
3% is not large, the data provide further evidence
that local treatment can also reduce distant
metastases.
The EORTC AMAROS trial is the 2nd randomised
phase III trial supporting the concept of axillary
radiotherapy and omission of axillary dissection
in clinically negative but histologically positive
sentinel lymph nodes in breast conserving
treatments. 4806 patients with positive sentinel
lymph node received either axillary dissection or
axillary and supraclavicular radiotherapy within
their adjuvant radiotherapy treatment. Axillary
recurrences were not significantly different
between both arms and toxicity was higher in the
axillary dissection arm.
Two very well conducted studies dealt with the
prognostic and predictive value of gene signatures
for breast cancer locoregional recurrence after
surgery and radiotherapy. The Amsterdam 70
gene signature (Mammaprint™) was shown to
correlate with local tumour control of breast
cancer, specifically in node-negative patients after
breast conserving treatment and node-positive
In this Corner
patients after mastectomy. In a re-evaluation of
the DBCG82 b/c cohort, where patients had been
randomised to receive either post-mastectomy
radiotherapy or not, a 7-gene set could be identified
that was able to classify the patients into low- and
high risk groups for local tumour recurrence.
Application of radiotherapy could completely
outweigh the disadvantage in the high-risk group
and this predictive value was independent of other
known clinical prognostic parameters. A caveat
was to be noted in the update of the ELIOT trial
(intraoperative partial breast irradiation). Here,
at 20 years follow up, the recurrence rates were
1% after whole breast irradiation and 10% after
intraoperative irradiation.
For head and neck cancer radiotherapy, a pooled
analysis of two GORTEC trials was presented to
evaluate the effect of very accelerated radio(chemo)
therapy in N3 tumour stages. In a total of
179 patients with N3 disease, very accelerated
radiotherapy (64.8 Gy in 3.5 weeks) led to similar
overall and distant metastases free survival as
compared to platinum-based radiochemotherapy),
whereas local tumour control was higher after
radiochemotherapy. Within the DAHANCA
19 randomised phase III trial, 619 patients with
head and neck squamous cell carcinoma were
treated with radio(chemo)therapy and Nimorazol
with or without simultaneous application of the
anti-EGFR antibody Zalutumumab. The local
relapse rate at 3 years was not significantly
different between both arms. This is the
second randomised dataset showing that triple
combinations of anti-EGFR antibodies with
radiochemotherapy in head and neck cancer do
not further improve treatment outcome compared
to radiochemotherapy alone. Within the 6-arm
NPC-0501 trial, nasopharyngeal cancer patients
were randomised to receive conventionally
fractionated or accelerated radiotherapy with
either simultaneous-adjuvant or neoadjuvantsimultaneous cisplatin-based chemotherapy. No
significant difference in locoregional recurrences
was detected, while toxicity was considerably
higher after neoadjuvant-simultaneous application
of chemotherapy. Last but not least, several
randomised trials on radiochemotherapy for
glioblastoma were presented. The CENTRIC trial
showed no improvement of progression free and
overall survival after additional application
In this Corner
of the Integrin-inhibitor Cilengitide during
radiochemotherapy. Within the AVAGLIO trial,
a prolongation of progression-free survival by
simultaneous application of Bevacizumab during
Temozolomide-radiochemotherapy did not
translate into the same benefit in overall survival.
Within the GLARIUS and the RTOG 0825 trial,
radiochemotherapy with irinotecan was compared
to Temozolomide—radiochemotherapy in MGMT
negative patients. Also here, no significant
improvement of overall survival could be shown
in the experimental arm. These glioblastoma trials
show again the difficulties in glioblastoma research
and underline the necessity to revisit our research
strategy in clinical glioblastoma treatment that
may currently suffer from too little radiobiological
and radio-oncological input on treatment
interactions and mechanisms of radioresistance.
Overall, the active work of radiation oncologists
in the scientific committee in several tracks of the
conference as well as the submission of excellent
abstracts has made ECC 2013 an extremely
successful conference for radiation oncology and
could stabilise our position in multidisciplinary
treatment. However, it was also obvious that
relative to the total number and to the excellent
consideration of our field within multidisciplinary
sessions and plenary sessions, the number of
participating radiation oncologists has room
for improvement. Only through the active
participation of many representatives specifically
from our discipline in European interdisciplinary
conferences can we help to hold our currently very
visible position in this multidisciplinary setting.
Mechthild Krause
Medical Faculty and University Hospital
Carl Gustav Carus
Dresden, Germany
5TH EMUC
Read the report on the 5th EMUC (European Multidisciplinary Meeting on
Urological Cancers) in the Conference Corner
In this Corner
DYNAMIC ONCOLOGY
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READ IT BEFORE
YOUR PATIENTS
Too important to miss...
A digest of essential
reading for all radiation
oncologists
CLICK OR TAP ON THE IMAGES
TO SEE THE EDITORS’ NAMES
In this Corner
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PROSTATE
Randomized Trial of
Hypofractionated
External-Beam Radiotherapy
for Prostate Cancer.
Pollack A, Walker G, Horwitz EM, Price R, Feigenberg S,
Konski AA, Stoyanova R, Movsas B, Greenberg RE,
Uzzo RG, Ma C, Buyyounouski MK.
J Clin Oncol. 2013 Oct 7. [Epub ahead of print]
PURPOSE
To determine if escalated radiation dose
using hypofractionation significantly reduces
biochemical and/or clinical disease failure
(BCDF) in men treated primarily for prostate
cancer.
(P = .745). There were no statistically significant
differences in late toxicity between the arms;
however, in subgroup analysis, patients with
compromised urinary function before enrollment
had significantly worse urinary function after
HIMRT.
PATIENTS AND METHODS
CONCLUSION
Between June 2002 and May 2006, men with
favorable to high-risk prostate cancer were
randomly allocated to receive 76 Gy in 38
fractions at 2.0 Gy per fraction (conventional
fractionation intensity-modulated radiation
therapy [CIMRT]) versus 70.2 Gy in 26 fractions
at 2.7 Gy per fraction (hypofractionated
IMRT [HIMRT]); the latter was estimated to
be equivalent to 84.4 Gy in 2.0 Gy fractions.
High-risk patients received long-term androgen
deprivation therapy (ADT), and some
intermediate-risk patients received short-term
ADT. The primary end point was the cumulative
incidence of BCDF. Secondarily, toxicity was
assessed.
The authors conclude that the hypofractionation
regimen did not result in a significant reduction
in BCDF; however, it is delivered in 2.5 fewer
weeks. Men with compromised urinary function
before treatment may not be ideal candidates for
this approach.
RESULTS
There were 303 assessable patients with a
median follow-up of 68.4 months. No significant
differences were seen between the treatment
arms in terms of the distribution of patients by
clinicopathological or treatment-related (ADT
use and length) factors. The 5-year rates of BCDF
were 21.4% (95% CI, 14.8% to 28.7%) for CIMRT
and 23.3% (95% CI, 16.4% to 31.0%) for HIMRT
5TH EMUC
Read the report on the 5th EMUC
(European Multidisciplinary
Meeting on Urological Cancers)
in the Conferences Corner
In this Corner
READ IT BEFORE
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PALLIATION
Phase II Trial of Palliative
Radiotherapy for
Hepatocellular Carcinoma
and Liver Metastases.
Soliman H, Ringash J, Jiang H, Singh K, Kim J, Dinniwell R,
Brade A, Wong R, Brierley J, Cummings B, Zimmermann C,
Dawson LA.
J Clin Oncol. 2013 Sep 23. [Epub ahead of print]
PURPOSE
To evaluate the feasibility and response to liver
radiotherapy (RT) in improving symptoms and
quality of life in patients with hepatocellular
carcinoma (HCC) or liver metastases (LM).
Eligible patients had HCC or LM, unsuitable
for or refractory to standard therapies, with an
index symptom of pain, abdominal discomfort,
nausea, or fatigue. The Brief Pain Inventory
(BPI), Functional Assessment of Cancer TherapyHepatobiliary (FACT-Hep), and European
Organisation for Research and Treatment of
Cancer Quality of Life Questionnaire C30
(EORTC QLQ-C30) were completed by patients
at baseline and each follow-up. The primary
outcome was the percentage of patients with a
clinically significant change at one month in the
BPI subscale of symptoms on average in the past
week. Secondary outcomes were improvement
in other BPI subscales and at other time points,
FACT-Hep and EORTC QLQ-C30 at each followup, and toxicity at 1 week.
hepatobiliary subscale were seen in 23% and 29%
of patients, respectively, at one month. There
were also improvements in EORTC QLQ-C30
functional (range, 11% to 21%) and symptoms
(range, 11% to 50%) domains. One patient
developed grade 3 nausea at one week.
CONCLUSION
Improvements in symptoms were observed at one
month in a substantial proportion of patients. A
phase III study of palliative liver RT is planned.
RESULTS
Forty-one patients (30 men and 11 women) with
HCC (n = 21) or LM (n = 20) were accrued.
At one month, 48% had an improvement in
symptoms on average in the past week. Fiftytwo percent of patients had improvement in
symptoms at its worst, 37% at its least, and
33% now. Improvements in the FACT-G and
In this Corner
READ IT BEFORE
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LYMPHOMA
Rituximab, Methotrexate,
Procarbazine, and Vincristine
Followed by Consolidation
Reduced-Dose Whole-Brain
Radiotherapy and Cytarabine in
Newly Diagnosed Primary CNS
Lymphoma: Final Results and
Long-Term Outcome.
Morris PG, Correa DD, Yahalom J, Raizer JJ, Schiff D,
Grant B, Grimm S, Lai RK, Reiner AS, Panageas K, Karimi S,
Curry R, Shah G, Abrey LE, Deangelis LM, Omuro A.
J Clin Oncol. 2013 Oct 7. [Epub ahead of print]
PURPOSE
A multicentre phase II study was conducted to
assess the efficacy of rituximab, methotrexate,
procarbazine, and vincristine (R-MPV) followed
by consolidation reduced-dose whole-brain
radiotherapy (rdWBRT) and cytarabine in
primary CNS lymphoma.
Patients received induction chemotherapy with
R-MPV (five to seven cycles); those achieving
a complete response (CR) received rdWBRT
(23.4 Gy), and otherwise, standard WBRT was
offered (45 Gy). Consolidation cytarabine was
given after the radiotherapy. The primary end
point was 2-year progression-free survival (PFS)
in patients receiving rdWBRT. Exploratory end
points included prospective neuropsychological
evaluation, analysis of magnetic resonance
imaging (MRI) white matter changes using the
Fazekas scale, and evaluation of the apparent
diffusion coefficient (ADC) as a prognostic factor.
median PFS was 3.3 years, and median OS
was 6.6 years. Cognitive assessment showed
improvement in executive function (P < .01) and
verbal memory (P < .05) after chemotherapy, and
follow-up scores remained relatively stable across
the various domains (n = 12). All examined MRIs
(n = 28) displayed a Fazekas score of ≤ 3, and no
patient developed scores of 4 to 5; differences in
ADC values did not predict response (P = .15),
PFS (P = .27), or OS (P = .33).
CONCLUSION
R-MPV combined with consolidation rdWBRT
and cytarabine is associated with high response
rates, long-term disease control, and minimal
neurotoxicity.
RESULTS
Fifty-two patients were enrolled, with median age
of 60 years (range, 30 to 79 years) and median
Karnofsky performance score of 70 (range, 50 to
100). Thirty-one patients (60%) achieved a CR
after R-MPV and received rdWBRT. The 2-year
PFS for this group was 77%; median PFS was
7.7 years. Median overall survival (OS) was not
reached (median follow-up for survivors, 5.9
years); 3-year OS was 87%. The overall (N = 52)
In this Corner
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LYMPHOMA
Impact of Rituximab and
Radiotherapy on Outcome
of Patients With Aggressive
B-Cell Lymphoma and Skeletal
Involvement.
Held G, Zeynalova S, Murawski N, Ziepert M, Kempf B,
Viardot A, Dreyling M, Hallek M, Witzens-Harig M,
Fleckenstein J, Rübe C, Zwick C, Glass B, Schmitz N,
Pfreundschuh M.
PURPOSE
To study clinical presentation, outcome, and the
role of radiotherapy in patients with aggressive
B-cell lymphoma and skeletal involvement
treated with and without rituximab.
Outcome of patients with skeletal involvement
was analysed in a retrospective study of nine
consecutive prospective trials of the German
High-Grade Non-Hodgkin lymphoma Study
Group.
RESULTS
Of 3,840 patients, 292 (7.6%) had skeletal
involvement. In the MabThera International
Trial (MInT) for young good-prognosis patients
and the Rituximab With CHOP Over 60 Years
(RICOVER-60) study for elderly patients, the
randomised addition of rituximab improved
event-free survival (EFS; hazard ratio for MInT
[HRMInT] = 0.4, P > 001; hazard ratio for
RICOVER-60 [HRRICOVER-60] = 0.6, P >
.001) and overall survival (OS; HRMInT = 0.4,
P < .001; HRRICOVER-60 = 0.7, P = .002) in
patients without skeletal involvement, but failed
to improve the outcome of patients with skeletal
involvement (EFS: HRMInT = 1.4, P = .444;
HRRICOVER-60 = 0.8, P = .449; OS: HRMInT
= 0.6, P = .449; HRRICOVER-60 = 1.0, P = .935).
Skeletal involvement was associated with a worse
outcome after cyclophosphamide, doxorubicin,
vincristine, and prednisone (CHOP) plus
rituximab (HREFS = 1.5, P = .048; HROS = 1.1;
P = .828), but not after CHOP without rituximab
(HREFS = 0.8, P = .181; HROS = 0.7, P = .083). In
contrast to rituximab, additive radiotherapy to
sites of skeletal involvement was associated with
a decreased risk (HREFS = 0.3, P = .001; HROS =
0.5; P = .111).
CONCLUSION
Rituximab failed to improve the outcome for
patients with diffuse large B-cell lymphoma with
skeletal involvement, although our data suggest a
beneficial effect of radiotherapy to sites of skeletal
involvement. Whether radiotherapy to sites of
skeletal involvement can be spared in cases with
a negative positron emission tomography after
immunochemotherapy should be addressed in
appropriately designed prospective trials.
In this Corner
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BREAST
Breast-Conserving Treatment
With or Without Radiotherapy
in Ductal Carcinoma In Situ:
15-Year Recurrence Rates and
Outcome After a Recurrence,
From the EORTC 10853
Randomized Phase III Trial.
Donker M, Litière S, Werutsky G, Julien JP, Fentiman IS,
Agresti R, Rouanet P, de Lara CT, Bartelink H, Duez N,
Rutgers EJ, Bijker N.
PURPOSE
Adjuvant radiotherapy (RT) after a local excision
(LE) for ductal carcinoma in situ (DCIS) aims at
reduction of the incidence of a local recurrence
(LR). The authors analysed the long-term risk on
developing LR and its impact on survival after
local treatment for DCIS.
CONCLUSION
At 15 years, almost one in three non-irradiated
women developed an LR after LE for DCIS. RT
reduced this risk by a factor of two. Although
women who developed an invasive recurrence
had worse survival, the long-term prognosis was
good and independent of the given treatment.
Between 1986 and 1996, 1,010 women with
complete LE of DCIS less than 5 cm were
randomly assigned to no further treatment (LE
group, n = 503) or RT (LE+RT group, n = 507).
The median follow-up time was 15.8 years.
RESULTS
Radiotherapy reduced the risk of any LR by 48%
(hazard ratio [HR], 0.52; 95% CI, 0.40 to 0.68; P <
.001). The 15-year LR-free rate was 69% in the LE
group, which was increased to 82% in the LE+RT
group. The 15-year invasive LR-free rate was 84%
in the LE group and 90% in the LE+RT group
(HR, 0.61; 95% CI, 0.42 to 0.87). The differences
in LR in both arms did not lead to differences in
breast cancer-specific survival (BCSS; HR, 1.07;
95% CI, 0.60 to 1.91) or overall survival (OS; HR,
1.02; 95% CI, 0.71 to 1.44). Patients with invasive
LR had a significantly worse BCSS (HR, 17.66; 95%
CI, 8.86 to 35.18) and OS (HR, 5.17; 95% CI, 3.09 to
8.66) compared with those who did not experience
recurrence. A lower overall salvage mastectomy
rate after LR was observed in the LE+RT group
than in the LE group (13% v 19%, respectively).
In this Corner
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BREAST
Randomized Controlled Trial
of Intensity-Modulated
Radiotherapy for Early Breast
Cancer: 5-Year Results Confirm
Superior Overall Cosmesis.
Mukesh MB, Barnett GC, Wilkinson JS, Moody AM,
Wilson C, Dorling L, Chan Wah Hak C, Qian W, Twyman N,
Burnet NG, Wishart GC, Coles CE.
PURPOSE
There are few randomised controlled trial
data to confirm that improved homogeneity
with simple intensity-modulated radiotherapy
(IMRT) decreases late breast tissue toxicity. The
Cambridge Breast IMRT trial investigated this
hypothesis, and the 5-year results are reported.
Standard tangential plans of 1,145 trial patients
were analysed; 815 patients had inhomogeneous
plans (≥ 2 cm3 receiving 107% of prescribed
dose: 40 Gy in 15 fractions over 3 weeks) and
were randomly assigned to standard radiotherapy
(RT) or replanned with simple IMRT; 330
patients with satisfactory dose homogeneity
were treated with standard RT and underwent
the same follow-up as the randomly assigned
patients. Breast tissue toxicities were assessed at
5 years using validated methods: photographic
assessment (overall cosmesis and breast shrinkage
compared with baseline pre-RT photographs) and
clinical assessment (telangiectasia, induration,
oedema, and pigmentation). Comparisons
between different groups were analysed using
polychotomous logistic regression.
0.92; P = .021). No evidence of difference was seen
for breast shrinkage, breast oedema, tumour bed
induration, or pigmentation. The benefit of IMRT
was maintained on multivariate analysis for both
overall cosmesis (P = .038) and skin telangiectasia
(P = .031).
CONCLUSION
Improved dose homogeneity with simple IMRT
translates into superior overall cosmesis and
reduces the risk of skin telangiectasia. These
results are practice changing and should
encourage centres still using two-dimensional RT
to implement simple breast IMRT.
RESULTS
On univariate analysis, compared with standard
RT, fewer patients in the simple IMRT group
developed suboptimal overall cosmesis (odds
ratio [OR], 0.68; 95% CI, 0.48 to 0.96; P = .027)
and skin telangiectasia (OR, 0.58; 95% CI, 0.36 to
In this Corner
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BREAST
The UK Standardisation of
Breast Radiotherapy (START)
trials of radiotherapy
hypofractionation for treatment
of early breast cancer:
10-year follow-up results of two
randomised controlled trials.
Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J,
Barrett-Lee PJ, Dobbs HJ, Hopwood P, Lawton PA, Magee
BJ, Mills J, Simmons S, Sydenham MA, Venables K, Bliss JM,
Yarnold JR; on behalf of the START Trialists’ Group.
Lancet Oncol. 2013 Oct;14(11):1086-1094. doi: 10.1016/
S1470-2045(13)70386-3. Epub 2013 Sep 19.
BACKGROUND
Five year results of the UK Standardisation of
Breast Radiotherapy (START) trials suggested
that lower total doses of radiotherapy delivered
in fewer, larger doses (fractions) are at least
as safe and effective as the historical standard
regimen (50 Gy in 25 fractions) for women after
primary surgery for early breast cancer. In this
prespecified analysis, the authors report the 10year follow-up of the START trials testing 13
fraction and 15 fraction regimens.
METHODS
From 1999 to 2002, women with completely
excised invasive breast cancer (pT1-3a, pN0-1,
M0) were enrolled from 35 UK radiotherapy
centres. Patients were randomly assigned to
a treatment regimen after primary surgery
followed by chemotherapy and endocrine
treatment (where prescribed). Randomisation
was computer-generated and stratified by centre,
type of primary surgery (breast-conservation
surgery or mastectomy), and tumour bed boost
radiotherapy. In START-A, a regimen of 50 Gy
in 25 fractions over 5 weeks was compared with
41·6 Gy or 39 Gy in 13 fractions over 5 weeks. In
START-B, a regimen of 50 Gy in 25 fractions over
5 weeks was compared with 40 Gy in 15 fractions
over 3 weeks. Eligibility criteria included age
older than 18 years and no immediate surgical
reconstruction. Primary endpoints were localregional tumour relapse and late normal tissue
effects. Analysis was by intention to treat. Followup data are still being collected.
RESULTS
START-A enrolled 2236 women. Median followup was 9·3 years (IQR 8·0-10·0), after which 139
local-regional relapses had occurred. 10-year rates
of local-regional relapse did not differ significantly
between the 41·6 Gy and 50 Gy regimen groups
(6·3%, 95% CI 4·7-8·5 vs 7·4%, 5·5-10·0; hazard
ratio [HR] 0·91, 95% CI 0·59-1·38; p=0·65) or the
39 Gy (8·8%, 95% CI 6·7-11·4) and 50 Gy regimen
groups (HR 1·18, 95% CI 0·79-1·76; p=0·41). In
START-A, moderate or marked breast induration,
telangiectasia, and breast oedema were significantly
less common normal tissue effects in the 39 Gy
group than in the 50 Gy group. Normal tissue
effects did not differ significantly between 41·6 Gy
and 50 Gy groups. START-B enrolled 2215 women.
Median follow-up was 9·9 years (IQR 7·5-10·1), after
which 95 local-regional relapses had occurred. The
proportion of patients with local-regional relapse
at 10 years did not differ significantly between
the 40 Gy group (4·3%, 95% CI 3·2-5·9) and the 50
Gy group (5·5%, 95% CI 4·2-7·2; HR 0·77, 95% CI
0·51-1·16; p=0·21). In START-B, breast shrinkage,
telangiectasia, and breast oedema were significantly
less common normal tissue effects in the 40 Gy
group than in the 50 Gy group.
CONCLUSIONS
Long-term follow-up confirms that appropriately
dosed hypofractionated radiotherapy is safe and
effective for patients with early breast cancer.
The results support the continued use of 40 Gy
in 15 fractions, which has already been adopted
by most UK centres as the standard of care for
women requiring adjuvant radiotherapy for
invasive early breast cancer.
In this Corner
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LUNG
Prediction of Survival by [18F]
Fluorodeoxyglucose Positron
Emission Tomography in
Patients With Locally Advanced
Non-Small-Cell Lung Cancer
Undergoing Definitive
Chemoradiation Therapy:
Results of the ACRIN 6668/
RTOG 0235 Trial.
Machtay M, Duan F, Siegel BA, Snyder BS, Gorelick JJ,
Reddin JS, Munden R, Johnson DW, Wilf LH, Denittis A,
Sherwin N, Ho Cho K, Kim SK, Videtic G, Neumann DR,
Komaki R, Macapinlac H, Bradley JD, Alavi A.
PURPOSE
In this prospective National Cancer Institutefunded American College of Radiology Imaging
Network/Radiation Therapy Oncology Group
cooperative group trial, it was hypothesised
that standardised uptake value (SUV) on posttreatment [18F]fluorodeoxyglucose positron
emission tomography (FDG-PET) correlates with
survival in stage III non-small-cell lung cancer
(NSCLC).
Patients received conventional concurrent
platinum-based chemoradiotherapy without
surgery; postradiotherapy consolidation
chemotherapy was allowed. Post-treatment
FDG-PET was performed at approximately 14
weeks after radiotherapy. SUVs were analysed
both as peak SUV (SUVpeak) and maximum
SUV (SUVmax); both institutional and central
review readings, with institutional SUVpeak as
the primary end point. Relationships between
the continuous and categorical (cutoff) SUVs and
survival were analysed using Cox proportional
hazards multivariate models.
with survival. Mean post-treatment SUVpeak
and SUVmax were 3.2 and 4.0, respectively. Posttreatment SUVpeak was associated with survival
in a continuous variable model (hazard ratio,
1.087; 95% CI, 1.014 to 1.166; P = .020). When
analysed as a prespecified binary value (≤ v > 3.5),
there was no association with survival. However,
in exploratory analyses, significant results for
survival were found using an SUVpeak cut-off
of 5.0 (P = .041) or 7.0 (P < .001). All results were
similar when SUVmax was used in univariate
and multivariate models in place of SUVpeak.
CONCLUSION
Higher post-treatment tumour SUV (SUVpeak
or SUVmax) is associated with worse survival in
stage III NSCLC, although a clear cut-off value
for routine clinical use as a prognostic factor is
uncertain at this time.
RESULTS
Of 250 enrolled patients (226 were evaluable for
pretreatment SUV), 173 patients were evaluable
for post-treatment SUV analyses. The 2-year
survival rate for the entire population was 42.5%.
Pretreatment SUVpeak and SUVmax (mean,
10.3 and 13.1, respectively) were not associated
In this Corner
READ IT BEFORE
YOUR PATIENTS
SIDE EFFECTS
Algorithm-based management
of patients with gastrointestinal
symptoms in patients
after pelvic radiation treatment
(ORBIT): a randomised
controlled trial.
Andreyev HJ, Benton BE, Lalji A, Norton C, Mohammed K,
Gage H, Pennert K, Lindsay JO.
Lancet. 2013 Sep 20. pii: S0140-6736(13)61648-7. doi:
10.1016/S0140-6736(13)61648-7. [Epub ahead of print]
BACKGROUND
Chronic gastrointestinal symptoms after pelvic
radiotherapy are common, multifactorial in
cause, and affect patients’ quality of life. The
authors assessed whether such patients could be
helped if a practitioner followed an investigative
and management algorithm, and whether
outcomes differed by whether a nurse or a
gastroenterologist led this algorithm-based care.
METHODS
For this three-arm randomised controlled trial
the investigators recruited patients (aged ≥18
years) from clinics in London, UK, with newonset gastrointestinal symptoms persisting
six months after pelvic radiotherapy. Using a
computer-generated randomisation sequence,
they randomly allocated patients to one of three
groups (1:1:1; stratified by tumour site [urological,
gynaecological, or gastrointestinal], and degree
of bowel dysfunction [IBDQ-B score <60 vs 6070]): usual care (a detailed self-help booklet),
gastroenterologist-led algorithm-based treatment,
or nurse-led algorithm-based treatment. The
primary endpoint was change in Inflammatory
Bowel Disease Questionnaire-Bowel subset score
(IBDQ-B) at six months, analysed by intention to
treat.
70 to the gastroenterologist group, and 68 to
the booklet group. Most had a baseline IBDQ-B
score indicating moderate-to-severe symptoms.
They recorded the following pair-wise mean
difference in change in IBDQ-B score between
groups: nurse versus booklet 4·12 (95% CI 0·048·19; p=0·04), gastroenterologist versus booklet
5·47 (1·14-9·81; p=0·01). Outcomes in the nurse
group were not inferior to outcomes in the
gastroenterologist group (mean difference 1·36,
one sided 95% CI -1·48).
CONCLUSIONS
Patients given targeted intervention following
a detailed clinical algorithm had better
improvements in radiotherapy-induced
gastrointestinal symptoms than did patients
given usual care. The findings suggest that for
most patients, this algorithm-based care can be
given by a trained nurse.
RESULTS
Between Nov 26, 2007, and Dec 12, 2011, the
investigators enrolled and randomly allocated
218 patients to treatment: 80 to the nurse group,
In this Corner
BRACHYTHERAPY
Welcome to the Brachytherapy
Corner!
The first GEC-ESTRO Workshop took place
towards the end of November. This event allowed
brachytherapy professionals to meet together and
exchange updates on the various projects that
they have been working on.
The GEC Working groups encompass a wide
range of scientific and clinical activities, such as
brachytherapy physics (BRAPHYQS) and the
clinical groups covering ano-rectal, breast, gynaecology, urology and head and neck. The members
of the groups presented and discussed the activities and advances taking place in their respective
field of expertise. Sally Baker will be highlighting some of the important moments during the
workshops.
Peter Hoskin, Bradley Pieters, Kari Tanderup
In this Corner
BRACHYTHERAPY
REPORT ON THE
FIRST GEC-ESTRO
WORKSHOP
22 November 2013
Brussels, Belgium
SALLY BAKER
The first GEC-ESTRO workshop was held in November 2013 in Brussels; a forum at which the six
brachytherapy specialist working groups (Gynaecology, Urology, Anorectal, Head & Neck, Breast
and Physics) highlighted their current projects
and invited discussion and collaboration within
the wider brachytherapy community. I attended
with a clinician and an Advanced Brachytherapy
Practitioner from The Christie Hospital, Manchester, UK, which allowed us to benefit from the
multidisciplinary nature of the workshop.
We were invited to attend the GEC-ESTRO Gyn
Network meeting at the ESTRO offices on the
day before the workshop. This network meeting
highlighted for me the pace of the progression
in developments in the field of 3D image guided
and optimised brachytherapy for gynaecological
cancers. Christian Kirisits detailed the new reporting recommendations for us to incorporate
into our own reporting practice (forthcoming
ICRU/GEC ESTRO Report 88). It was clear that
there are many opportunities within the network
and beyond to collaborate with other centres on
studies and also on future developmental work.
Such collaboration will lead to improvements
in techniques and hopefully benefits to patient
outcomes. The groups are open and keen for new
members.
The first session of the workshop discussed the
role of brachytherapy in salvage therapy for patients with biochemical failure. Salvage therapy
and focal therapy for prostate is currently a topic
of great debate, and Alfredo Polo, from the UroGEC working group, described some of the issues
surrounding this, including the difficulties in
identifying which patients will benefit from local
salvage, the problems associated with re-biopsy,
and the importance of functional imaging.
Jean-Michel Hannoun-Levi from the breast
cancer working group detailed the protocol for
a proposed phase II trial of accelerated partial
breast irradiation, using interstitial multi-catheter
brachytherapy, to investigate acute and late side
effects, quality of life and cosmesis.
Christian Kirisits from BRAPHYQS, the physics quality system working group, presented the
results of a four year project investigating ‘uncertainty budgets’ for different brachytherapy types.
This highlighted errors associated with source
strength determination, treatment planning, dose
delivery including applicator reconstruction, and
interfraction/intrafraction changes that lead to
a 12% total dosimetric uncertainty for the target in a single fraction of cervix brachytherapy.
Data from a multi-centre study that compared
planning images with images taken immediately
before treatment was used to quantify the uncertainty associated with changes in the dosimetric
parameters due to the alterations in target and
organ at risk volumes with respect to the planned
treatment. The impact of the total uncertainties
associated with each parameter on the dose-response curves for target and organs at risk was
reported by Nicole Nesvacil, demonstrating
In this Corner
less certainty of the dose response for organs at
risk with higher D2cc values. The uncertainties
associated with the HR-CTV D90 are lower and
thus the impact on the dose response curve of
these uncertainties is lower.
The late morning session of the workshop focused
on the role of brachytherapy in organ preservation, with presentations from the ano-rectal,
breast, and urology working groups. The main
implication of the findings from these groups was
the emphasis on determining those patients most
likely to respond and benefit from brachytherapy, thereby avoiding surgery and its associated
complications. The need to collaborate with other
centres was emphasised in order to make use of
a larger patient cohort to identify and improve
techniques and provide brachytherapy with good
clinical outcomes.
An overview of work packages from the BRAPHYQS working group was given, including a
wide range of important projects such as dosimetry audits, phantom studies and in vivo dosimetry, with the aim of improving QA and the
clinical implementation of brachytherapy. Rob
Van der Laarse gave a very interesting talk on the
difficult task of working towards DICOM connectivity between different treatment planning
systems; this work by the group will be of great
benefit for future studies and collaboration between centres.
The final session of the workshop was on clinical
trials in brachytherapy from the breast, ano-rectal, urology, head and neck and gynaecology
working groups. A prospective multi-centre study
of low dose rate prostate seed brachytherapy
following transurethral resection of the prostate
(TURP) was proposed by Carl Salembier from
the UroGEC working group because of the advanced optimisation possibilities now achievable
in prostate seed planning. By presenting a clear
protocol for centres to follow this study brings
forward seed brachytherapy as a treatment option. Previously TURP had been considered a
contraindication for seed brachytherapy. Of particular interest was the report of the EMBRACE
and retro-EMBRACE studies by Kari Tanderup
and Alina Sturdza that looked at dose effect relations through correlations between dose-volume
and dose-point parameters and local control/toxicity outcomes for cervix patients. Image guided
cervix brachytherapy from both studies showed
excellent local control with a limited number
of serious late effects and is recommended to
be the standard of care. The fact that the results
demonstrating correlation have already been used
in order to identify the essential parameters for
reporting and optimising cervix brachytherapy
plans in the future indicates the importance and
cohesion of the working group. The protocol for
the follow up trial, EMBRACE II, is under development, with dose prescription guidelines aiming
to improve patient outcomes.
The workshop was a lively forum for discussion
between individuals and centres. With so
In this Corner
much experience in one place it was an ideal
opportunity to discuss and compare opinions,
both during and in between sessions. It is essential to have good communication and collaboration between centres that use the specialised
techniques of brachytherapy so that best practice
can be established and developed. I believe that
GEC-ESTRO facilitates this, and the multidisciplinary attendance at such workshops (135 attendees at this first meeting) should be a priority
for brachytherapy centres.
Sally Baker
Principal Brachytherapy Physicist
The Christie, Manchester, UK
Peter Hoskin, organiser of the Workshop
Frank-André Siebert reporting on BRAPHYQS
ADVANCED BRACHYTHERAPY FOR PHYSICISTS
18-21 May 2014 | Brussels, Belgium
Read the interviews with Jack Venselaar and Dimos Baltas, Course Directors of
the new ESTRO teaching course on Advanced Brachytherapy For Physicists
In this Corner
RADIOBIOLOGY
“So was 2013
really a good year
for radiobiology?”
As usual we encourage you
to contact us with comments
(good or bad) at our
“electronic” mail address
[email protected]
Dear Radiobiology Corner Reader,
As we approach the New Year we have decided to invite our Radiobiology Committee members and some of our radiobiology friends to share with us their thoughts
on what they consider to have been the
radiobiology highlights of 2013. We asked
what has been your “Best of 2013”? This
might have been a paper, conference, new
collaboration, personal achievement or
something else. As you will see in this
issue the responses have been wide ranging. The following highlights and pictures
nicely summarise a radiobiology year that
has been full of activities and accomplishments, big and small.
The achievements in the continuing quest
to find opportunities to target tumour
radio-resistance stand out. But it is also
good to see that ESTRO has played an important role supporting radiation science
and facilitating collaboration by holding scientific conferences and providing
travel grants. The ESTRO endorsed and
supported “Wolfsberg” and “PREVENT”
meetings have already been highlighted
in a previous issue and were the 2013
highlights for several of us. The interaction and exchange of knowledge and
CLICK life
OR TAP ON THE IMAGES
expertise is a vital part of our scientific
and supporting high quality conferences and meetings is an important task for
ESTRO.
So was 2013 really a good year for radio-
In this Corner
RADIOBIOLOGY
“So was 2013
really a good year
[email protected]
highlights for several of us. The interaction and exchange of knowledge and
expertise is a vital part of our scientific life
and supporting high quality conferences and meetings is an important task for
ESTRO.
So was 2013 really a good year for radiobiology? Well, this is up to you to decide.
New cellular processes and radiation resistance determinants have been revealed.
Moreover, new initiatives have been
formed in order to identify genetic determinants of normal tissue response, and
new treatment combinations have been
proposed with targeted agents. All in all,
very positive, but we certainly want things
to move faster. Indeed, the translation to
the clinic is a difficult and demanding
path with many challenges to be overcome
as funding becomes scarcer. As we discovered in the literature this year, rather than
investing in multiple avenues of research
and diverse activities, we will have to focus better and invest in a few of the most
promising areas. There have been a lot of
new ideas and some initial testing of novel
strategies, but only a few have been able to
progress the ideas to the level that warrant
detailed clinical testing.
CLICK
Our congratulations and best wishes
goOR
to TAP ON THE IMAGES
our ESTRO radiobiology community and
to everyone wherever they may be who
has made a contribution to the scientific
and clinical progress that has been made
during 2013 and to an even more fruitful
In this Corner
RADIOBIOLOGY
“So was 2013
really a good year
[email protected]
detailed clinical testing.
Our congratulations and best wishes go to
our ESTRO radiobiology community and
to everyone wherever they may be who
has made a contribution to the scientific
and clinical progress that has been made
during 2013 and to an even more fruitful
2014.
Conchita, Anne and Martin
In this Corner
BEST OF 2013:
OUR HIGHLIGHTS
IN RADIOBIOLOGY
RADIOBIOLOGY
The mechanisms driving radioresistance
in glioblastoma
Intracranial models for glioblastoma
Marc Vooijs
Brad Wouters
The Wolfsberg meeting
Microenvironment and radiotherapy
Anthony Chalmers
Marie-Catherine Vozenin
Three important meetings
The Hallmarks of Cancer and the Radiation
Oncologist: Updating the 5Rs of Radiobiology
Jan Alsner
Peter Sminia
The tumour suppressor gene PTEN
We all want to see radiotherapy developing further, better and stronger
Rafal Suwinski
Conchita Vens
The Wolfsberg meeting, the conference on
Tumour Microenvironment and Cellular Stress
and several high potential approaches...
Paul Span
In this Corner
BEST OF 2013:
OUR HIGHLIGHTS IN RADIOBIOLOGY
RADIOBIOLOGY
The mechanisms driving
radioresistance in glioblastoma
Brad Wouters
Princess Margaret Cancer Centre
Toronto, Canada
BRAD WOUTERS
For me, one of the highlights this year was a recent study by Bhat et al.1 in the Aldape lab at MD
Anderson which sheds light on the mechanisms
driving radioresistance in glioblastoma. This disease is characterised by extreme radiation resistance, and hence, understanding the underlying
molecular features of this disease is likely to be
informative of more general mechanisms mediating radiosensitivity.
Previous work has shown that glioblastomas can
be subtyped into two distinct genomic classes
referred to as either proneural or mesenchymal.
These two tumour types show distinct gene expression profiles, and underlying mutations as
well as major differences in radiosensitivity. The
mesenchymal subtype demonstrates significantly
more resistance than the proneural type. However, the MD Anderson group showed stem cells
derived from some of the mesenchymal tumours
demonstrated plasticity and had a tendency to
adopt a proneural (radiosensitive) phenotype during culture in vitro. Nevertheless, these stem cells
reverted back to a mesenchymal (radioresistant)
phenotype in vivo through interactions with macrophages and microglia in the tumour microenvironment in a TNF-α/NF-κB-dependent manner.
Demonstration of this plasticity between proneural and mesenchymal states, and identification of
a targetable pathway that controls, suggests there
may be new therapeutic possibilities to modulate
radiosensitivity of this disease.
REFERENCE
1. Mesenchymal differentiation mediated by NF-kB
promotes radiation resistance in glioblastoma
Bhat KP, Balasubramaniyan V, Vaillant B, Ezhilarasan R, Hummelink K, Hollingsworth F, Wani K,
Heathcock L, James JD, Goodman LD, Conroy S,
Long L, Lelic N, Wang S, Gumin J, Raj D, Kodama Y,
Raghunathan A, Olar A, Joshi K, Pelloski CE, Heimberger A, Kim SH, Cahill DP, Rao G, Den Dunnen
WF, Boddeke HW, Phillips HS, Nakano I, Lang FF,
Colman H, Sulman EP, Aldape K.
Cancer Cell, 24(3):331-46. 2013
In this Corner
BEST OF 2013:
RADIOBIOLOGY
Microenvironment
and radiotherapy
Marie-Catherine Vozenin
Centre Hospitalier Univ. Vaudois
Lausanne, Switzerland
MARIE-CATHERINE
VOZENIN
Microenvironment contribution to tumour
response to radiotherapy and its relevance in
radiobiology has greatly evolved during recent
years.
Interestingly, fifteen years ago radiation therapy was seen as an “old-fashioned” anti-cancer
treatment, whereas today radiotherapy is at the
forefront of innovation. I think that radiotherapy
will be one of the greatest contributors to tumour cure in the future when appropriately
combined with other therapeutic approaches.
The immunological contribution to cancer
development and cancer treatment response
is well characterised. The high presence of Tumour-Infiltrating Lymphocytes, TILs correlates
well with recurrence free survival, especially
when cytotoxic CD8 lymphocytes (CTLs) are
infiltrating the tumour. In addition, the lymphocyte T helper polarisation into TH1 cells is
expected to enhance CTLs anti-tumor efficacy.
On the other hand, TH2 and Treg (regulatory)
recruitment at the tumour site is immunosuppressive and induces immune escape. Similarly
macrophages also seem to have a fine tuned role
in tumour immunology. M1 macrophages have
been shown to activate tumour-killing mechanisms and to direct antitumour response by
promoting a CD8 cytotoxic response. Whereas
Tumour Associated Macrophages (TAMs) are
known to suppress anti-tumour immunity by
modifying the tumour environment and are
expressing an M2-like phenotype. Therefore,
Th1/M1 polarisation can be seen as promoting
anti-tumour immunity, whereas Th2/M2 induce
immunotolerance.
Immunomodulatory agents and their use in
combination with radiotherapy are of great
promise and stand to benefit from radiotherapy’s
local anti-tumour efficacy and abscopal effect.
Several recent reports, including the Klug et al
paper [1] in the November issue of Cancer Cell
and the comment by De Palma et al., [2] related
to Klug’s paper, suggest that radiotherapy is
Fifteen years ago, microenvironment studies
mostly, and in some cases only, focused on hypoxia, whereas today radiobiologists are dissecting the complex interplay between tumour cells,
immune cells infiltration, vessels, fibroblasts and
extracellular matrix. The complexity of the picture is great, but interpretation has been helped
by the improved accuracy in defining the various cell populations involved and today has led
to new therapeutic strategy proposals in which
radiation therapy takes a major role.
In this Corner
BEST OF 2013:
able to trigger M1 versus M2 polarisation depending upon the dose and modality of administration. Klug et al. showed that “low dose”
irradiation (LDI 2-5 Gy) associated with immunotherapy was able to re-polarise TAM into
M1 macrophages that would promote cytotoxic
action. Therefore, assuming that the right radiotherapy protocol is applied, one would expect
an improvement of anti-tumour immunity
when the disease is locally irradiated. In addition, radiation-induced humoural and paracrine action in abscopal effect can be anticipated
which will also benefit distant relapse and metastatic spread.
REFERENCES
1. Low-Dose Irradiation Programs Macrophage
Differentiation to an iNOS(+)/M1 Phenotype
that Orchestrates Effective T Cell Immunotherapy
Klug F, Prakash H, Huber PE, Seibel T, Bender N,
Halama N, et al.
Cancer Cell. 2013;24:589-602.
2. A New Twist on Radiation Oncology: Low-Dose Irradiation Elicits Immunostimulatory Macrophages that Unlock Barriers to Tumor Immunotherapy
De Palma M, Coukos G, Hanahan D.
Cancer Cell. 2013;24:559-61.
In this Corner
BEST OF 2013:
RADIOBIOLOGY
Three important meetings
Jan Alsner
Department of Experimental Clinical Oncology
Aarhus University Hospital
Aarhus, Denmark
For me, three meetings stood out as highlights in
2013. First, I had the great pleasure of co-chairing
the PREVENT (Prediction, Recognition, EValuation, Eradication of Normal Tissue effects of
radiotherapy) meeting in Geneva in April with
Marie-Catherine Vozenin. We aimed for a multidisciplinary meeting and were fortunate to have
a number of speakers from outside our normal
fields. For example we heard from epidemiologists who use population-based approaches to
study aspects of radiation adverse effects and
experts in treating fibrosis that is not induced by
radiotherapy.
A second highlight of the year was the Wolfsberg
Meeting in June. The scientific presentations at
Wolfsberg meetings are always outstanding, illustrated by the large number of very good abstracts
that could not be accepted due to the limitation
on the number of participants. The social events at
Wolfsberg contribute greatly to the success and popularity of these meetings. This year, it was a great
personal pleasure to be on the Wolfsberg Sports
Cup winning team “Team Microenvironment”.
JAN ALSNER
is the first successful major grant application for
the consortium. REQUITE is an EU FP7 supported collaborative project co-ordinated by Catharine
West (Manchester) and Chris Talbot (Leicester).
The overall aim of the project is to develop validated clinical models and incorporate biomarkers that,
before treatment, identify which cancer patients
may be at risk of side-effects and use the models
to design interventional trials aimed at reducing
side-effects and thereby improving the quality of
life of cancer patients who undergo radiotherapy.
I have worked in radiogenomics for many years
and it is great to see how the field is gaining new
momentum with the conclusion of a number of
large genome-wide studies. This is an inspiring
time and is energising all members of the consortium to work even harder on the many unsolved
issues by extending international collaborations.
Another highlight of the year for me was a smaller joint meeting in Cambridge in October which
started with the 5th annual meeting in the International Radiogenomics Consortium and was followed by the kick-off meeting for REQUITE which
In this Corner
BEST OF 2013:
RADIOBIOLOGY
The tumour suppressor
gene PTEN
Rafal Suwinski
Centre of Oncology
Gliwice, Poland
RAFAL SUWINSKI
Recent years have brought a remarkable breakthrough in the understanding of molecular
pathways that are responsible for cancer progression and resistance to cytotoxic therapies. Medical oncology introduced numerous
agents that target the most important of these
pathways, creating the basis for targeted therapy. Radiation biology closely monitors these
achievements, given that several mechanisms
relevant to the activity of targeted agents are
also relevant to radiosensitivity of the tumour.
Recent studies have demonstrated that tumour
suppressor gene PTEN (phosphatase and tensin homolog deleted on chromosome ten) is
defective in several cancer types. The defect of
PTEN, (the gene that is involved in PI3K/mTOR
pathway), as well as tumour hypoxia, are considered among the major causes of radioresistance.
Potiron VA et al. addressed these findings and
demonstrated that dual PI3K/mTOR inhibitor was able to sensitise radioresistant prostate
cancer cells in both normoxic and hypoxic conditions. The study may be considered as one of
the signs that shows the future directions of
clinically oriented radiobiology. Integration of
medical oncology, molecular biology, classical
radiobiology and radiation therapy will likely
contribute to major clinical advances in the near
future.
REFERENCE
Radiosensitization of prostate cancer cells by
the dual PI3K/mTOR inhibitor BEZ235 under
normoxic and hypoxic conditions
Potiron VA, Abderrahmani R, Giang E, Chiavassa S,
Di Tomaso E, Maira SM, Paris F, Supiot S.
Radiother Oncol. 2013 Jan;106(1):138-46. 12.
In this Corner
BEST OF 2013:
RADIOBIOLOGY
The Wolfsberg meeting,
the conference on Tumour
Microenvironment and Cellular
Stress and several high potential
approaches...
Paul Span
Department of Radiation Oncology
Radboud University Medical Centre
Nijmegen, the Netherlands
PAUL SPAN
In 2013, I had the pleasure of attending the 2013
International Wolfsberg Meeting on Molecular
Radiation Biology/Oncology. This meeting was
once again of a high standard, and I especially
enjoyed the fact that there is ample time in the
programme to read and discuss the numerous
posters from established as well as young, up
and coming investigators. As always, the organisation was flawless in all respects (although
the judging of the sporting event could possibly
benefit from a little more objectivity!).
The International Conference on Tumour Microenvironment and Cellular Stress held in 2013
on Corfu, Greece was similarly a very enjoyable
highpoint of the year. This was just the second
occasion on which this meeting has been held
and the standard was high, with a good balance
of time for discussion and interaction. It would
seem that relatively small meetings are the most
fruitful in that respect.
Considering the achievements in radiobiology
during 2013, I can see several high potential approaches that have been on the rise over the last
couple of years. Our understanding of signaling
pathways involved in intrinsic and acquired
radioresistance is expanding rapidly. The addition of molecular targeted therapy to targeted
local radiotherapy may combine the best of both
worlds, with locally applied radiotherapeutic
treatment being systemically enhanced by medical immunotherapeutic agents. This approach
shows promise but also complexity given the
large number of available combinations. The use
of imaging to monitor treatment efficacy and to
identify treatment escape in a timely manner
will be crucial for clinical success.
In addition, growing attention is being directed towards aspects of metabolism and immune
function as important parts of the tumour microenvironment and their particular effects on
tumour growth and treatment sensitivity. It will
be very interesting to see how the different disciplines involved in this environment will be able
to join forces on these intricate topics.
Finally, there is a rapidly expanding literature
on next generation sequencing of tumours. The
data generated by these studies might soon be
used to identify tumours that will or will not be
sensitive to radiotherapy or the processes involved in radioresistance. To this end, it will be
important to have quality-controlled biobanking
facilities for the collection of radiotherapy trial
patient samples.
In this Corner
BEST OF 2013:
RADIOBIOLOGY
Intracranial models for
glioblastoma
Marc Vooijs
Maastro (Maastricht Radiation Oncology)
Maastricht, The Netherlands
Supported by an ESTRO TTG grant, Sanaz Yahyanejad (Maastro) visited the University of Glasgow laboratory of Anthony Chalmers to learn
more about intracranial models for glioblastoma
using precision neurosurgery.
The Glasgow model was successfully transferred
to Maastricht University where Yahyanejad is
studying the role of NOTCH signaling in radiotherapy resistance in the group of Marc Vooijs.
The photograph of the CT scan shows an intracranial glioblastoma delineated with contrast-enhanced CT using treatment planning system
software on SmART (Small Animal Radiotherapy) platform developed by Frank Verhaegen and
co-workers at Maastro.
Anthony Chalmers
Sanaz Yahyanejad
Intracranial mouse glioblastoma model
MARC VOOIJS
In this Corner
BEST OF 2013:
RADIOBIOLOGY
The Wolfsberg meeting
Anthony Chalmers
Beatson Cancer Centre
Glasgow, UK
Returning to the Wolfsberg meeting after a fouryear interval was the highlight of my radiobiological year. Being invited to speak at the meeting was a huge honour and a very great pleasure.
And watching three members of my lab team
relishing the Wolfsberg experience for the first
time was the icing on the cake.
Wolfsberg 2013
Team building, Wolfsberg style
ANTHONY CHALMERS
In this Corner
BEST OF 2013:
RADIOBIOLOGY
The Hallmarks of Cancer
and the Radiation Oncologist:
Updating the 5Rs of
Radiobiology
Peter Sminia
Radiobiologist VU University Medical Centre,
PETER SMINIA
I enjoyed reading the recently published paper
by Good and Harrington entitled “The Hallmarks of Cancer and the Radiation Oncologist:
Updating the 5Rs of Radiobiology”, in which
they seek to link the 5Rs of Radiobiology to
the 9 Hallmarks of Cancer (Tip: use it for your
students!). In particular, their paragraph saying: “Our ability to build machines that deliver
radiation with ever greater accuracy and conformality is testament to the skill and ingenuity
of engineers, medical physicists and computer
scientists. Despite this phenomenal progress,
radiotherapy will continue to fall short of its
promise. The next quantum leap in progress will
require radiation oncologists to immerse themselves in the biological basis of cancer and its
response to radiation”. And, I would add: ... and
radiobiologists to provide the information about
new and exciting results from their own and
their colleagues’ laboratories and translation of
those data into clinical practice!
Over the last few years, a number of radiobiological questions have been raised regarding
the use of (flattening filter-free) Volumetric
Modulated Arc Therapy, which has now been
introduced into patients’ therapy. But what
about the larger tissue volumes exposed to lower irradiation dose and the very high dose rates
with regard to toxicity, tumour response and
induction of secondary malignancies? Studies
by colleagues in the field emerged, as well as
our own laboratory report, that addresses the
dose rate issue. This is just another example of
the fact that further progression in radiotherapy requires expert input from dedicated basic
and translational scientists in radiobiology. The
Wolfsberg meeting, organised in assocation
with ESTRO, and the many other national and
international meetings provide the forum for
exchange of knowledge in a fruitful and pleasant place, just like this Radiobiology Corner. We
need these meetings and fora if we are to move
radiation oncology forward in 2014 and beyond!
REFERENCE
The Hallmarks of Cancer and the Radiation
Oncologist: Updating the 5Rs of Radiobiology
Clinical Oncology 25, 2013, 569-577
In this Corner
BEST OF 2013:
RADIOBIOLOGY
We all want to see radiotherapy
developing further, better and
stronger
Conchita Vens
NKI (Netherland Cancer Institute)
My best of 2013? Well, we have discussed paper
highlights and conferences before, so I don’t want
to repeat myself. On a personal note, I felt very
honoured by the trust placed in me by the ESTRO
members who voted for me to become an ESTRO
Board member this year. We had the first Board
meeting in December with the new members and
it was with great pleasure that I participated.
The impressive thing to me was that there is a
clear consensus among such a multidisciplinary
group concerning where we want to move towards. We all want to see radiotherapy, and from
my particular perspective, radiobiology, developing further, better and stronger and we know that
ESTRO can play a substantial role in this. We
may not always all agree on how things can and
should be done, but it was clear to me that having
the same goal in sight instantly created a strong
bond. So I’m very much looking forward to the
future discussions in the coming year.
Wolfsberg meeting
CONCHITA VENS
In this Corner
PHYSICS
“We are delighted
to announce that
the Physics Corner
team has been
strengthened by
the addition of
Mischa Hoogeman.”
Dear Reader,
We are delighted to announce that the Physics
Corner team has been strengthened by the
addition of Mischa Hoogeman from Rotterdam.
On the next page you can read a little background
about Mischa.
We also continue our recent paper review feature,
again highlighting one paper from each of the
‘big four’ scientific journals in our field.
Along the same line we also encourage you
to take a close look at the December issue of
Radiotherapy & Oncology (www.thegreenjournal.
com). This issue of the Journal is completely
devoted to physics and comprises a collection of
papers originally presented orally at the Biennial
Physics Conference in Geneva 2013, which was
part of the 2nd ESTRO Forum. Hopefully you will
find papers that stimulate further clinical and
scientific advances in our field.
We wish you all the best for 2014.
Ludvig Muren ([email protected]),
Frank Van den Heuvel (frank.vandenheuvel@
uz.kuleuven.ac.be),
Mischa hoogeman ([email protected])
In this Corner
PHYSICS
INTRODUCING
MISCHA HOOGEMAN...
New member of Physics
Corner Team
Mischa Hoogeman received his MSc in experimental physics from the University of Amsterdam. His PhD work involved scanning-tunneling microscopy studies on atomic surface
diffusion at crystalline metallic surfaces. After
receiving his PhD from the University of Leiden he switched to the field of medical physics.
He worked for several years at the Antoni van
Leeuwenhoek / Netherlands Cancer Institute
as a postdoctoral researcher investigating internal organ motion and dose-effect modelling in
prostate cancer patients. Having completed his
training in medical physics Mischa was appointed to the staff of the Medical Physics Department at Erasmus MC in Rotterdam.
Mischa’s research interests include online-adaptive radiotherapy, robotic radio-surgery, image
registration, and more recently proton therapy.
He supervises PhD students and postdoctoral
researchers involved in research on these topics.
Mischa is also involved in setting up the HollandPTC proton therapy centre, a joint effort
between the Erasmus MC and LUMC medical
centres and the Delft University of Technology.
HollandPTC is one of the four proton therapy
initiatives in the Netherlands.
MISCHA HOOGEMAN
In this Corner
PHYSICS
A 4D-optimization concept for scanned ion
beam therapy
C. Graeff, R. Lüchtenborg, J. Gordon Eley , M. Durante, C. Bert
Radiother Oncol 2013;109(3):419-24
Comparative study of layered and volumetric rescanning for different scanning speeds of proton
beam in liver patients
K. Bernatowicz, A. J. Lomax and A. Knopf
Phys Med Biol 2013;58(22):7905-20
EDITORS’ PICKS
Highlight Radiotherapy Physics Papers
Assessing the uncertainty in QUANTEC’s
dose-response relation of lung and spinal cord
with a bootstrap analysis
M. Wedenberg
Int J Radiat Oncol Biol Phys 2013; 87: 795-801
Characterization of a novel EPID designed for
simultaneous imaging and dose verification in
radiotherapy
S. J. Blake, A. L. McNamara, S. Deshpande, L. Holloway,
P. B. Greer, Z. Kuncic, P. Vial
Medical Physics 2013; 40(9):091902
In this Corner
EDITORS’ PICKS
PHYSICS
A 4D-OPTIMIZATION
CONCEPT FOR SCANNED
ION BEAM THERAPY
Christian Graeff a, Robert Lüchtenborg a, John Gordon Eley b,
Marco Durante a, Christoph Bert a,c
a. GSI Helmholtzzentrum für Schwerionenforschung GmbH,
Darmstadt, Germany
b. The University of Texas MD Anderson Cancer Center,
Houston, USA
c. University Clinic Erlangen, Radiation Oncology, Erlangen,
Germany
Radiother Oncol. 2013 Dec;109(3):419-24. doi: 10.1016/j.
radonc.2013.09.018. Epub 2013 Oct 31
Corresponding author: Christian Graeff
Email: [email protected]
CHRISTIAN GRAEFF
WHAT WAS YOUR MOTIVATION
FOR INITIATING THIS STUDY?
The optimisation of treatment plans for
moving tumours on the entire 4D-CT offers
the possibility of i) conformal treatment plans
with extended potential for OAR-sparing, ii)
managing complex tumour motion beyond mere
translation, and iii) converting the problem of
conformal range adaptation of the ion beam from
a complex online hardware problem to an offline
software one. The first two points have already
been demonstrated for photon therapy, but the
last one is specific to particle therapy, so that the
benefit of 4D-optimisation will be even greater.
WHAT WERE THE MAIN
CHALLENGES DURING THE WORK?
To find a working strategy for 4D-optimisation
in scanned ion beam therapy, which exploits its
advantages, such as the easy and fast deflection of
the beam, but also permits delivery with a high
duty cycle that is synchronised to the breathing
motion. In addition, we wanted to reduce the
problem of optimisation while still allowing for
complete and conformal target coverage.
The solution of assigning subsections of the target
to each motion phase resulted in a 4D-treatment
plan, which required modification of our
treatment control system. The modification of
the existing system for an experimental proof of
concept was difficult, though the final solution
was not.
WHAT IS THE MOST IMPORTANT
FINDING FROM YOUR STUDY?
That 4D-optimisation for a carbon ion beam is
feasible, results in plans that can be effectively
delivered, and achieves conformal dose coverage
for large and complex tumour motions and
geometries.
WHAT ARE THE IMPLICATIONS OF
THIS RESEARCH?
We developed a 4D-optimisation strategy which
was successfully tested in a planning study and in
an experiment with simple phantom geometries.
Although planning and delivery for the
conformal dose to moving targets are therefore
feasible, it remains to be shown that the resulting
plans can also be made robust enough for clinical
applicability. The two main points here are the
precision of the motion monitoring system and
tolerance of irregular motion especially with
respect to the original planning 4D-CT.
In this Corner
EDITORS’ PICKS
PHYSICS
COMPARATIVE STUDY OF
LAYERED AND VOLUMETRIC
RESCANNING FOR DIFFERENT
SCANNING SPEEDS OF PROTON BEAM IN LIVER PATIENTS
K. Bernatowicz1,2, A. J. Lomax1,2 and A. Knopf1,2
1. Proton Therapy Center, Paul Scherrer Institute, Villigen PSI,
Switzerland
2. ETH Zurich, Zurich, Switzerland
Phys Med Biol. www.ncbi.nlm.nih.gov/pubmed/24165090# 2013 Nov 21;58(22):7905-20. doi: 10.1088/00319155/58/22/7905. Epub 2013 Oct 29.
Corresponding author: Kinga Bernatowicz
WHAT WAS THE AIM OF THE
STUDY?
rescanning methods by simulating four realistic
BPAT scenarios and have evaluated the resultant
dose distributions calculated for two liver cases
under different motion conditions and for
different treatment plans (i.e. different number of
fields and field directions) and rescanning modes.
We have found that layered rescanning was
optimal for slow scanning systems (i.e. energy
switching times of 1s), both in terms of dose
homogeneity and treatment time. On the other
hand, the effectiveness of volumetric rescanning
appears to be less sensitive to the starting phase
of motion. For fast scanning systems (i.e. energy
switching times of << 1s) both rescanning
approaches are viable.
WHAT WERE THE CHALLENGES?
THIS RESEARCH?
Scanned proton therapy is a well-established
cancer treatment for a number of indications
and is an increasingly popular delivery method
for new facilities. However, interplay effects
are a limiting factor in the treatment of mobile
targets with this modality, which can result in
significant dose inhomogeneities within the
target volume. One way to overcome this effect
is rescanning, for which there are two main
approaches; volumetric, where the full volume is
scanned several times, or layered, which applies
several scans per energy plane before switching
the energy.
In general, treatment facilities and manufacturers
employ different beam position adjustment
times (BPATs) depending on the capabilities
of their hardware, which results in different
temporal characteristics of their delivery. Hence,
dosimetric effects resulting from irradiation of
moving tumours will vary depending on these
differing BPATs.
HOW DID YOU CARRY OUT THE
STUDY?
KINGA BERNATOWICZ
This study provides the first guidelines on the
suitability of different proton delivery designs
with respect to their suitability for treating
moving targets. Although faster scanning
facilities are desirable, we have shown that
rescanning solutions are also feasible using
existing proton delivery systems and could be
implemented in practice, particularly when
multiple field plans are used.
In this work, we have investigated different
In this Corner
EDITORS’ PICKS
PHYSICS
ASSESSING THE UNCERTAINTY IN QUANTEC’S
DOSE-RESPONSE RELATION
OF LUNG AND SPINAL
CORD WITH A BOOTSTRAP
ANALYSIS
Minna Wedenberg, Medical Radiation Physics, Department
of Oncology-Pathology, Karolinska Institutet, Stockholm,
Sweden, and RaySearch Laboratories, Stockholm, Sweden
Int J Radiat Oncol Biol Phys 2013; 87: 795-801
Corresponding Author: Minna Wedenberg
Dose-response relations of normal tissue are
important for appraising toxicity risk and are
used to make recommendations for radiation
therapy. These relations are uncertain since they
tend to be derived from a limited number of
patients. The aim of this study was to quantify
this uncertainty and we studied QUANTEC’s
estimated population-based dose-response
relations with a bootstrap method.
variability are disregarded, as in our study. The
bootstrap method can assess different aspects of
uncertainty and in this study we generated 95%
pointwise confidence intervals of dose-response
relations, giving upper and lower limits on
toxicity risk, and we visualised the uncertainty in
model parameters of normal tissue complication
probability (NTCP) models. For the cases
studied, we showed that the common assumption
of Gaussian distributed and uncorrelated model
parameters do not hold.
WHAT WERE THE MAIN
THIS RESEARCH?
The key challenge was to ascertain sufficiently
detailed outcome data from the original studies,
as this is often not provided in the published
papers. Effective application of the bootstrap
method requires information on individual
patient outcomes; sample means and variances
do not suffice.
FINDING OF YOUR STUDY?
MINNA WEDENBERG
Treatment decisions and clinical guidelines
should acknowledge and account for the
uncertainty in empirical dose-response relations
derived from limited numbers of patients.
The proposed bootstrap method assesses the
inherent uncertainty in clinical outcome data
and translates this into uncertainty in the doseresponse relation. The bootstrap should also
be utilised to estimate uncertainty in other
biological models derived from empirical data.
There is substantial uncertainty in published
dose-response relations, even when they
combine evidence from multiple studies
such as in the QUANTEC review, and when
sources of variability other than sampling
In this Corner
EDITORS’ PICKS
PHYSICS
CHARACTERIZATION OF A
NOVEL EPID DESIGNED FOR
SIMULTANEOUS IMAGING
AND DOSE VERIFICATION IN
RADIOTHERAPY
Samuel J. Blake, Aimee L. McNamara, Shrikant Deshpande,
Lois Holloway, Peter B. Greer, Zdenka Kuncic, Philip Vial
Medical Physics 2013; 40(9):091902
Corresponding Author: Philip Vial,
Department of Medical Physics, Liverpool and Macarthur
Cancer Therapy Centres, NSW, Australia;
There is a need for effective in vivo dose
verification during radiotherapy. In contrast to
the dramatic improvements in image-guided
radiotherapy (IGRT) over the last decade, most
radiotherapy patients worldwide still receive
no dose verification during treatment. One of
the most promising solutions proposed for in
vivo dosimetry is the use of Electronic Portal
Imaging Devices (EPIDs). EPIDs are optimised
for imaging and lack fundamental dose response
characteristics required for accurate dosimetry.
To date, research and development towards
resolving EPID dosimetry has focused on model
based solutions, with relatively little research
aimed at improving the detector design for
dosimetry. This project proposes a new EPID
design based on a standard amorphous silicon
(a-Si) photodiode array combined with an array
of plastic scintillator fibers.
WHAT WERE THE MAIN
SAMUEL J. BLAKE
Imaging requires efficient x-ray detection, usually
addressed by the use of high atomic number (Z)
materials. Dosimetry requires water equivalent
dose response, precluding the use of high Z
materials. Achieving adequate sensitivity and
resolution for MV imaging with water equivalent
materials poses a significant challenge.
FINDING OF YOUR STUDY?
Our study demonstrates that plastic scintillator
fibers coupled directly to an a-Si photodiode
array provides a highly water equivalent
2-dimensional radiotherapy dosimeter. The
prototype plastic scintillator array EPID has
reduced overall sensitivity and spatial resolution
compared to the standard EPID, due in part to
limitations in the manufacturing process and the
relatively low optical yield of plastic scintillators.
Modelling work is underway to determine the
optimal plastic scintillator array design for
simultaneous imaging and dosimetry.
THIS RESEARCH?
An EPID capable of simultaneous imaging
and dosimetry would provide a more robust
and accurate in vivo dosimetry solution and,
consequently, a simpler implementation model
for the large scale uptake of in vivo dosimetry as
routine practice.
In this Corner
PHYSICS
PHYSICS
MEMBERS’
ASSEMBLY
7 April 2014
from 13.30 - 14.30
at ESTRO 33 in Vienna
COME AND JOIN US AND SHARE
YOUR OPINIONS ON THE PHYSICS
ACTIVITIES IN ESTRO
The assembly is open to all Physics members
of ESTRO, and is a platform to present and
discuss the activities of the Physics Committee. The first assembly was held last year in
Geneva at the 2nd ESTRO Forum and proved
to be a great success.
Details of the agenda and venue will be
communicated to you closer to the date and
we all hope to see you there.
In this Corner
RTT
“This is an exciting
time for the UK
and RTTs especially to
be involved in adaptive
RT in a trial setting.”
Welcome to all of you to this month’s RTT
Corner!
The RTT committee members have been
particularly busy recently preparing for the
upcoming ESTRO 33 congress in Vienna. Our
colleagues in charge of the RTT track highlight
for us what to expect so I would encourage you
all to read about the plans for this event and
hopefully we will see you there!
The first article has been written by RTTs
from the UK Radiotherapy Trials QA group.
This details the complex IGRT credentialling
programme which has been developed for the
first adaptive radiotherapy clinical trial in the
UK. This multi-centre clinical trial presented
challenges to the group, as explained in the
article, but this is an exciting time for the UK
and RTTs especially to be involved in adaptive
RT in a trial setting.
ANGELA
BAKER
The second article reports on an initiative
between the UK NCRI Clinical and
Translational Radiotherapy working group
and the Society and College of Radiographers
to develop research roles for RTTs and
associacted training requirements. I have
been fortunate enough to be involved with
this ongoing work which is something that is
particularly close to my heart as a Research
RTT.
We would be very interested to hear from
other countries on this topic. Please email me
if you would like to offer an article for a future
edition, discuss collaboration or exchange
ideas on increasing the level of RTT research.
In this Corner
RTT
“This is an exciting
time for the UK
and RTTs especially to
be involved in adaptive
RT in a trial setting.”
other countries on this topic. Please email me
if you would like to offer an article for a future
edition, discuss collaboration or exchange
ideas on increasing the level of RTT research.
Finally, in this RTT Corner we report on
the recent ESTRO ‘Train the RTT Trainers’
course. The article has been written by a team
from Macedonia who attended this extremely
popular and successful course and details their
learning experience.
I hope you will all enjoy reading the RTT
Corner. If you would like to contribute, feel
free to send an email either to me (angela.
[email protected]) or to Martijn
Kamphuis ([email protected]). This Corner
is a great place to share your vision and
knowledge.
ANGELA
BAKER
Angela
In this Corner
RTT
NATIONAL PERSPECTIVES:
THE UNITED KINGDOM
IGRT
Emma Parsons, Yat Tsang & Elizabeth Miles
Corresponding author: Emma Parsons, RTTQA
Radiographer, Mount Vernon Cancer Centre,
Northwood, UK
THE DESIGN AND IMPLEMENTATION OF AN IMAGE GUIDED RADIOTHERAPY
CREDENTIALING PROGRAMME IN THE UK
In the United Kingdom (UK), safe and efficient
implementation of IGRT protocols is encouraged
through participation in clinical trials. To date,
the UK’s experience of adaptive treatment in a
clinical trial setting has been limited to single
centre feasibility studies. The NRAG report published in 2007 outlined a national strategy for
radiotherapy services providing a template for
developing services nationwide 1. The report advised that four-dimensional adaptive radiotherapy is the future standard of radical radiotherapy
treatment the NHS should aspire to. This report
is supported by the recently published guidance
for implementation and use of IGRT from the
National Radiotherapy Implementation Group
(NRIG) through the National Cancer Action
Team 2.
HYBRID (A multicentre randomised phase II
study of HYpofractionated Bladder Radiotherapy
with or without Image guided aDaptive planning) is the first national UK multi-centre trial
to adopt a ‘plan of the day’ adaptive treatment
technique (CRUK/12/055). All patients receive a
total dose of 36Gy delivered in 6 weekly fractions
of 6Gy and are randomised between standard or
adaptive planning. The standard arm employs a
EMMA PARSONS
REFERENCES
single plan production using standard CTV-PTV
expansions, which is then delivered for the entirety of treatment using daily Conebeam CT taken
prior to each fraction. For patients allocated to
the adaptive “plan of the day” arm three plans
will be generated for three different PTVs: small,
medium and large. The pre-treatment Conebeam
CT for these patients will be utilised to choose
the ‘plan of the day’ depending on the bladder
volume.
As the primary objective of HYBRID is to assess
whether an adaptive technique can reduce the
level of acute non-genitourinary side effects resulting from hypofractionated radiotherapy for
bladder cancer, it is imperative that the ‘plan of
the day’ is accurately and consistently selected
across all centres recruiting patients to the trial.
Therefore a comprehensive Quality Assurance
(QA) programme is being implemented, which
contains both pre-trial and on-trial components
with an emphasis on the unique image guided
radiotherapy (IGRT) component of the trial.
The QA programme has been designed by the UK
NCRI Radiotherapy Trials QA (RTTQA) group.
This is a national multidisciplinary group
ACKNOWLEDGEMENTS
In this Corner
c
o
a
p
e
t
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w
q
p
I
U
g
a
p
Th
•
•
comprising physicists, RTTs (UK titled: radiographers) and clinicians tasked with designing
and implementing trial specific quality assurance
programmes. The aim of these programmes is to
ensure protocol compliance and minimise variations in radiotherapy planning and delivery in a
multicentre trial setting. IGRT QA is challenging
when there are variations in equipment, image
quality, matching techniques and IGRT training
programmes across multiple investigator sites.
In line with other international QA groups, the
UK RTTQA group has developed an IGRT programme to address the importance of consistency
across all recruiting sites and compliance of IGRT
practice with trial protocol.
The IGRT credentialing for HYBRID includes the
following steps:
• Facility questionnaire: This is designed to
gauge the IGRT experience of a centre to date.
It gains information regarding the type of
IGRT used, action thresholds, frequency of
interventions and imaging doses.
• Process document: Details are collected on all
aspects of tasks for the complete patient pathway and includes details on all imaging procedures.
• In house IGRT training programme: It is a
requirement of HYBRID that sites have an
established IGRT training programme already
in place before joining the trial. They should be
utilising conebeam CT for treatment of bladder patients.
• HYBRID specific training programme: Practice cases are provided for centres to work
through with answers provided.
• IGRT independent review cases: Two patients
with 6 CBCTs will be given to centres (12
match decisions) to assess the plan of the day
choices. The match results will be exported to
the RTTQA group for review.
• Verification of electronic data transfer: Check
DICOM or RTOG data can be suitably anonymised and transferred to and from centres.
This includes the CBCT and registration objects.
• IGRT site visit: Sites are visited during the first
patient’s treatment course to review the process of image registration and decision-making
and discuss any issues that may have arisen.
The design and implementation of the IGRT
credentialing programme for HYBRID is both
exciting and challenging. It is the first multicentre adaptive trial in the UK to utilise an IGRT
credentialing programme. This has been developed by the RTTQA group in close collaboration
with the HYBRID trial management group. It is
intended that this programme and the lessons
learnt will inform subsequent trials with complex
IGRT components and/or adaptive radiotherapy
components.
HYBRID is funded by Cancer Research UK and the study is co-ordinated by the Cancer
Research UK funded Clinical Trials and Statistics Unit at the Institute of Cancer Research ([email protected])
The HYBRID TMG, including: Robert Huddart (Chief Investigator), Emma Hall, Rebecca Lewis, Shama Hassan, Angela Baker, Helen McNair, Vibeke Hansen and Shaista Hafeez
1. National Radiotherapy Advisory Group. Radiotherapy: Developing a world class
service for England. Report to the Ministers from National Radiotherapy Advisory
Group. Department of Health, May 2007
2. National Cancer Action Team. National Radiotherapy Implementation Group Report.
Image Guidance Radiotherapy (IGRT): Guidance for implementation and use. London: NCAT, 2012
In this Corner
RTT
NATIONAL PERSPECTIVES:
THE UNITED KINGDOM
RTT LED
RESEARCH
Elizabeth Miles, Helen McNair, Charlotte
Beardmore, Rachel Harris, Heidi Probst,
Carolyn Chan
Corresponding author: Elizabeth Miles, Radiotherapy Trials QA (RTTQA) Group Coordinator,
Mount Vernon Cancer Centre, Northwood, UK
ELIZABETH MILES
DRIVING FORWARD RTT (UK TITLED: RADIOGRAPHER) LED RESEARCH
IN THE UK
In 2008 the National Cancer Research Institute
(NCRI) conducted a rapid review of radiotherapy
and associated radiobiology research in the UK
[1]. As a consequence, the NCRI Clinical and
Translational Radiotherapy (CTRad) working
group was launched in 2009 to focus on issues
relating to radiotherapy and radiobiology [2,3].
The group is multi-professional, with representation from clinical oncologists, medical physicists,
scientists, RTTs, statisticians and consumer members, with four work streams focusing on different
areas of radiotherapy research: Science base, Phase
I/II trials, Phase III trials and New technology,
Physics and Quality Assurance. The remit of the
group is broad with the ultimate aim of developing a portfolio of practice-changing clinical trials
and promoting translation of new discoveries into
practice.
Part of the CTRad action plan was to develop academic career paths in all professional disciplines
and specifically to increase training and resources
for RTTs. In September 2013 CTRad worked collaboratively with the Society and College of Radiographers (SCoR) to bring together UK RTTs,
radiotherapy service managers, physicists, clinical
oncologists, funders, professional body representatives, and lay members for a ‘Think Tank’, to discuss the current and future position of research for
RTTs.
The NCRI CTRad group has previously supported similar Think Tanks for Physicists (2011)
and Clinical Oncologists (2010, 2011, and 2013).
Radiotherapy research frequently demands multiprofessional team input and critical to maintaining
research development within radiotherapy is the
need to support the development of higher level
skills amongst the therapeutic radiography profession.
The Think Tank forum brings together a professional community to share best practice, identify
research priorities and recognise associated unmet professional needs and subsequently forward
plan for emerging areas in the field. For the RTTs’
Think Tank, in order to be as inclusive as possible
whilst providing a practical and progressive forum
for discussion, the following criteria were used to
identify participating centres:
Cancer Research UK centre status (awarded or
anticipated)
Expression of commitment and research priority for radiotherapy research by both the host
NHS Trust and University
Radiotherapy related science research portfolio
Clinical radiotherapy research portfolio
Completion of the SCoR research capacity survey
Twenty-one centres were invited and, of these, 20
centres were represented on the day. The identified
centres were encouraged to register three professionals for the event and the final 68 attendees included representation from the following groups:
research RTTs, clinical trials RTTs, radiotherapy
service managers, physicists, clinicians and
In this Corner
patient representatives. Prior to the event all invited
centres were asked to complete a Strengths Weaknesses Opportunities and Threats (SWOT) analysis;
subsequently five centres were selected to present
their results to the audience on the day.
After an introduction to NCRI CTRad from the
current group chair, Professor Neil Burnet, formal
presentations were given throughout the day. These
included highlighting research aims and roles,
from a clinician’s, physicist’s and RTTs’ perspective.
The results from the recent SCoR research capacity survey provided a background to current RTTs
research activity and possible research funding
streams and methods of collaboration with Higher
Education Institutes were explored. Interactive sessions then sought to determine what attendees felt
were possible barriers to research (via a questionnaire) and five key questions related to research
were discussed.
From the SWOT presentations and barriers to
research questionnaire there were positive areas
identified by a number of individual centres. These
included:
High quality equipment and technology in centres with the potential for innovative work
Increased participation in clinical trials providing access to trial associated networking and
support mechanisms
Interprofessional working resulting in good
relationships with the multi profession team
(MPT) and the opportunity for collaboration
Selected dedicated staff positions that differentiate between trials and research RTTs
Good academic links and association with
Higher Education Institutions (HEIs) to support
further study
Strong physics teams able to provide scientific
project support
The top five barriers to research were also identified and are listed below. The top two barriers
identified by the RTTs aligned with those highlighted by the physicist’s think tank in 2011, the
remaining three aligned quite closely to the physicist’s findings.
1. Lack of protected research time
2. Insufficient external funding
3. Not enough research capacity on treatment machines
4. Inadequate staffing levels
5. Lack of early involvement of RTTs in the development of research ideas and proposals.
Additional areas highlighted were the requirement
for more support and guidance in developing the
research RTT position, the continued need for
peer support, the challenge of balancing clinical
trials and research work and raising the profile of
the radiography profession along with announcing
achievements through publication.
The event was well attended by a cross section
of staff disciplines. Subsequent feedback from a
number of centres has been very positive. There is
keen interest in research from RTTs and this event
provided open discussion enabling barriers for
research to be both identified and related to those
highlighted by other staff groups. On leaving, participants were asked to complete a postcard detailing what they would like to achieve, on returning
to their centre, as a result of discussions during
the day. Ongoing encouragement and support has
been identified as a priority and will continue initially by the SCoR following up with centres on the
postcard aims plus provision of supporting information. Further collaborative work will concentrate on ways to overcome the recognised barriers
and ultimately support a national drive to increase
RTT led research.
As a final thought it would be interesting to hear
from other countries how radiographer research is
structured and any ongoing work that is in place to
further develop this.
1. National Cancer Research Institute. Rapid review of radiotherapy and associated radiobiology. London, UK: NCRI. 2008 [cited 17 December 2011]. Available from: www.
ncri.org.uk/includes/Publications/reports/radiotherapyreport08_web.pdf
2. Maughan TS. A new opportunity for radiotherapy research in the UK. Clin Oncol (R
Coll Radiol) 2009;21:157–8.
3. Maughan TS, Illidge TM, Hoskin P, McKenna WG, Brunner TB, Stratford IJ, et al. Radiotherapy research priorities for the UK. Clin Oncol (R Coll Radiol) 2010;22:707–9.
In this Corner
RTT
ESTRO 33:
WHY YOU SHOULD PARTICIPATE
Developing your scientific skills and knowledge
Enjoying the benefits in your daily practice
ESTRO
4 - 8 April 2014
Vienna, Austria
Grabbing the educational opportunities
Taking the chance to expand your networking opportunities
www.estro.org
In this Corner
ESTRO 33: WHY YOU SHOULD PARTICIPATE
RTT
DEVELOPING
YOUR SCIENTIFIC
SKILLS AND
KNOWLEDGE
ESTRO 33
4-8 April 2014
Vienna, Austria
Opportunities to keep up to date with scientific
developments in the field of radiation therapy
abound at all ESTRO congresses and ESTRO 33 in
Vienna will be no exception.
This year, the Scientific Advisory Group (SAG) for
RTTs has specifically endeavored to ensure that the
scientific programme is inclusive for the clinical,
research and educational interests of all RTTs.
A main focus of this programme for RTTs is the
area of Image Guided Radiation Therapy and
Adaptive Radiation Therapy. With increasingly
sophisticated position verification imaging strategies available to RTTs in their daily practice, this
congress will focus on the implementation of these
in the clinic as well as their impact on correction
strategies and margin determination. The highlight
of this topic for many will undoubtedly be the RTT
debate on IGRT, which poses the conundrum of
the potential obsolescence of 2D electronic portal
imaging in the current era of cone beam CT.
Another major feature of the congress is the further developments in contouring of organs at risk,
both from the perspective of the expanding role of
RTTs in this regard and the validation of autocontouring tools.
MICHELLE LEECH
At ESTRO 33, the current management of pallia-
tive patients will be under review, including the
development of fast-track palliation services as
well as the role of the RTT in tending to the specific psychosocial needs of the terminally ill. The
theme of supportive care will also extend into
another symposium, this time on the management
of all patient groups.
There will also be significant interest for RTTs in
the interdisciplinary track, with RTT contributions
in the symposia on safety and quality in radiotherapy as well as adaptive radiotherapy for shrinking
tumours.
As the congress is hosted in the beautiful city of
Vienna, it is fitting that a special symposium on
the Vienna school of radiotherapy and its impact
over the past century will be included and this is
sure to be of interest to RTT delegates.
The scientific programme of ESTRO 33 is inclusive of all aspects of the RTT roles in the clinic,
research and education. We look forward to seeing
you there and to your valued contribution to the
RTT track next April.
Michelle Leech
Co-chair of the ESTRO 33 SAG
for radiation technology
In this Corner
RTT
ENJOYING THE
BENEFITS IN
YOUR DAILY
PRACTICE
ESTRO 33
4-8 April 2014
Vienna, Austria
MARTIJN KAMPHUIS
There are many different reasons to attend ESTRO
33. The congress covers a wide spectrum of topics
ranging from theoretical sessions looking at small
field dosimetry to practical sessions on palliative
care. And if that were not wide enough, there are
sessions that are as diverse as the biological aspects
of modelling hypoxia and the health economics
of treatment. Every attendee is sure to discover
something of interest to them that is both new and
important.
Radiation therapists are naturally very keen to
expand their knowledge, particularly when it includes direct clinical implications. While reading
the scientific programme for the RTT Track, you
will discover that most of the sessions have been
designed from this point of view, so let’s have a
closer look.
The pre-meeting course on Image Guided Adaptive Radiotherapy starts with some essential theoretical lectures enabling RTTs to understand the
clinical rationale of IGART and be able to critically
appraise their own practice. This important theory
is followed by practical sessions that demonstrate
and discuss the procedures that are being performed in different clinics and countries. Learning
from the successes and pitfalls of others in the field
is extremely useful. Sometimes it may be possible
to just “copy and paste” procedures into your own
practice, whilst on other occasions lectures will inspire you to design something specifically for your
own work and practice.
The great success of the scientific programme for
RTTs over time has in no small part been due to
the principle of always starting with a theory based
teaching session, followed by more practical clinically based sessions. ESTRO 33 has not deviated
from this successful format. The Scientific Advisory Group (SAG) has created a very interesting
and varied agenda for the meeting which is an unmissable event for RTTs.
I hope you will enjoy the programme and return
home inspired and energised to improve your procedures, or initiate new ones for the benefit of your
patients.
Martijn Kamphuis
Co-chair of the ESTRO 33 SAG
for radiation technology
In this Corner
RTT
GRABBING THE
EDUCATIONAL
OPPORTUNITIES
ESTRO 33
4-8 April 2014
Vienna, Austria
The challenge of ESTRO 33 from an educational
point of view is to provide the attendees with the
knowledge and understanding of the best current practices in radiation oncology. With a strong
focus on carefully thought out learning objectives,
ESTRO 33 will provide a significant contribution
to the knowledge and skills of all participants,
developing professional attitudes and providing
further inputs and further role development in the
future.
FILIPE MOURA
The mixture of formal and informal educational
sessions form the backbone of the continuous
professional development that ESTRO 33 contributes to, and these are combined with unique tools
for strengthening your professional self-confidence
and work as a radiation therapist.
The integration of a high quality pre-meeting
course, eight sessions of onsite based delineation
workshops and four days of RTT scientific programme that ESTRO 33 offers is an enviable range
of educational subjects and approaches. A must, if
you want to boost your talents and be better connected to the world of RT - and all in one meeting!
Filipe Moura
ESTRO RTT Committee Chair
In this Corner
RTT
TAKING THE
CHANCE TO
EXPAND YOUR
NETWORKING
OPPORTUNITIES
ESTRO 33
4-8 April 2014
Vienna, Austria
ESTRO 33 is a perfect opportunity for the RTT
community to meet, discuss and expand their
personal network with colleagues from other centres and countries. Attending this meeting in the
centre of Europe is a great chance to share your
knowledge with others, gain from their professional experiences and perspectives whilst raising the
profile of our profession as radiation therapists.
As an extra bonus, there will be a technical exhibition area where you can visit the booths of companies with products in the field and see and learn
about their new products.
ANDREAS
OSZTAVICS
Of course it is always important to take every
chance to meet up with old friends and make new
ones on a more social level. As the conference
gives us one of the few chances for RTTs to get to-
gether during the year, it is a great opportunity to
mix and celebrate with your RTT colleagues before
being awarded your Certificate.
By developing and expanding our contacts, we give
our projects a chance to benefit and grow from the
various inputs as well as ensuring that our important discipline is able to develop and properly
contribute at the heart of the treatment team.
All of my colleagues on the Organising Committee
look forward to welcoming you in Vienna to share
our expertise in this great field and get to know
each other.
Andreas Osztavics
Local Organising Committee
In this Corner
PART II
TRAIN THE RTT (RADIATION THERAPISTS) TRAINERS
- CONSOLIDATION PHASE
RTT
In collaboration with the IAEA
BEST PRACTICE
IN RADIATION
ONCOLOGY
A FOUR PHASE PROJECT
TO TRAIN RTT TRAINERS
28 - 30 October 2013
Vienna, Austria
SASHO
PEJKOVIKJ
GORAN
STOJANOVSKI
Course Directors
Mary Coffey, RTT, Adjunct Professor, Discipline of Radiation therapy, School of Medicine, Trinity College
Dublin (IE)
Guy Vandevelde, Lecturer, High School of Health Sciences, University of Brussels (BE)
Teachers
Michelle Leech, Associate Professor, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin (IE)
Andreas Osztavics, RTT, Medical University of Vienna, AKH (AT)
Danilo Pasini, RTT, Policlinco Universitario A. Gemelli, Rome (IT)
Eduardo Rosenblatt, Radiation Oncologist, International Atomic Energy Agency, Vienna (AT)
This teaching course was a follow up to the introductory week held in Vienna from 9th - 13th September, 2012. The course consisted of three days of
course evaluation, lectures and work on templates
to organise the next courses as part of the overall
project. We experienced a friendly learning environment and great support from teachers. They
were more than helpful and demonstrated their
skills, knowledge, and organisational skills in an
excellent light. We had a great opportunity to learn
and improve our knowledge, and adopt some of
their skills from which we will benefit greatly when
organising our courses. But this course did not just
teach us how to plan and hold a course, our faculty
inspired us with fresh new ideas and ways to use
them.
The question that arises is what have we learnt
from this project and what have we achieved?
Well, to start with we were a group of total strangers; nobody knew his colleague from another
country even though we came from neighbouring
countries. This course and its organisers achieved
something very special; we became connected, we
shared information, friendships were made and we
started to network. We became aware of the problems and hardships that burden our colleagues,
and know that we are experiencing the same. We
also learnt of their achievements in radiotherapy
and progress in their countries.
The venue was in the Hotel Ibis and it was excellent with perfect conditions to carry out our
responsibilities and to learn. Our teachers and
course directors had put together a tight schedule
with a programme of presentations and
In this Corner
workshops. The social dinner was held in a beautiful Viennese restaurant called Mill with delicious
food and drinks. The atmosphere was cheerful and
very friendly, we had the opportunity to connect
and exchange ideas for future development and
cooperation between us. And finally, we extend
our gratitude to our course directors, teachers and
also ESTRO and IAEA for giving us the opportunity to attend this unique event.
Goran Stojanovski
University Clinic For Radiotherapy And Oncology
Skopje, R. Macedonia
[email protected]
Sasho Pejovikj
University Clinic For Radiotherapy And Oncology
Skopje, R. Macedonia
[email protected]
ADVANCED SKILLS FOR TREATMENT DELIVERY
09-12 February 2014 | Amsterdam, The Netherlands
Read the interview with Rianne de Jong, the Course Director on the new ESTRO
teaching course on Advanced Skills For Treatment Delivery
In this Corner
ESTRO SCHOOL
E-LEARNING
How FALCON impacted
on my learning
REPORT ON THE USE OF
THE E-COUNTOURING PLATFORM
DURING TWO LIVE COURSES
ESTRO visited Asia again. I was privileged to
participate in two exceptional courses on Target Volume Determination - From Imaging to
Margins which took place in Bangkok, Thailand,
and the Multidisciplinary Management of Head
and Neck Oncology which took place in Indore,
India. I must say that I am an avid follower of
ESTRO’s live courses, having attended five so far.
I must also give a big shout out to the South East
Asian Radiation Oncology Group (SEAROG) and
the Association of Radiation Oncologists of India (AROI) for hosting these successful events so
well.
In both courses they used an E-Learning resource
called Fellowship in Anatomical Delineation
and Contouring (FALCON). I would now like to
share my experience on this.
FALCON
Fellowship in Anatomic deLineation & CONtouring
JOEL RESUBAL
Each delegate was given pre-course contouring
homework which was found on the FALCON
website via EduCase. There were occasional problems logging-in but help was readily available
from the project manager Miika Palmu. It was
noticeable that the website required a reliable and
fast Internet connection in order to run smoothly. The contouring tools were easy to use and were
similar to the functions that one would use at the
workplace, of course this is with the exception
of the ‘undo’ command. The image fusion with
Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Positron Emission
Tomography (PET) were perfect for refining the
contour.
The most exciting use of FALCON was during the clinical workshop at the Target Volume
Determination course. Delegates were divided
into different groups and then sent to a room
equipped with a contouring terminal and projector. Four areas including the central nervous
system, head and neck, lung, and prostate all had
to be contoured using FALCON. FALCON was
an indispensable tool that certainly created lively discussions amongst a group of delegates that
were of all nationalities. The conversations created debates that provided insights on the contouring approaches from various countries based
on their own clinical experiences. The workshop
then appropriately ended with a plenary session
where FALCON demonstrated how differences
in individual contours were reduced by the group
activity. For both courses, the contours of individuals and groups were then compared with the
help of the experts which provided answers to
most of the issues and controversies that came up
during the activity.
There were more FALCON cases in the Target
Volume Determination course compared to the
Multidisciplinary Management of Head and Neck
Oncology course since the former is primarily a
contouring course. That course was further
In this Corner
enriched by the participation of a radiologist who
sometimes grappled with the radiation oncologist
in terms of contouring the gross tumour volume.
Other than this, the user experience of FALCON
for both courses is equally good.
FALCON contouring has greatly impacted on my
learning in terms of tackling the common concerns and challenges that I have seen in my everyday practice as a radiation oncologist. However,
the learning goes beyond the course, as thank-
fully the cases continue to be available online for
review. The whole experience has enriched my
knowledge and skills in contouring and has made
me far more confident when treating my patients.
I hope ESTRO will continue to travel to Asia for
these sessions. By making the courses affordable
and accessible ESTRO is helping more medical
professionals in this part of the world who have
the desire to learn and zeal for excellence in patient care.
Joel Resubal
Department of Radiation Oncology
St Luke’s Medical Center
Manila, Philippines
In this Corner
ESTRO SCHOOL
COURSE REPORTS
Quantitative methods in Radiation Oncology:
Models, Trials and Clinical Outcomes
Multidisiplinary Management of Head and Neck
Cancer
13 - 16 October 2013 | Cambridge, UK
27 - 30 October 2013 | Indore, India
Basic Treatment Planning
13 - 17 September 2013 | Utrecht, The Netherlands
Image Guided Radiation Therapy
20 - 24 October 2013 | London, UK
VIEW THE 2014 COURSES
LIST AND REGISTER NOW >
In this Corner
COURSE REPORTS
ESTRO SCHOOL
QUANTITATIVE
METHODS IN RADIATION ONCOLOGY:
MODELS, TRIALS AND
CLINICAL OUTCOMES
13 - 16 October 2013
Cambridge, UK
COURSE DIRECTOR:
Søren M. Bentzen (USA)
ANNA WILKINS
“A HIGHLY STIMULATING AND
COMPREHENSIVE REVIEW OF MODELLING TECHNIQUES IN RADIATION
ONCOLOGY”
On behalf of the course participants, I would
like to express our gratitude to Professors Søren
Bentzen, Ivan Vogelius, Johannes Langendijk,
Francesca Buffa, Randall Ten Haken, Philippe
Lambin, Neil Burnet and the ESTRO organisers for a highly stimulating and comprehensive
review of modelling techniques in radiation oncology held at Robinson College, University of
Cambridge. Over the four days a multi-discipli-
nary audience including physicists, clinicians and
radiobiologists were given an invaluable insight
to this area. The broad course encompassed the
theoretical intricacies of applying Monte Carlo
methods in IMRT optimisation through to pragmatic considerations for scoring toxicity in the
clinic. A thoughtfully constructed programme
comprised diverse daily lectures enabling participants to build a gradual and thorough understanding without feeling overwhelmed by theory
and formulae.
Within radiobiology, we discussed the Lyman
(LKB) and Relative Seriality models, as well as
In this Corner
COURSE REPORTS
the less familiar Damage Injury/Critical Volume
model and other Equivalent Uniform Dose approaches. This included a critical evaluation of the
models together with emphasis on their relevance
to specific organs. Of considerable current relevance was expert explanation of NTCP modelling
within the QUANTEC analysis; an enlightening
and alternative clinically based approach was
demonstrated by Prof Langendijk’s anatomical
model to mitigate radiation-induced dysphagia.
For those of us less familiar with statistics, an
initial refresher of important aspects central to
clinical trials and their interpretation was helpful
before moving swiftly but intelligibly into more
complex topics. Highly relevant to trial design
was emphasis on appropriate sample size and the
common pitfalls in power calculations. Monte
Carlo methods and neural networks were well
explained, while many “real life” demonstrations
from the fields of genomics and imaging enabled
us to appreciate how these methods can help in
the handling of big datasets.
ing drug radiation interactions was also stimulating and clinically relevant.
An unexpected highlight of the course was the
“Meet the Professor” session allowing appointments with experts to discuss our own research
projects. Opportunities for constructive advice
continued throughout the course and this, combined with a truly multi-disciplinary audience,
meant discussions were particularly dynamic.
There was an impressive early morning attendance at Prof Bentzen’s daily summary sessions,
which included illuminating demonstrations of
design flaws and analytical weaknesses of major
studies. Particularly as a clinician, it was useful to
be reminded of the importance of not obsessing
over p-values, without understanding study data
and its relevance.
Cambridge is a beautiful university city, which
meant that participants could enjoy evensong at
Kings College, viewing Isaac Newton’s original
texts in the Wren Library and lively discussions
in historical English pubs. I would highly recommend this course to anyone keen to further their
knowledge of statistics and modelling in radiation oncology.
Anna Wilkins
Clinical Research Fellow,
Institute of Cancer Research,
London, UK
[email protected]
It was exciting to hear about “Rapid Learning
Healthcare” - a new innovation to progress international data sharing and therefore improve
model construction. Explanation of the potential
use of models in imaging and their role in explor-
In this Corner
COURSE REPORTS
ESTRO SCHOOL
BASIC TREATMENT
PLANNING
13 - 17 September 2013
Utrecht, The Netherlands
COURSE DIRECTOR:
Michelle Leech (IE)
“A FINE MIX OF THEORETICAL AND
PRACTICAL SESSIONS”
I was very pleased that I was able to attend this
year’s edition of the ESTRO Basic Treatment
Planning course held in UMC Utrecht. Whilst
this was my first ESTRO School course, the feedback from my colleagues in New Zealand regarding the quality of past ESTRO school courses
was overwhelmingly positive. I am pleased to say,
having now been on the course, that I was certainly not disappointed, the course was well organised and well-balanced.
IHAB RAMADAAN
The course provided a fine mix of theoretical and
practical sessions that provided a solid grounding
to understanding the basic principles of radiotherapy treatment planning. The multi-disciplinary composition of the teaching staff ensured
that the content was accessible to all the participants, who were representative of multiple disciplines, including radiation therapists, radiation
oncologists and medical physicists.
A typical day on the course started with a session of presentations, given by different members
of the teaching staff. These addressed various
aspects of treatment planning, from clinical
In this Corner
COURSE REPORTS
evidence and rationale for tolerances, to key
physical principles that underpin the modelling
of treatment planning systems and algorithms.
Practical aspects of treatment planning such as
patient positioning and immobilisation were also
discussed. Participants were encouraged to ask
questions and compare the techniques taught
at the course with the current practice at their
respective departments. I found this part of the
course quite insightful as it allowed me to see the
variety of techniques that are used around the
world when looking at effective cancer treatment
and the improvement of patients’ quality of life.
These presentations were followed by interactive
contouring tutorials on the FALCON virtual platform, where participants could contour a number
of organs in different sites. At the end of each tutorial, the contours produced by each pair of participants are all superimposed on the stock CT
image along with the ‘reference’ contour that was
drawn by an experienced member of the teaching
staff. I found this to be an excellent method to
demonstrate the effect of inter-observer variation
on treatment planning and what this means from
the point of view of safety margins and treatment
delivery.
In the afternoon, the day was wrapped up with a
hands-on treatment planning session on typical
CT images of different disease sites. During these
sessions, all the major and commercially available treatment planning systems were available for
use. While several participants preferred to trial
these sessions on the same treatment planning
system (TPS) that they have in their departments,
I appreciated the opportunity to try different
planning systems. However, working with an unfamiliar TPS did mean that there was somewhat
of a learning curve necessary before coming to
grips with the creation of a treatment plan. Nevertheless, members of the teaching staff and the
vendor application specialists were always available to provide assistance.
The following day, the planning scenario was
discussed and some participants were asked to
discuss the plans that they had produced. Various members of the teaching staff would join
the discussions and explore the rationale behind
the different decisions taken to create the plan,
such as beam geometry, the use of wedges, and
target coverage. These sessions were helpful in
demonstrating common approaches to treatment
planning and the necessity for understanding the
need to compromise between target coverage and
normal tissue dose constraints.
Other parts of the course dealt with risk analysis
and the importance of treatment planning quality assurance and safeguards that are necessary
to reduce the likelihood of treatment planning
incidents that can have major consequences for
patients. I especially appreciated the exercise
involving the identification of potential errors in
the treatment planning process that can lead to
serious radiation exposure accidents.
Overall the course was a valuable learning experience that also offered me the opportunity to meet
other colleagues from around the world.
Ihab Ramadaan
Radiation Oncology Medical Physics Registrar
Wellington Blood & Cancer Centre
Wellington, New Zealand
[email protected]
In this Corner
COURSE REPORTS
ESTRO SCHOOL
IMAGE GUIDED
RADIATION THERAPY
20 - 24 October 2013
London, UK
COURSE DIRECTOR:
Dirk Verellen (BE)
“CONTRASTING OPINIONS WERE
SOUGHT AND DISCUSSED”
I enjoyed attending the ESTRO course on IGRT
in London. It was a comprehensive programme
covering the technical, clinical and quality assurance issues in IGRT. It was also well structured,
with an initial clear technical background on
IGRT concepts, issues and technologies, followed
by a clinical section on implementation of IGRT
in different anatomical sites.
INDRANIL MALLICK
The expert faculty had given particular thought
on making the course understandable to the wide
audience, by providing a background to the technical aspects of IGRT on which clinical practice is
based. Concepts like error calculations, adaptive
planning, quality assurance and technical differences between commonly available platforms
were covered in detail.
There were physical site-visits to different centres practising IGRT in London, and this gave us
a chance to interact with the staff there and ask
questions on how IGRT is being implemented
on a day-to-day basis. I visited St Bartholomew’s
Hospital where the physicists and radiographers
were very enthusiastic about taking us through
In this Corner
COURSE REPORTS
different aspects of their IGRT processes, including quality assurance.
On Day 4 and 5, the applications of IGRT in
most of the common sub-sites were covered, and
standard protocols were analysed. Differences in
practice were discussed and debated.
There was plenty of scope for discussion and I
was able to have all my questions answered. I
liked the group discussion sessions where contrasting opinions were sought and discussed.
Constructive and honest feedback was constantly
sought. I hope that the course will continue to
adapt and evolve as IGRT becomes a more and
more complex process.
This was my first ESTRO teaching course and as
an international attendee I was impressed with
the organisation. I am glad ESTRO is making an
active effort to take their courses to non-European destinations as I think that this will have a
clear impact in many countries across the world.
Indranil Mallick
Consultant Radiation Oncologist
Tata Medical Center
Kolkata, India
[email protected]
In this Corner
COURSE REPORTS
ESTRO SCHOOL
MULTIDISIPLINARY
MANAGEMENT
OF HEAD AND NECK
CANCER
27 - 30 October 2013
Indore, India
COURSE DIRECTORS:
Vincent Grégoire (BE)
Lisa Licitra (IT)
“THE MOST INTERESTING PART OF
THE COURSE WAS THE TUMOUR
DELINEATION“
The course was held at Sri Aurobindo Institute of
Medical Sciences, Indore, India and was attended
by 145 participants from India and three from
overseas.
SHIKHA HALDER
The course was well structured and was conducted
under the guidance of course director Dr Vincent
Gregoire. Surgical, medical and radiation management were discussed in great detail as well as the
anatomy and radiology of the head and neck region.
The multidisciplinary approach covered the correct method of clinical examination and investigation including the use of genetic markers for
diagnosis. For each site, treatment was discussed
according to tumour stage, including all aspects
of surgical management and indications for
chemoradiation, neoadjuvant chemotherapy or
radiotherapy alone. Furthermore, the fractionation schedule in radiation oncology, which is so
important, was also discussed, including SIB, use
of six days a week fractionation and use of nimerazole as radiation sensitiser.
The most interesting part of the course was the
In this Corner
COURSE REPORTS
tumour delineation; it was important to learn
from the errors we had made in our tumour delineation on a case of carcinoma of the pyriform
fossa which had been given to us as pre-course
homework for delineation. Our knowledge was
updated with the latest protocols for head & neck
tumour delineation which are going to be published
soon.
Dr Joshi and the AROI faculty for allowing us to
upgrade our knowledge and help us to treat our
patients better.
I would also like to thank the project manager
Mr Miika Palmu for effortlessly co-ordinating
with all the participants before and during the
course.
Shikha Halder
Roentgen-BLK Radiation Oncology Centre
BL Kapur Memorial Hospital
New Delhi, India
The course was very interactive and informative.
I thank all the faculty members for answering all
our queries so patiently during the course and
during tea and lunch breaks.
The evening gala dinner organised by the committee was enjoyable and gave us the opportunity
to talk and interact informally with all the participants.
On behalf of all the participants I would like to
thank the entire faculty: Dr V. Grégoire, Dr L.
Lictira, Dr P. Nicolai, Dr C. Grau, Dr R. Leemans,
Dr J. Eriksen, Dr J-P.Machiels, Dr A. D’Cruz and
In this Corner
ESTRO SCHOOL
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In this Corner
,
2014 NEW ESTRO COURSES
ESTRO SCHOOL
INTERVIEW WITH
RIANNE DE JONG,
COURSE DIRECTOR
ADVANCED SKILLS FOR TREATMENT DELIVERY
09-12 February 2014 | Amsterdam, The Netherlands
Who should participate?
Although radiation therapy is very much a
group effort from physicians, physicists and radiation therapists (RTTs), this course is aimed
at RTTs only. It is targeted towards RTTs who
wish to expand their understanding on modern
radiation therapy treatment design and delivery. The programme is suitable for both the
beginner and the more experienced RTT.
RIANNE DE JONG
What will be the main focus?
The main focus of the course will be to provide a
comprehensive overview of the steps in modern
radiation therapy - target definition, treatment
planning, image guidance, treatment delivery,
and to be able to demonstrate this in the practical sessions. For more details on this please look
at the programme in the school guide.
What should the participants have improved in
terms of knowledge, skills and competencies?
In this Corner
The participants will gain an understanding of
the tools available in modern radiation therapy and the best ways to use them. For example,
pre-treatment imaging for target definition,
errors and margins, IMRT, image guidance
inside the treatment room. Except for treatment
planning, we will practice the skills that go with
these steps, like calculating margins, and registration and evaluation of kV Conebeam CT
images. Something else that we will discuss, that
is also very important, is the position of the RTT
in the multi-disciplinary team with emphasis on
factors that may be of influence on that can help
in expanding their role.
How will you decide if the course has been successful?
For me this course will be successful if we have
not only inspired RTTs to expand their role
within the multi-disciplinary team, but that we
have successfully given them the tools and skills
in order to achieve this.
many topics. We also took into account some
other factors such as gender, nationality and
ESTRO teaching experience. We ended up with
very enthusiastic and eager members of the faculty.
We very much look forward to welcoming you
as a participant on this new course!
How did you select the members of the faculty?
We tried to pick a team with an even distribution of clinical experience as we are covering so
In this Corner
ESTRO SCHOOL
INTERVIEW WITH
WOLFGANG DÖRR,
COURSE DIRECTOR
UNDERSTANDING AND MANAGEMENT OF MORBIDITY
06-08 March 2014 | Brussels, Belgium
This course is suitable for professionals from all
disciplines related to radio (chemo) therapy. It is
primarily designed for trainees in radiation oncology and for radiation oncologists eager to update
their knowledge on various morbidity aspects. It
is important to mention that it is also relevant for
other disciplines, such as psycho-oncology, RTT,
nursing and translational radiobiology.
WOLFGANG DÖRR
What will be the main focus?
The course covers general aspects of treatmentrelated morbidity, including general principles of
normal tissue reactions, strategies for assessment
and documentation of treatment-related morbidity,
management of “systemic” morbidity (nausea/
emesis/fatigue) and important facets of healthrelated quality of life. The site-specific module in
2014 will detail aspects of morbidity in head and
neck and chest radiation oncology. In 2015 the
site-specific module will be abdominal and
In this Corner
pelvic radiotherapy. This two year rotation will
then be repeated in future years. The course will
also demonstrate approaches for prevention, mitigation and treatment of adverse events and for
supportive care.
to advise and motivate patients using supportive
measures in their daily clinical routine. They will
also gain the necessary skills in order to support
their department with morbidity assessment and
management issues.
What should the participants have improved on
in terms of:
Knowledge:
By the end of the course the participants will have
a better understanding of the biological basis of
clinically relevant side effects in radiation oncology. They will be better prepared to identify clinical
symptoms and their consequences for the patient,
and to correctly apply instruments for assessment
and documentation. The participants will also
become more aware of the established and developing prophylactic and therapeutic strategies.
Competencies:
The participants will develop the ability to identify
the individual risks of each patient, identification
and scoring of individual morbidity symptoms
and patterns, as well as deduction of (clinical and
psychological) consequences for the individual
patient. This will then allow them to use individually adjusted prophylactic and interventional approaches.
Skills:
With the use of intensive discussions on various
cases, the participants will develop excellent skills
How will you determine how successful the course
has been?
There are two ways in which we will determine
the success of the course. First, we will review all
the feedback that we receive from the participants,
both during the course and after. Then, we will
also look at the results from the voluntary course
examination to see how well the participants have
understood the material.
Why was the course created?
With an increasing number of cancer survivors,
we feel it is necessary to give more attention to the
topic of treatment-related morbidity. Prophylactic
and management strategies need to be provided to
patients in order to minimise the impact that their
treatment may have on their future lives. In order
to do this, it is necessary that people have the correct knowledge and skills in all the areas.
How did you select the members of the faculty?
It was important that we picked certain members of the faculty that were experts in morbidity
issues and who came from a variety of different
disciplines. As we use a lot of clinical cases on the
course we encouraged experienced radiation oncologists to join the team to help with the general
discussions.
In this Corner
ESTRO SCHOOL
INTERVIEW WITH
JACK VENSELAAR
& DIMOS BALTAS,
COURSE DIRECTORS
ADVANCED BRACHYTHERAPY FOR PHYSICISTS
JACK VENSELAAR
DIMOS BALTAS
We are aiming at a target group of medical physicists: our colleagues who are interested in expanding their knowledge in this field. It is a unique
opportunity to become familiar with current and
most recent developments in brachytherapy physics. Some participants may have attended other
brachytherapy teaching courses, but this one is
entirely dedicated to the physics behind it. It can
also be recommended for PhD Students in the field
of brachytherapy physics.
What will be the main themes?
It is a 3½ day course which will start with a global
introduction. The topics that will be covered are
advanced dose calculation methodologies, dose
optimisation and evaluation techniques, specific
imaging issues, measurements, radiobiology, and
accuracy and quality management in brachytherapy. Furthermore, there will be ample time for discussion and meeting industry representatives and
teachers. A practical session on treatment planning
and a round table discussion on treatment
In this Corner
delivery verification are both planned.
What should the participants have improved in
terms of knowledge, skills and competencies?
At the end of the course the participants should
understand the essentials of recent developments
and advanced issues in the 3D-treatment planning
developments in radiobiology, 3D imaging, and
treatment delivery aspects. Open and private discussions will have supported this, and we believe
that the practical session and the contributions
from the vendors will have contributed to the feeling we all have: “there is really something going on
in the physics and technology of brachytherapy”.
How will you consider whether the course has
been successful?
We really hope that we can demonstrate that the
course fulfills a specific need: education to a high
level of understanding for important members of
the local brachytherapy teams. Therefore the goal
is to achieve improvements in procedures and clinical results in the departments of the participants.
This is much more important than any list of
scoring on the course evaluation forms. We hope
for a high attendance, confirming our feeling that
a regular course like this is important.
Why was the course created?
Physicists have always participated in other
ESTRO courses on clinical brachytherapy. The
experience of the course directors has been that
when they acted as teachers on those courses, there
was insufficient in the programme to satisfy the
needs of physicists with not enough time for physics or depth in the topics that were presented to
make attendance worthwhile. Now, in a dedicated
course, we can forget such limitations and address
the topics to the depths they deserve.
How did you compose your faculty?
The faculty is composed of our friends and colleagues from several very active research groups
in the EU and USA. Specifically members of the
GEC-ESTRO Braphyqs working group and the
AAPM BTSC (Brachytherapy Subcommittee)
were actively involved in the publication of pioneer
reports on Brachytherapy physics. We believe it is
one of the best possible teams for such a course.
Furthermore we are very pleased to have two outstanding invited speakers, our ESTRO president
Philip Poortmans from Tilburg, The Netherlands,
and for radiobiology Mark de Ridder from Brussels, Belgium, to complete our team. It will be a
challenge for the speakers, and also for the participants to join us in this high-end course.
DON’T FORGET THE
PRE-MEETING COURSES
AT ESTRO 33!
VIEW THE PROGRAMME
OF THE FIVE COURSES
In this Corner
ESTRO SCHOOL OF
RADIOTHERAPY & ONCOLOGY
WWW.ESTRO.ORG
ADVANCED SKILLS FOR
TREATMENT DELIVERY
09-12 February 2014
Amsterdam, the Netherlands
NEW!
MULTIDISCIPLINARY TEACHING
COURSE ON PROSTATE CANCER
EANM/ESTRO EDUCATIONAL
SEMINAR
POSITRON EMISSION TOMOGRAPHY (PET)
IN RADIATION ONCOLOGY
23-27 February 2014
COMBINED DRUG-RADIATION
TREATMENT: BIOLOGICAL BASIS,
CURRENT APPLICATIONS AND 
PERSPECTIVES
CLINICAL PARTICLE THERAPY
08-11 June 2014 | St. Petersburg, Russia
23-27 February 2014 | Nice, France
IMRT AND OTHER CONFORMAL
TECHNIQUES IN PRACTICE
UNDERSTANDING AND
MANAGEMENT OF MORBIDITY
NEW!
08-12 June 2014 | Torino, Italy
06-08 March 2014 | Brussels, Belgium
BRACHYTHERAPY FOR PROSTATE
CANCER
ADVANCED TECHNOLOGIES
19-21 June 2014
Dublin, Republic of Ireland
07-11 March 2014 | Amman, Jordan

COMPREHENSIVE QUALITY
MANAGEMENT IN RADIOTHERAPY
MODERN BRACHYTHERAPY
TECHNIQUES
09-12 March 2014 | Gdansk, Poland
PART I – RISK MANAGEMENT & PATIENT
SAFETY
26-29 June 2014 | Poznan, Poland
DOSE MODELLING AND
VERIFICATION FOR EXTERNAL
BEAM RADIOTHERAPY
BIOLOGICAL BASIS OF PERSONALISED RADIATION ONCOLOGY
09-13 March 2014 | Prague, Czech Republic
ESTRO 33
PRE-MEETING COURSES
04 April 2014 | Vienna, Austria
PHYSICS FOR CLINICAL
RADIOTHERAPY
EVIDENCE AND NEW
CHALLENGES IN RECTAL CANCER
08-11 May 2014 | Prague, Czech Republic

25-29 May 2014 | Istanbul, Turkey
EVIDENCE-BASED RADIATION
ONCOLOGY: A CLINICAL
REFRESHER COURSE WITH A
METHODOLOGICAL BASIS
05-10 October 2014 | Varna, Bulgaria
BEST PRACTICE IN RADIATION
ONCOLOGY - A WORKSHOP TO
TRAIN RTT TRAINERS
IN COLLABORATION WITH THE IAEA
PART I - TRAIN THE RTT TRAINERS
20-24 October 2014 | Vienna, Austria
MULTIDISCIPLINARY TEACHING
COURSE ON LUNG CANCER

24-26 October 2014 | Guangzhou, China
COMBINED DRUG-RADIATION
TREATMENT: BIOLOGICAL BASIS,
CURRENT APPLICATIONS

AND PERSPECTIVES
02-05 November 2014
Yogyakarta, Indonesia
ADVANCED TECHNOLOGIES

ACCELERATED PARTIAL BREAST
IRRADIATION
ESOR/ESTRO COURSE:
MULTIDISCIPLINARY APPROACH
OF CANCER IMAGING
CLINICAL PRACTICE AND
IMPLEMENTATION OF
IMAGE-GUIDED STEREOTACTIC
BODY RADIOTHERAPY
07-11 September 2014 | Florence, Italy
IMAGING COURSE FOR
PHYSICISTS
14-18 September 2014 | Porto, Portugal
NEW!
BASIC CLINICAL RADIOBIOLOGY
28 September - 02 October 2014
Florence, Italy
November 2014 | India (date to be confirmed)
BACK TO BACK WITH ADVANCED
TREATMENT PLANNING
16-20 September 2014 | Budapest, Hungary
IMAGE-GUIDED RADIOTHERAPY
AND CHEMOTHERAPY IN
GYNAECOLOGICAL CANCER –
FOCUS ON ADAPTIVE
BRACHYTHERAPY
29 June - 02 July 2014 | Athens, Greece
BASIC TREATMENT PLANNING
16-18 May 2014 | Tokyo, Japan
ADVANCED BRACHYTHERAPY
PHYSICS
MULTIDISCIPLINARY
MANAGEMENT OF HEAD AND
NECK ONCOLOGY
06-09 September 2014 | Barcelona, Spain
A JOINT COURSE FOR CLINICIANS AND
PHYSICISTS
04-08 May 2014 | Madrid, Spain
TARGET VOLUME
DETERMINATION - FROM
IMAGING TO MARGINS
29 June - 02 July 2014 | Brussels, Belgium
2014
ADVANCED TREATMENT
PLANNING
BACK TO BACK WITH BASIC TREATMENT
PLANNING
21-25 September 2014 | Budapest, Hungary
06-08 November 2014
Maastricht, the Netherlands
3RD MASTERCLASS IN RADIATION
ONCOLOGY
09-12 November 2014 | Lisbon, Portugal
TARGET VOLUME DETERMINATION
- FROM IMAGING TO MARGINS
09-13 November 2014 | Vienna, Austria
IMAGE-GUIDED RADIOTHERAPY
IN CLINICAL PRACTICE
30 November – 04 December 2014
Brussels, Belgium
QUANTITATIVE METHODS IN
RADIATION ONCOLOGY: MODELS,
TRIALS AND CLINICAL OUTCOMES
07-10 December 2014 | Vienna, Austria
YOUNG ESTRO
“Many Young
Societies are active
around Europe.”
In this edition, we continue our series about what
you should know if you want to publish in the Green
Journal. Eric Lartigau, as one of the clinical editors
has accepted our invitation to answer our questions
about what it takes to get published in Radiotherapy
& Oncology.
We also publish the mobility grant report from
Emmanuel Oyeyemi Oyekunle, a Medical Physicist
from Nigeria, who visited the Department of
Radiotherapy at the Medical University of Vienna in
Austria, to learn about the optimisation of dose in
cervix brachytherapy via magnetic resonance imaging
(MRI) guidance.
The Young Corner also features the Young Radiation
Oncology Group (YROG) from the EORTC report
and the Young Portuguese Radiation Oncology
Society’s report on their activities. As you’ll see, many
Young Societies are active around Europe, which is a
great thing !
CLICK OR TAP ON THE
IMAGES TO SEE THE
EDITORS’ NAMES
We hope you enjoy this new issue of the Young
Corner!
Catharine Clark & Jean-Emmanuel Bibault
In this Corner
YOUNG ESTRO
INTERVIEWS WITH
GREEN JOURNAL
EDITORS - PART II
Eric Lartigau (Clinical editor)
How many articles do you receive every year?
Has the number increased recently?
The Green Journal receives 1300 papers per year*
and the acceptance rate is between 15-20%.
Personnally I handled 118 clinical articles in 2011
and 24 were accepted and in 2012, of the 100
I received, 19 articles were accepted.
* 567 clinical papers in 2011 and 907 in 2012
Could you explain to us in broad terms what the
review process involves?
Papers are distributed by the Editor-in-Chief to
the editors who then distribute to the reviewers.
After review, a proposal is made by the editors
and sent to the Editor-in-Chief for the final decision.
How do you choose the people you ask to review
the manuscripts you receive?
We try to choose the reviewer according to their
field of competence, in line with the theme of the
article.
Are manuscripts sent with or without the name of
the authors/affiliation?
The manuscripts are sent with names and affiliations.
How many revisions do you allow before rejecting
an article?
There are no strict rules, it all depends on the
reviewer’s comments.
Do you ask for a dedicated analysis by a statistician for some articles?
If one of the reviewers thinks it is required, we
can do that.
Finally, what should an author never do when
writing and submitting his article?
What we consider not worth publishing: small
retrospective monocentric study, written in poor
English, and failing to follow the Journal’s recommendations!
What quality criteria do you consider before a
decision can be made on a manuscript?
We will always consider the level of evidence provided by the study. Priority is given to prospective
randomised studies
ERIC LARTIGAU
Is good written English absolutely mandatory or
do you accept articles that can be corrected before
publication?
It is highly recommended to have an article written in good English.
In this Corner
YOUNG ESTRO
MOBILITY
GRANT REPORT
Optimisation of dose in
cervix brachytherapy via
Magnetic Resonance Imaging
(MRI) guidance
Emmanuel Oyeyemi Oyekunle
HOST INSTITUTE: Department of Radiotherapy,
Medical University of Vienna,
Vienna General Hospital (AKH), Vienna, Austria
16th September - 6th October 2013
EMMANUEL OYEYEMI
OYEKUNLE
THe radiotherapy department in Vienna is a global centre of excellence in brachytherapy where
diverse facilities are available to enable the 3D
image guided technique. The equipment includes
three High Dose Rate (HDR) Afterloaders (Microselectron, Gammamed and Flexitron) with
their corresponding treatment planning systems
(TPS), three Pulse Dose Rate (PDR) Afterloaders
(Nucletron), Magnetic Resonance Imaging (MRI)
unit, Computer Tomography (CT) Unit, Ultrasound Unit (in theatre) and in-vivo probes.
In the first week, I observed brachytherapy applications for two new patients in the theatre with
MRI films in sight and the procedure fully guided
by an ultrasound unit. The first procedure lasted about two hours and involved a patient who
presented with carcinoma of the cervix with a
recto-vaginal fistula. An intrauterine tandem and
ring applicator were used with additional needles
to sufficiently cover the target volume as revealed
on MRI. The starting point of Dose Optimisation
in brachytherapy is accurate selection of applicator type and dimensions to ensure the tumour in
question is well targeted and covered. Every aspect
of the application procedure from tumour visualisation to applicator/catheter/probe placement was
carefully monitored and verified by the ultrasound
facility after the patient had undergone spinal
anaesthesia. The second patient had presented with
carcinoma of the vagina with rectal involvement.
In her case, tandem-cylinder applicator with template (allowing additional needles) was utilised.
More implants which include use of specialised
applicators (Vienna II ring-tandem) were also observed in subsequent weeks.
Usually, patients undergo both MRI and CT. The
former provides excellent and better delineation of
the target and organs at risk than the latter. While
MRI is routinely done for all new patients following implant for the purpose of treatment planning,
it is not repeated before subsequent fractions of a
given application are administered. This therefore
necessitates CT prior to brachytherapy fractions to
ascertain reproducibility of images inter-fraction
and particularly applicators with respect to the
target and organs at risk. If any significant changes
are observed, the plan will be modified accordingly before the subsequent fraction is administered.
For the most part, my time was spent in the
planning room where I keenly observed 3D
brachytherapy plan generation undertaken by my
supervisor, Dr. Daniel Berger (Medical Physicist,
DIR.) on the TPS. In the case of ring-tandem
applicator, optimisation of dose always begins
with a standard loading pattern and dose
In this Corner
prescription to a reference point ‘A’ before manual
optimisation is implemented via dwell time and position modifications to engender optimal dose (Point
‘A’ dose or more) at the High Risk Clinical Target
Volume (HR-CTV) D90 and minimal dose at the
organs at risk, OAR (bladder, rectum and sigmoid).
In general, image guided treatment planning at
the centre follows systematic steps: transfer of
MRI/CT slices to TPS, applicator placement/reconstruction, source loading and dose prescription, contouring of target volumes (HR-CTV,
IR-CTV, LR-CTV, OAR etc.), dose optimisation,
and plan assessment.
I was very familiar with ‘Flexiplan’ TPS at the
host centre which is technically the same as another, ‘HDRbasic’ (for Gynesource Afterloader)
which is used at my home institution. Because
it was not as regularly used as other planning
systems, I was privileged to have the opportunity to make frequent practice 3D-image cervix
brachytherapy plans on ‘Flexiplan’ using existing
MRI/CT images in order to fully acquaint myself
with the system.
First, I initiated planning with the standard loading pattern and standard prescription for gynaecological applicators (with and without needles)
and then proceeded to dose optimisation which is
desirable.
Volume-based brachytherapy planning enables
thorough evaluation of plans as regards best dose
distribution in target volume and control of organs at risk doses which are the two main goals of
brachytherapy.
Plan evaluation is undertaken using a dose volume
histogram with a spreadsheet of physical-biological documentation of external beam radiotherapy
(EBRT) and brachytherapy to check the biological
effective dose (BED) and EQD2 accordingly. Additionally, rectum and bladder probes are used for
in-vivo dosimetry to monitor volume-based organ
doses obtained in 3D plans.
In the third week, I met the Head of the Department, the renowned Prof. Richard Pötter personally and attended the 3D brachytherapy plans review
which involved brachytherapy oncologists and the
medical physicists.
In conclusion, I had a pleasant stay and fruitful
learning. I’m sincerely grateful to ESTRO and the
host institution for the kind gesture given to me to
broaden my expertise in brachytherapy, particularly the aspects of 3D planning and dosimetry.
Emmanuel Oyeyemi Oyekunle
Medical physicist, Department of Radiotherapy,
University College Hospital (UCH), Ibadan, Nigeria
[email protected]
IF YOU WOULD LIKE TO FIND OUT
MORE ABOUT MOBILITY AWARDS
PLEASE GO TO :
www.estro.org/school/articles/grants/
estro-mobility-grants
In this Corner
YOUNG ESTRO
YROG
Young radiation oncologists
getting involved in clinical
research
Orit Kaidar-Person , YROG Chair
ORIT
KAIDAR-PERSON
I am delighted to report on the Young Radiation Oncologists Group (YROG) of the European Organisation for Research and Treatment of
Cancer (EORTC) - Radiation Oncology Group
(ROG). This is a new working party (WP) within the ROG, initiated by the current ROG chair,
Prof. Philippe Maingon. The aim of creating
the YROG was to incorporate young radiation
oncologists working in EORTC member institutions into the work done within the ROG.
This way we hope to stimulate the creation of a
new generation of radiation oncologists who are
dedicated to clinical research.
The EORTC promotes multidisciplinary cancer research in Europe, conducted in over 300
university hospitals in 32 countries. Its network
of investigators comprises more than 2500 scientists and clinicians collaborating in 20 multidisciplinary groups. The ROG is one of the most
active groups within EORTC. Joining the ROG
and becoming a YROG member is a great career
opportunity for young oncologists. We warmly
invite you to join the YROG if you are a radiation
oncologist in training and up to 5-years from
completion of your residency, if you are working
in an EORTC member institution. Membership
would enable you to work side by side with world
leaders in oncology and to take part in the plan-
ning and conduct of a wide variety of clinical
trials. Fellowship opportunities are also available
for YROG members.
The YROG sessions are a platform for young
radiation oncologists to present research proposals, local studies and innovative ideas, and to be
noticed in the European arena. We also encourage YROG members to present and discuss study
proposals that involve radiation therapy that were
created in FLIMS and other workshops at YROG
sessions.
The YROG sessions aim to support young radiation oncologists in their scientific activities. They
are also intended as a means to stimulate the
ROG through fresh and new ideas, with the hope
and expectation that this will lead to fruitful collaboration.
The ROG includes different disease-oriented
working parties (WPs) including Breast, Lung,
Genitourinary; so young members can also join
and participate actively in any WP they find
interesting and inspiring. For those who are
interested in translational science, there is a new
Early Phase Trials WP, led by Sofia Rivera (radiation oncologist and a past editor of the Young
Corner of the newsletter and co-chair of the
In this Corner
ESTRO Young Task Force) and Conchita Vens
(Radiobiologist, NKI, Amsterdam).
We want to reassure you that becoming a YROG
member is not very time consuming, although
this does to a certain extent depend on the
amount of time you can spend and your desire to
become really active in the field of research in radiation oncology. Each YROG member is expected to participate in at least one of the two ROG
meetings held each year. We warmly welcome all
new members with initiatives and ideas regarding
future activities for YROG and who wish to contribute to the group.
The first YROG session was held at the recent
ROG meeting, Brussels September 9-11, 2013.
Prior to the YROG session we organised a morning 5K run for our young members and the older
but young in spirit. We enjoyed some beautiful
scenery in Brussels followed by a light break-
fast. The brave runners were given a sports shirt
with the YROG logo as a token for being “good
sports”. The YROG session included three interesting lectures by YROG members. Jean-François
Daisne (Belgium) presented the topic of individualised prophylactic node radiotherapy in clinical
N0 HNSCC patients using SPECT-CT. This innovative concept aimed to decrease toxicity, allow
better dose constraints without compromising
treatment. Samir Patel (Canada) spoke about
histone deacetylase inhibitors as radiosensitisers.
During his talk, Samir reviewed both pre-clinical
and clinical data and explored the role of valproic
acid (antiepileptic which has histone deacetylase
inhibitor activity) in the treatment of GBM patients during the course of TMZ-based chemoradiotherapy. The last presenter was Jessica Scaife
(UK), who introduced her PhD project which is
a part of the Cancer Research UK Programme
known as VoxTox, aimed at linking radiation
dose at the voxel level with toxicity. Jessica Scaife
has accepted an invitation to become a co-chair
of the next YROG meeting that will be held in
Bristol.
We invite you all to join us and present
your work at the next meeting in Bristol, UK
27-29 March 2014!
For more details please go to the EORTC ROG
website or email:
Orit Kaidar-Person
Radiotherapy Unit
Oncology Institute
Rambam Health Care Campus
Haifa, Israel
[email protected]
In this Corner
YOUNG ESTRO
YPROG
Young Portuguese Radiation
Oncologists Group
(SPRO Jovem)
COORDINATOR: Luís Vasco Louro
Following the recent trend throughout
Europe, the Young Portuguese Radiation
Oncologists Group (SPRO Jovem) was created
on March 2013. As we speak, we are still in
an embryonic stage, nonetheless we are an
enthusiastic group of young radiation oncologists, willing to contribute to the evolution of
radiation oncology.
Our group’s objectives include: promoting continuous education of young radiation oncologists, with special attention to international
observers and fellowships; creating protocols
with other societies in order to facilitate international fellowships, experience and knowledge
exchange; promoting research activity, both
nationally and internationally; networking and
cooperating with other young groups in order to
encourage and facilitate joint projects; emphasise the need for a uniform radiation oncology
residency programme in Portugal and assist in
its implementation.
Being such a new group we are still undergoing the initial process of laying foundations
for future work and projects. Nevertheless we
are already planning an annual meeting of our
society’s Young Members (both radiation oncology residents and junior radiation oncologists),
taking the first steps to offer a website to our
Young Radiation Oncologists which will feature
upcoming courses and conference information,
as well as the experience of our members on
national or international fellowships and/or as
observers.
Many other projects are planned and in the near
future we would like to start a national research
project and, if possible, participate in international initiatives. The creation of a scholarship to help
promote new national research projects is another of our main goals. In these times of financial
difficulties our members have to double their
efforts to be able to afford to go to courses and
conferences, and we therefore feel that it is of the
utmost importance for the continuing education
of our members to be able to offer grants.
At this time we are giving priority to informing
people about our existence and creating tighter
bonds with the existing Young Radiation Oncologists groups and, of course, ESTRO.
Looking forward to jointly improve our future
as radiation oncologists,
SPRO Jovem
In this Corner
Luís Vasco Louro – Instituto Português de Oncologia do Porto, Porto, Portugal
Ana Amado - Centro Hospitalar de Lisboa Norte – Hospital de Santa Maria, Lisboa, Portugal
Artur Aguiar – Instituto Português de Oncologia do Porto, Porto, Portugal
Beatriz Nunes – Centro Hospitalar de Lisboa Norte – Hospital de Santa Maria, Lisboa, Portugal
Gonçalo Fernandez – Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
João Casalta Lopes – Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Maria Inês Antunes – Hospital do Espírito Santo (Lenicare), Évora, Portugal
Maria João Serra – Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
Marisa Padilha – Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
Miguel Labareda – Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
Pedro Meireles – Centro Hospitalar de S. João, Porto, Portugal
Rubina Teixeira – Clínica Quadrantes, Funchal, Portugal
Rute Pocinho – Instituto Português de Oncologia de Lisboa, Portugal
Tânia Teixeira – Centro Hospitalar e Universitário de Coimbra, Portugal
In this Corner
YOUNG ESTRO
FLIMS 16 WORKSHOP
APPLICATIONS
OPEN ONLINE!
21-27 June 2014
Flims, Switzerland
FLIMS 16
Joint ECCO-AACR-EORTC-ESMO Workshop on Methods in Clinical Cancer Research
ONLINE APPLICATIONS FOR THE 16TH EDITION OF THE FLIMS
WORKSHOP ‘METHODS IN CLINICAL CANCER RESEARCH’
ARE NOW OPEN.
Apply online before 10 February 2014 to take part in this
renowned and prestigious workshop in oncology!
With the aim of reversing the decline in the numbers of
clinical scientists, the workshop manages to develop a strong,
expanding base of well-trained clinical researchers.
Discover here why this workshop is the most stimulating,
interactive and multidisciplinary educational activity on clinical
trial methodology in oncology. View testimonials from Flims 15
to appreciate this unique, once-in-a-lifetime opportunity for
young clinical cancer researchers.
Join us in Flims for a life changing experience and understanding
of cancer research.
In this Corner
HEALTH
ECONOMICS
“Cost of illness
studies are important tools to help
inform decisions
about the allocation
of resources.”
Cost of illness studies measure the economic
burden of a disease or a set of diseases.
Together with other types of health economic
analyses, cost of illness studies are important
tools to help inform decisions about the allocation of resources for service provision, prevention
strategies and research funding. However, their
usefulness may be limited by the selection of data
used in the analysis or the types of method used.
This can make comparisons of studies within and
between disease types difficult.
In this corner, we highlight an article recently
published in the Lancet Oncology reporting on
a comprehensive population-based cost analysis
evaluating the cost of all cancers in the 27 countries of the European Union.
In this Corner
HEALTH
ECONOMICS
THE COST OF
CANCER:
WHERE DOES
THE MONEY GO?
In their recently published article in the Lancet
Oncology (Economic burden of cancer across the
European Union: a population-based cost analysis.
Lancet Oncol 2013;14:1165-74), Luengo-Fernandez and colleagues report on a comprehensive
population-based cost analysis evaluating the
cost of all cancers in the 27 countries of the European Union (EU). They used a methodological
framework to obtain data and value cancer-related resource use that was similar to a previous
approach that had been used to estimate the costs
of cardiovascular disease and dementia.
All costs relate to the timeframe of 2009, irrespective of the time of disease onset and were
collected as country-specific aggregate data from
international and national sources. The healthcare, informal care and costs of productivity
losses were collected and included according to
the prevailing norms of the countries reporting
the data. Public and private healthcare service
resource data were collected for five categories of
cancer health-care services: primary care, emergency care, outpatient care, hospital inpatient
care and drugs, and accounted for private as well
as public expenditures. Country-specific unit
costs were applied to value the resources.
The total cost of cancer in the EU was estimated
at €126 billion in 2009. The four countries with
the largest populations in the EU - Germany,
France, Italy, and the UK - accounted for €82.9
billion or 66% of all costs. 60% of the economic
burden of cancer was incurred in non-health-care
areas, with productivity losses due to early death
costing €42.6 billion and to lost working days
€9·43 billion. Informal care costs €23.2 billion.
The remaining 40% of the total EU cancer costs,
€51.0 billion, or €102 per citizen, were incurred by
health care systems and represent 4% of the total,
all cause, EU health-care expenditure. Hospital
inpatient care accounted for 56% of the cancer
related health care costs (€28.4 billion), followed
by drug expenditure 27% (€13.5 billion). Outpatient care, primary care, and emergency care
when added together accounted for 17% of the
cost (€9.1 billion).
The four major cancer types represented 44% of
the total economic cost of cancer in the EU (€55.3
billion), lung cancer being the biggest cost (€18.8
billion), followed by breast (€15 billion), colorectal
(€13.1 billion) and prostate cancer (€8.4 billion).
Breast cancer accounted for the highest cost to
healthcare systems and had the largest drug costs.
Lung cancer conversely consumed most inpatient
care and accounted for the highest productivity
losses attributable to mortality.
Not surprisingly, enormous variations were seen
amongst the different countries. The proportion
of healthcare related costs, of healthcare cost per
patient, of economic cost per cancer type, unit
costs, the number of contacts with healthcare services, the number of years and days lost because
of premature death and morbidity all varied
substantially. Cancer related healthcare expenditure strongly correlated with national income
In this Corner
(p<0·0001) and with cancer incidence (p=0·003).
As a matter of comparison, the cost of cancer in
the USA, excluding informal care and morbidity
losses, was estimated at US$202 (€157) billion in
2008, of which $77 (€60) billion were direct medical costs and $124 (€97) billion were mortality
costs. As a consequence, the USA devoted $255
per person (€196) to cancer related healthcare in
2008. This is greater than any country in the EU
and about €100 more per citizen than the EU as a
whole after adjustment for price differentials. The
reason for this difference was beyond the scope of
the article and can only be hypothesised upon.
The economic burdens of cardiovascular disease
and dementia across the EU were estimated using the same framework. Comparison with the
present analysis on cancer suggests that cancer
imposes a lower economic burden on the EU
than cardiovascular disease (€126 billion vs. €195
billion), although it has higher productivity losses, due to premature mortality in people of work-
ing age. The costs of dementia were estimated for
2007 for the 15 countries belonging to the EU
before 2004. In these 15 countries, the economic
burden of dementia was €189 billion compared
with €117 billion for cancer in 2009, which can be
explained by the much higher costs of informal
care necessary for individuals with dementia, by
far outweighing the higher healthcare costs of
cancer.
and where to allocate scarce resources in a health
care environment that is under continuous pressure from budgetary restrictions.
This analysis demonstrates that although cancer
is a major public health issue affecting 2.45 million people and resulting in 1.23 million deaths
in the EU in 2008, and that the total cost related
to cancer is substantial, it is not excessive when
compared to the cost of certain other chronic diseases. Despite the limitations of systematic cost
of illness studies, such as the one discussed here,
they do provide valuable data permitting comparisons of the socioeconomic burden of different
diseases. Such information is important to help
health policy makers in their decisions on how
In this Corner
ESTRO
CONFERENCES
“It’s not only
a question of
quantity but
also of quality.”
WHAT THE ESTRO 33 ABSTRACT
MEETING REVEALED…
The ESTRO 33 Abstract Meeting took place
in mid-December and is always a key moment
during the organisation of a congress. This year
we received a record number of abstracts: 1,843!
Importantly this is not only a record of quantity
but one of quality too. On the following pages the
Chairs of the various Tracks share their views and
thoughts about the submissions and the emerging
and hot topics within their particular specialty.
Five hundred abstracts will be displayed on site
during the conference. Due to the record number
of abstracts that have been submitted there will
also be a record number of e-posters. Particular
attention is being given to the e-posters to ensure
that they receive the high visibility they deserve.
Twenty workstations will be set up so that the
e-posters can be reviewed and downloaded
during the conference as well as allowing e-mail
communication with the author of the poster. In
addition, all of the e-posters will be accessible for
at least one year after the congress on the ESTRO
website.
CLICK OR TAP ON THE
IMAGES TO SEE THE
EDITORS' NAMES
With almost 80 poster discussion sessions, as well
as the best poster awards for clinicians, physicists,
radiation therapists and radiobiologists there will
be a lot going on which must not be missed!
On another note, thanks to the generosity of our
ambassador members, the ESTRO Solidarity
Fund will make it possible for colleagues from
economically challenged European countries
to attend the conference. The names of the 12
recipients of the grant and the winners of the other
In this Corner
ESTRO
CONFERENCES
“It’s not only
a question of
quantity but
also of quality.”
Fund will make it possible for colleagues from
economically challenged European countries
to attend the conference. The names of the 12
recipients of the grant and the winners of the other
ESTRO awards are announced at the end of this
Corner. We look forward to meeting and greeting
them at the conference.
Talking about greeting, it’s now time to wish you
a happy and prosperous 2014. A year that will be
full of exciting conferences and many new things
to learn and share!
Eralda & Agostino
CLICK OR TAP ON THE
IMAGES TO SEE THE
EDITORS' NAMES
In this Corner
ESTRO
CONFERENCES
FOCUS ON ESTRO NEXT ANNUAL CONGRESS
ESTRO 33
4 - 8 April 2014
Vienna, Austria
The meeting will focus on the latest data from all areas of radiation
oncology: clinical oncology, radiation physics, radiation technology,
brachytherapy and radiobiology.
Through teaching lectures, symposia, presidential sessions, proffered
papers, poster discussions and debates, you will be presented with all
the state-of-the-art science in the field.
Join un for this important event and together we will look at the
challenges of tomorrow in the individualisation of patient treatment.
ESTRO 33
Interview with the Chairs of the Scientific
Advisory Groups
Daniel Zips, Claudio Fiorino, Peter Hoskin, Michelle Leech,
Martijn Kamphuis, Brad Wouters
Abstracts in figures
Awards and Grants to be given at ESTRO 33
Donal Hollywood Award, Company Awards, Academic Award,
ESTRO Solidarity Fund
In this Corner
ESTRO
4 - 8 April 2014
Vienna, Austria
WWW.ESTRO.ORG
In this Corner
ESTRO 33
ESTRO
CONFERENCES
CLINICAL
TRACK
Daniel Zips
Chair of the Scientific Advisory Group for Clinical Radiotherapy
and co-Chair of the Scientific Programme Committee
INTERVIEW WITH
DANIEL ZIPS
netic predictors of radiosensitivity (large cohort
studies).
What is the overall quality of the abstracts of the
clinical track?
We received a high number of abstracts for the
clinical track, many of which were of excellent
quality. Among these there were several on randomised trials, including studies on breast, rectum, head and neck and prostate.
Can you tell us a bit more about the randomised
trials?
We have received a good number of reports on
randomised trials and we have decided to highlight them in dedicated sessions.
What are the hot topics?
They are numerous but I would say those that
have generated most interest are the use of large
databases to evaluate long-term outcome in RT;
the relevance of HPV (where there has been good
new data); regional irradiation in breast cancer,
and optimal radio-chemotherapy in rectal cancer.
Can we expect poster discussions?
Absolutely. We have three poster discussions
where interesting abstracts from clinical studies
will be discussed by experts. For example, interesting new data on brain tumours, particle therapy and paediatric tumours.
What are the emerging topics, highlighting innovative trends?
We will definitely be looking at the studies on
the role of androgen deprivation for intermediate
prostate cancer, the risk of secondary lung cancer
after RT for breast cancer, the relevance of HPV
for non-oropharyngeal head and neck cancers,
hypoxia imaging-based dose escalation, and geDANIEL ZIPS
In this Corner
ESTRO 33
ESTRO
CONFERENCES
PHYSICS
TRACK
Claudio Fiorino
Chair of the Scientific Advisory Group for Radiation Physics
and co-Chair of the Scientific Programme Committee
CLAUDIO FIORINO
INTERVIEW WITH
CLAUDIO FIORINO
What is the overall quality of the abstracts received?
Although it is always difficult to give a comprehensive score of the quality of more than 700
physics abstracts submitted this year, my impression is that we received an enormous amount of
material of very high quality. The blind scoring
process involved more than 80 reviewers from
almost all European countries who selected the
abstracts objectively, following an effective peer
review system. So the audience should find high
quality proffered oral sessions as well as four interesting poster discussions. The large number of
abstracts received also imposed quite strict selection criteria for the posters, so that high quality
work will also be seen in the poster sessions.
What are the hot topics? What are the emerging
topics, highlighting innovative trends?
We had some confirmation of existing topics and
evidence of some new trends. Dosimetry, planning optimisation and imaging represent the
largest numbers, as in the recent programmes.
However, we also had a big increase in a few
emerging topics, in particular those related to
adaptive radiotherapy (dose accumulation, defor-
mation, monitoring of changes during radiotherapy, management of intra-fraction motion) and
predictive models in radiotherapy.
Within different areas, we had a large increase of
proton/heavy ions studies and clinical applications of biological/functional imaging.
Is there any other aspect of the Physics Track
that you would like to draw attention to?
I would like to underline the net increase of real
“inter-disciplinary” contributions involving
physicists committed to working with clinicians,
radiation biologists, statisticians and bio-engineers in many boundary areas. I see this path of
radiotherapy physics “outside physics” as a very
positive evolution, not only for the physics community but also for the whole radiation oncology
world, showing how the integration of physics
skills into enlarged research and professional
teams is a factor of paramount importance for
the development of radiotherapy research and the
profession in Europe.
At the same time, physicists do not forget their
original role of expert “controller” and “optimiser” of the use of radiation to treat cancer,
always keeping paramount their attention to the
accuracy and safety requirements in a rapidly
high-tech context such as that of radiotherapy.
In this Corner
ESTRO 33
ESTRO
CONFERENCES
BRACHYTHERAPY
TRACK
Peter Hoskin
Chair of the Scientific Advisory Group for Brachytherapy
PETER HOSKIN
INTERVIEW WITH
PETER HOSKIN
What are your initial comments on the abstracts
received for the Brachytherapy track?
We received a large number of high quality abstracts and have selected those for oral presentations and posters on the basis of their scientific
content. The abstract with the highest score
on prostate brachytherapy will be included in the
pleanary session and we have a rejection rate of
10% to ensure that the quality of presentations is
of a high standard throughout.
Abstracts were received from a wide geographical
area with a significant number of abstracts from
China and the USA; one of the top scoring abstracts
was from Japan. We can see that the ESTRO audience is definitely spreading beyond well Europe.
The brachytherapy track will have four proffered
papers sessions: prostate, gynae, breast and
physics. What are the hot topics?
The popular topics this year are brachytherapy for
local recurrence of prostate cancer, brachytherapy
for salvage treatment at other sites and in vivo dosimetry in the physics track alongside other high
quality abstracts on HDR prostate monotherapy and new contributions from the EMBRACE
group.
What are the emerging topics from among all
the papers that you read?
Image guided brachytherapy in cervical cancer
is prominent once again in the programme. New
reporting guidelines for vaginal dosimetry will
be presented and a teaching lecture will highlight
the new ICRU GEC ESTRO guidelines. Accelerated Partial Breast Irradiation (APBI) is a focus
for several of the oral presentations in the breast
session and in physics there is a plenary talk and
oral presentations on in vivo dosimetry.
Have some awards already been decided?
Yes. The Nucletron Award for the most innovative paper has been awarded for an interesting
randomised trial study from Romania on Head
& Neck.
The GEC-ESTRO Best Junior Presentation sponsored by Nucletron will also be awarded at the
meeting .
Who should attend the brachytherapy track?
The programme will naturally be of interest for
brachytherapists but all clinicians, RTTs and
physicists will find topics relevant to their practice in the Brachytherapy track.
Brachytherapy is also well represented in the
Interdisciplinary track providing interest for all
those active in radiation oncology.
In this Corner
ESTRO 33
ESTRO
CONFERENCES
INTERVIEW WITH
MICHELLE LEECH &
MARTIJN KAMPHUIS
RTT
TRACK
Michelle Leech & Martijn Kamphuis
Co-chairs of the Scientific Advisory Group for
Radiation Technology
What is the overall quality of the abstracts you
received?
Quality is very high particularly in the areas of
IGRT and treatment planning.
141 abstracts were submitted for the RTT track,
of which 90 were either on IGRT or treatment
planning. In fact, the total number of abstracts is
50% more than at the 2nd ESTRO Forum last year.
The number of abstracts is also a little higher
than at ESTRO 31.
Image guidance, particularly in relation to dose
reduction and the evaluation of patient positioning. There is also considerable interest in contouring with new approaches to the inherent difficulties posed by contouring and delineation.
For the first time, the highlight of the RTT session will be presented on Sunday 6th April in the
Interdisciplinary track.
MICHELLE LEECH
MARTIJN KAMPHUIS
What is the emerging topic of interest?
Current perspectives on psychosocial aspects of
patient care is emerging as a topic of interest for
RTTs at ESTRO 33.
Can you tell us a bit more on the Interdisciplinary track?
RTT papers will be presented in both symposia
and proffered papers sessions of the interdisciplinary track. This is the first time that our discipline is contributing to the proffered papers
session.
What can you say about the geographical origin
of the abstracts?
We have international participation ranging
from within Europe to Australia, Asia and North
America.
What can you say to the young radiation therapists in the audience?
In addition to the Young Scientific Programme,
there will be a dedicated young moving poster
session in the RTT track with a wide variety of
topics to appeal to the audience.
WHY IS ESTRO 33 OF INTEREST
FOR RADIATION THERAPISTS?
READ VIEWS & INTERESTING
ARTICLES IN THE RTT CORNER
In this Corner
ESTRO 33
ESTRO
CONFERENCES
RADIOBIOLOGY
TRACK
Brad Wouters
Chair of the Scientific Advisory Group for Radiobiology
INTERVIEW WITH
BRAD WOUTERS
What is the overall quality of the abstracts
received?
We received a higher number of abstracts this
year than on previous occasions and the overall
quality has continued to improve. We also received several very high scoring abstracts that
reflect their overall importance to our field.
Is there any other aspect of the Radiobiology
track that you would like to draw attention to?
Several high scoring abstracts have demonstrated the clinical potential of using biology
to extract features of importance for clinical
outcome. This included DNA based genomic
studies and RNA expression studies in prostate
cancer.
We received a large number of abstracts for
several areas of biology. These included studies
investigating the combination of radiation with
novel targeted drugs aimed at signaling pathways important in cancer cells. Another area of
importance this year was the potential of radiation to influence the immune system and immune directed therapies.
What are the emerging topics, highlighting innovative trends?
There is a resurgence in research addressing
normal tissue radiobiology, using genetics as a
predictive tool. Several high impact studies using large numbers of patients from clinical consortia are presented this year.
DON'T MISS THE BEST OF 2013
IN RADIOBIOLOGY IN THE RB
CORNER
BRAD WOUTERS
In this Corner
FOCUS ON FUTURE ESTRO CONFERENCE
ESTRO 33
ABSTRACTS
IN FIGURES
1,843 ABSTRACTS RECEIVED!
A total of 1,843 abstracts were received and the distribution by sub-specialty is presented in the table
below. Twelve papers will be presented in the Interdisciplinary Track. This Track aims to share the
science between all the oncology professionals and provide attendees with sessions on new technologies, translational aspects of novel radiobiological concepts with clinical promise, as well as addressing issues that relate to quality and safety in radiation oncology and trial methodology.
ABSTRACTS SUBMITTED: 1843
Radiobiology
106
Brachytherapy
170
WHY IS ESTRO 33 OF
INTEREST FOR RADIATION
THERAPISTS?
Read views and interesting
articles in the RTT Corner
RTT
136
Tracks
Clinical
721
Physics
710
Oral
Poster Poster on
discussion display
Clinical
64
26
161
Physics
72
36
169
RTT
30
7
36
Brachytherapy
24
9
50
Radiobiology
18
0
40
Interdisciplinary
12
Awards &
highlights
9
In this Corner
ESTRO 33
ESTRO
CONFERENCES
AWARDS &
GRANTS
TO BE GIVEN
AT ESTRO 33
We are pleased to announce the
names of the recipients of an
award or grant at ESTRO 33.
MORE INFORMATION
ON THE AWARDS
DONAL HOLLYWOOD AWARD
COMPANY AWARDS
Pernille Lassen, Denmark
• ABSTRACT: "No prognostic impact of HPV on
RT-outcome in advanced non-oropharynx cancer - analysis of 1606 DAHANCA patients"•
• PRIZE: The recipient of this award receives complimentary registration to ESTRO 33, hotel
accommodation and round trip economy class
travel.
ESTRO-VARIAN AWARD
Bianca Hoeben, The Netherlands
• ABSTRACT: "PET imaging for characterization
of head and neck tumors"
• PRIZE: 7500 €
ESTRO-ACCURAY AWARD
Deepak Gupta, India
• ABSTRACT: "Real time prostrate gland motion
and deformation during cyberknife stereotactic
body radiotherapy"
• PRIZE: 5000 €
In this Corner
ESTRO 33
ESTRO
CONFERENCES
ESTRO-NUCLETRON BRACHYTHERAPY
AWARD
Henrike Westerveld, The Netherlands
• ABSTRACT: "Evaluation and comparison of a
novel vaginal dose reporting method in 153
cervical cancer patients"
• PRIZE: 2000 €
NUCLETRON TRAVEL GRANTS
Eva Ambroa Rey, Spain
Alexey Lozhkov, Russia
Pedro Gallego Franco, Spain
Ahmed Salem, Jordan
Ingrid Fumagalli, France
• PRIZE: Each recipient is awarded 1000 €
GEC-ESTRO BEST JUNIOR PRESENTATION
- sponsored by Nucletron
ACADEMIC AWARD
ESTRO SOLIDARITY FUND
ESTRO-JACK FOWLER UNIVERSITY OF
WISCONSIN AWARD
Michael Dec, Poland
Eva Ambroa, Spain
Pedro Gallego Franco, Spain
Rui Valle Marquez, Portugal
Francisco Javier San Miguel Avedillo, Spain
Laura Fachal, Spain
Tamás Pócza, Poland
Gábor Stelczer, Poland
Ramón Polo Cezón, Spain
András Herein, Hungary
Paula Ibanez, Spain
Joanna Socha, Poland
• PRIZE: Each recipient is awarded free registration
for the Congress and membership of ESTRO
during 2014.
Thomas Ravkilde, Denmark
• ABSTRACT: "Real-time dose reconstruction
during volumetric modulated arc therapy with
dynamic MLC tracking"
• PRIZE: 1000 €
Viktoras Rudzianskas, Lithuania
• ABSTRACT: "Investigation of radiation therapy
effectiveness and safety of recurrent head and
neck squamous cell carcinoma"
• PRIZE: 1500 €
LATE BREAKING ABSTRACTS
MORE INFORMATION ON
ESTRO 33 ON
WWW.ESTRO.ORG
Late breaking abstract submission will be open as of the first week of January.
Deadline to submit late breaking abstracts is 31st of January 2014.
Read online the conditions that apply for late breaking abstract submission.
In this Corner
ESTRO
CONFERENCES
FOCUS ON PAST CONFERENCES
EMUC
EMUC
15-17 November 2013
Marseille, France
ESTRO report
Over the course of three days, three separate but intrinsically linked
disciplines attended a scientific meeting and exchanged views on
the treatment of urological cancers. The 5th edition of the European
Multidisciplinary Meeting on Urological Cancers was jointly organised by EAU (European Association for Urology), ESMO (European
Society for Medical Oncology) and ESTRO.
EAU Report
By Marco van Vulpen and David Dearnaley
By Loek Keizer
In this Corner
EMUC
ESTRO
CONFERENCES
ESTRO
REPORT
MARCO VAN VULPEN
DAVID DEARNALEY
The fifth edition of the European Multidisciplinary Meeting on Urological Cancers (EMUC)
took place in Marseille from November 15th to
November 17th 2013. More than 750 professionals from all over the world who are involved in
the management of urological cancers, gathered
to discuss recent achievements in the field. The
number of participants increased more than
50% since last year EMUC in Barcelona, as the
EMUC meeting seems to be increasingly appreciated. This increase probably can be explained
due to the growing need for a multidisciplinary
approach in urological cancer care. The attendants consisted of a broad range of professionals:
urologists (app 50%), radiation oncologists (app
20%), medical oncologists (app 20%), radiologists, pathologists, physician assistants and other professions (app 10%). The faculty represented
the major societies involved in urological cancers: ESTRO, EAU, ESMO, EORTC and ESUR.
The conference was entitled “From guidelines to
personalized cancer care”. Around 200 abstract
were presented during oral sessions or displayed
as posters. The format featured state-of-the art
lectures, practice-oriented case discussions with
voting and debates over the most controversial aspects in everyday clinical practice. A real
interaction with the audience was enabled by
providing the opportunity to text questions and
comments “live” to the faculty by keypad. This
resulted in interesting discussions which showed
a clear picture of opinions of the different partners and provided a better understanding of
each other perspectives.
Several sessions were of great interest for the
radiation oncology community. T. Wiegel discussed modern radiotherapy techniques for
prostate cancer, with the title “does dose matter?”. G. Villeirs and F. Lecouvet showed how
In this Corner
EMUC
MRI and choline PET can be used in clinical
practice. This resulted in an in depth discussion
on the benefits, costs and quality assurance.
H. van der Poel discussed the prerequisites of
focal therapy: index lesion should be visible,
dosimetry should be possible, toxicity should be
reduced and survival should be at least similar
to treatment of the entire gland. He also focused
on the vision, published by Coleman and Scardino (Curr Opin Urol 2013;23(2):123-8): ”Although
none of the advances in cancer detection, targeted imaging or focal treatment have yet proven to
be game-changing, together, they have contributed to a movement towards less invasive, focal
treatment for prostate cancer and a growing
awareness of the potential clinical benefits of
this form of therapy”. P. Ost and G. de Meerleer
showed the possibility to postpone hormonal
therapy in patients with oligometastastatic disease. The potential for bladder sparing protocols
based on radio-chemotherapy was presented by
N. James. Also the role of radiotherapy in penile
cancer, testicular cancer and even renal cancer
was discussed. All speakers plead for more direct involvement of radiation oncologists in the
decision making for patients. Translational and
basic science topics were also addressed during
the various sessions of the meeting.
The next EMUC Meeting will take place in Lisbon, Portugal from 14-16 November 2014. This
meeting promises to review developments in
management in the fast-changing practice of
urological cancers. These developments are only
possible in a multidisciplinary approach. This is
evolving and gaining strength year on year in
EMUC in an interactive way.... So please block
your agenda for 6th EMUC in Lisbon!
Marco van Vulpen & David Dearnaley
ESTRO representatives
In this Corner
EMUC
ESTRO
CONFERENCES
EAU
REPORT
LOEK KEIZER
Early on in the proceedings, as Prof. Manfred
Wirth welcomed the delegates on behalf of the
EAU, the make-up of the 700-strong audience became clear. By voting with their IML Connectors,
it was established that just over 55% of the audience were urologists, 20% were medical oncologists and 10% were radiation oncologists. Other,
smaller categories included radiologists, researchers and industry representatives. Two thirds of
the attendees worked in an academic institution,
and 43% were not affiliated with any of the three
organising associations.
together in multidisciplinary teams is the future
for the treatment of urological cancers.”
The scientific programme of the meeting was designed to appeal to all three specialties, emphasising particularly the way in which all three work
together in modern clinical practice. Dr. Marco
Van Vulpen co-chaired several of the sessions,
offering perspectives as a representative of the
radiation oncologists.
Loek Keizer
Editor EAU
“We shouldn’t be working as separate, sometimes
opposing columns within medicine: collaboration
is vital to receive funding and improve care for
the patient. We are starting to see multidisciplinary clinics in the United States, where urologists
buy their own radiotherapy equipment, and employ radiation therapists. This approach is very
promising, in my opinion.”
“Multidisciplinary meetings like this are essential. Urologists and radiation oncologists aren’t
fluent enough in each other’s “language”. Urologists tend to be more focused on surgical procedures when dealing with urological cancers,
whereas radiotherapists approach tumours with
probabilities and sigmoid curves. I’m convinced
that learning each other’s language and working
In this Corner
CALENDAR
OF EVENTS
2014
JANUARY
23 - 25/01
COMy - The 1st World Congress on Controversies in Multiple Myeloma
ESTRO recommended event
Bangkok, Thailand
Read more >
FEBRUARY
06 - 08/02
Developing your Research Idea: A practical course for Radiation Therapy Health Care Professionals
ESTRO Endorsed course
Dublin, Ireland
Deadline for registration: 15/01/ 2014
Read more >
10 - 11/02
Beyond the Genetic Prescription Pad: Personalizing Cancer Medicine in 2014
Toronto, Canada
Deadline for registration: 10 January 2014
Read more >
10 - 14/02
ICTR-PHE 2014
ESTRO endorsed event
Geneva, Switzerland
Read more >
23 - 27/02
Radiobiology & Radiobiological Modelling in Radiotherapy
ESTRO supported COURSE
Port Sunlight Wirral, UK
Read more >
MARCH
14 - 15/03
Perspectives in lung cancer - 15th European congress
Deadline for registration: 16 January 2014
Read more >
APRIL
04 - 08/04
ESTRO 33
ESTRO annual congress
Vienna, Austria
Read more >
MAY - JUNE
30/05 - 02/06
RPM 2014 - International Conference on Radiation Protection in Medicine
Varna, Bulgaria
Deadline for registration: 31 March 2014
Read more >
21 - 27/06
FLIMS 16 - Methods in Clinical Cancer Research
Flims, Switzerland
Deadline for registration: 10 January
Read more >
OCTOBER
01 - 04/10
Protons in Therapy and Space
Erice, Italy
Read more >
NOVEMBER
07 - 09/11
EMUC 2014 - European Multidisciplinary Meeting on Urological Cancers
Lisbon, Portugal
Read more >
2015
APRIL
24 - 28/04
3rd ESTRO Forum
ESTRO interdisciplinary congress
Barcelona, Spain
CREDITS
ESTRO
Bimonthly Newsletter
N° 92 | January - February 2014
European SocieTy for
Radiotherapy & Oncology
OFFICERS
President: V. Valentini
President-Elect: P. Poortmans
Past-President: J. Bourhis
EDITOR
C. Hardon-Villard
EDITORIAL ADVISERS
J. Kazmierska and L. Muren (ESTRO Board
Members)
TWG
GRAPHIC DESIGN
Daneel Bogaerts / Nathalie Boitière
Cover: © Fotolia Anyaivanova
Editorial: p1 - © Fotolia Ivan Kmit
Society Life corner: p2 - © Fotolia Christian Schwier / p13 - © Fotolia Momius
RTT corner: p12 - © Fotolia Dmitry Vereshchagin / p13 - © Fotolia Woodapple
ESTRO Conferences corner: p13 - © Fotolia Rido
Published every two months and distributed
by the European SocieTy for Radiotherapy
& Oncology.
DEADLINES FOR SUBMISSION
OF ARTICLES IN 2014
March/April 2014 Issue > 13 January 2014
May/June 2014 Issue > 15 March 2014
July/August 2014 Issue > 15 May 2014
Sept./Oct. 2014 Issue > 14 July 2014
Nov./Dec. 2014 Issue > 15 September 2014
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]
Opinions expressed in the ESTRO NewsLetter do
not necessary reflect those of the Society or of its
Officers.

newsletter january - february

Transcrição

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