ESTRO 2025 - Abstract Book

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Invited Speaker

ESTRO 2025

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Speaker Abstracts TOPGEAR Trevor Leong Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia

Abstract:

TOPGEAR is an international randomised phase 3 trial of preoperative chemoradiation for resectable gastric and gastro-oesophageal junction cancer. The final results of TOPGEAR were presented at ESMO 2024 in Barcelona with simultaneous publication in the New England Journal of Medicine. Overall, the TOPGEAR data was not favourable for radiation oncology, and together with results from several other recent phase 3 trials, suggests a diminished role for radiotherapy in gastrointestinal malignancies, particularly gastro-oesophageal cancer. Nevertheless, there are many positive aspects of the TOPGEAR trial, including the comprehensive quality assurance program and global recruitment of participants. This talk will discuss the strengths of the trial, areas for improvement, and strategies for future development of radiotherapy in gastro-oesophageal cancer. The talk will also review media reporting of the TOPGEAR results and its influence on clinician perception of radiotherapy.

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Speaker Abstracts Is in-house development cost effective? Peter Remeijer Department of Radiotherapy, The Netherlands Cancer institute, Amsterdam, Netherlands

Introduction

Historically, in-house software development has been important in specialized fields like radiation oncology, especially where industry solutions were unavailable or insufficient. Institutions such as the Netherlands Cancer Institute (NKI) have developed software to meet both specific clinical and research needs, and were also successful in setting up collaborations with industry. Because of the small scale of many of these developments, and limited regulatory demands, the required investments remained manageable. Recent regulatory changes, however, for example the Medical Device Regulation (MDR) in Europe, have significantly increased the complexity and cost of in-house software development. Compliance demands extensive documentation, validation, prospective risk assessments, and adherence to strict quality management systems. While external audits may not be required for in-house developed applications, the internal regulatory process adds substantial time and effort as well. Furthermore, modern software development practices also contribute to rising costs. Version control, automated testing (unit, system, and integration tests), and maintaining separate environments for development, testing, acceptance, and production require additional infrastructure and effort. While these practices enhance the quality and maintainability of the software, they also extend development timelines and required resources.

The cost of in-house developed software versus commercial software

To illustrate the cost of developing medical in-house software, including MDR compliance, we examine two recent in-house software developments at the NKI: AI autocontouring for brachytherapy 1 , and SmartAdapt 2 . Both applications do not involve any user interaction and generate DICOM outputs (RTstructs, and virtual CT scans and