ESTRO 36 Abstract Book

Radiotherapy &Oncology Journal of the European SocieTy for Radiotherapy and Oncology Journal of the European SocieTy for Radiotherapy and Oncology

Volume 123 Supplement 1 (2017)

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Radiotherapy & Oncology is available online: For ESTRO members: http://www.thegreenjournal.com For institutional libraries: http://www.sciencedirect.com Radiotherapy ncology is available online: For ESTR e bers: http:// .thegreenjournal.co For institutional libraries: http://ww .sciencedirect.com Radiotherapy &Oncology Journal of the European SocieTy for Radiotherapy and Oncology ESTRO 36 5-9 May 2017 Vienna, Austria

Volume 123 Supplement 1 (2017)

Radiotherapy & Oncology is available online: For ESTRO members: http://www.thegreenjournal.com For institutional libraries: http://www.sciencedirect.com

Amsterdam • Boston • London • New York • Oxford • Paris • Philadelphia • San Diego • St. Louis • osto • Lo o • e ork • xfor • Paris • P ila el ia • Sa iego • St. Lo is ster a

International Standard Serial Number 0167-8140

© 2017 Elsevier Ireland Ltd. All rights reserved.

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ESTRO 36 CONTENT

SATURDAY 6 MAY 2017 Teaching Lecture

The role of radiotherapy in small cell lung cancer -current status and future developments ..............Abs. 1 Immunotherapy. ...................................................................................................................Abs. 2 MRI for RO physicists: what is what? QA geometrical distortions...................................................Abs. 3 Cavity Theory: separating the facts from the myths ...................................................................Abs. 5 High tech or low tech for metastatic disease, how does one decide and what is the cost-benefit? . ....Abs. 6 Gene editing: How this technique can be used to study radiation responses? .................................Abs. 7 Target delineation and target definition for PBI . .....................................................................Abs. 8-9 Joint Symposium ESTRO-ASTRO: Cutting edge combined modality therapies (Focus on NSCLC) ......................... Abs. 10-13 Symposium with Proffered Papers Radiotherapy plus immunotherapy combination: rationale and results so far . ......................... Abs. 14-18 Joint symposium ESTRO-AAPM: New technological and computational developments in particle therapy ............. Abs. 19-21 Symposium CT imaging, new developments ........................................................................................ Abs. 22-24 High tech or low tech for metastatic disease, how does one decide and what is the cost-benefit? . ......................................................................................... Abs. 25-27 Symposium with Proffered Papers Novel approaches in heart / lung matters .......................................................................... Abs. 28-31 Symposium Expanding brachytherapy indications ................................................................................ Abs. 32-34 Proffered Papers Radiobiological modeling . ............................................................................................... Abs. 35-41 Poster Viewing Session 1: Haematology / Paediatrics / Sarcoma ................................................................ Abs. 42-50 Proffered Papers Joint Clinical - GEC ESTRO on cervix cancer ....................................................................... Abs. 51-56 Symposium Response adapted treatment ........................................................................................... Abs. 57-59 Proffered Papers Dosimetry and detector development for particle therapy .................................................... Abs. 60-65 Quantitative and functional imaging ................................................................................. Abs. 66-71 Improvements in positioning and motion management ........................................................ Abs. 72-77 Symposium with Proffered Papers Novel approaches in gut matters ...................................................................................... Abs. 78-80 Proffered Papers Skin . ........................................................................................................................... Abs. 81-86 Poster Viewing Session 2: Palliative and health services research ............................................................... Abs. 87-93 Award Lecture Van der Schueren Award lecture ...........................................................................................Abs. 94 Iridium Award Lecture .........................................................................................................Abs. 95 Honorary Physicist Award Lecture . ........................................................................................Abs. 96 Symposium The optimal approach to treat oligometastastic disease: different ways to handle an indication quickly gaining acceptance ......................................................................... Abs. 97-100 Symposium with Proffered Papers Targeting tumour heterogeneity ....................................................................................Abs. 101-105 Symposium Innovations in ion beam therapy ...................................................................................Abs. 106-108 Imaging for therapeutic response / toxicity evaluation . ....................................................Abs. 109-111 Comprehensive motion management and immobilisation solutions in radiation therapy .........Abs. 112-114

Symposium with Proffered Papers Novel approaches in brain matters ................................................................................Abs. 115-119 Symposium Brachytherapy pays ....................................................................................................Abs. 120-123 Proffered Papers Prostate ....................................................................................................................Abs. 124-130 Poster Viewing Session 3: Treatment planning . ....................................................................................Abs. 131-138 Proffered Papers Lung .........................................................................................................................Abs. 139-144 Joint Symposium ESTRO-JASTRO: Oligometastatic disease ........................................................................Abs. 145-148 Proffered Papers Best of particles .........................................................................................................Abs. 149-154 Imaging and image analysis .........................................................................................Abs. 155-160 Novelties in image guidance .........................................................................................Abs. 161-166 Symposium Novel approaches in particle biology ..............................................................................Abs. 167-170 Proffered Papers Prostate 1 . ................................................................................................................Abs. 171-176 Breast .......................................................................................................................Abs. 177-182 Poster Viewing Session 4: Brachytherapy miscellaneous ........................................................................Abs. 183-190 Award Lecture Honorary Members’ Award Lectures ...............................................................................Abs. 191-193 SUNDAY 7 MAY 2017 Teaching Lecture Role of radiotherapy in extranodal lymphomas ...................................................................... Abs. 194 Strategies to increase safety in radiation oncology: how to make accidents less likely to occur ............................................................................................................ Abs. 195 Automated planning, knowledge-based planning and other novel developments in treatment planning - how do they work and perform? ......................................................... Abs. 196 Building of NTCP models that contain non-dosimetric parameters . ........................................... Abs. 197 Particle therapy: how to start up and carry out daily clinical practice ......................................... Abs 198 Three-dimensional organoid culture system .......................................................................... Abs. 199 Commissioning of dose calculations in brachytherapy TPS ....................................................... Abs. 200 Symposium New developments in Personalised Radiation Oncology (PRO) . ..........................................Abs. 201-204 Safety and clinical and cost effectiveness of multi-modality IGRT and ART . .........................Abs. 205-208 Robust optimisation in protons and photons . ..................................................................Abs. 209-211 Ultra fast online therapy adaptation (replanning, dose accumulation QA) ............................Abs. 212-214 Particle theraphy: how to start up and carry out daily clinical practice ................................Abs. 215-217 Symposium with Proffered Papers Combining tumour and normal tissue models ..................................................................Abs. 218-222 Symposium Paediatric brachytherapy . ............................................................................................Abs. 223-225 Proffered Papers Dose measurement and dose calculations . .....................................................................Abs. 226-232 Poster Viewing Session 5: Lung and breast ..........................................................................................Abs. 233-241 Proffered Papers Understanding RBE and its relevance in vivo ...................................................................Abs. 242-246 Joint Symposium ESTRO-CARO: Waiting times and QA .............................................................................Abs. 247-250

Proffered Papers Automated and robust treatment planning . ....................................................................Abs. 251-256 Best of online MRI-guided radiotherapy ..........................................................................Abs. 257-262 Variabilities in volume definition . ..................................................................................Abs. 263-268 Proffered Papers Prostate 2 . ................................................................................................................Abs. 269-274 Physics treatment verification .......................................................................................Abs. 275-280 Poster Viewing Session 6: Imaging .....................................................................................................Abs. 281-287 Presidential Symposium Presidential Symposium ..................................................................................................... Abs. 288 Award Lecture Jens Overgaard Legacy Award Regaud Award Lecture ....................................................................................................... Abs. 290 Symposium New paradigm in HNSCC ..............................................................................................Abs. 291-293 Symposium with Proffered Papers Costs and value of radiotherapy innovations: how to assess ..............................................Abs. 294-297 Debate This house believes that proton guided photons (online MR guided therapy) will be superior to photon guided protons (CBCT proton therapy) ................................................Abs. 298-299 Proffered Papers Intra-fraction motion management ................................................................................Abs. 300-306 Symposium Focus on ART: the clinical difficulties ..............................................................................Abs. 307-309 Symposium Registration and fusion techniques ................................................................................Abs. 310-312 Proffered Papers Breast and gynaecology . .............................................................................................Abs. 313-319 Poster Viewing Session 7: Upper and lower GI .....................................................................................Abs. 320-328 Proffered Papers Head and Neck ...........................................................................................................Abs. 329-334 Symposium GTFRCC ....................................................................................................................Abs. 335-338 Proffered Papers Dose measurement and dose calculation for proton beams ...............................................Abs. 339-344 Treatment planning applications . ..................................................................................Abs. 345-350 Adaptive strategies .....................................................................................................Abs. 351-356 Proffered Papers Physics Dosimetry . .....................................................................................................Abs. 357-362 Eye/GYN . ..................................................................................................................Abs. 363-368 Poster Viewing Session 8: Radiobiology ...............................................................................................Abs. 369-374 Award Lecture Jack Fowler University of Wisconsin Award ........................................................................... Abs. 375 Company Award Lectures .............................................................................................Abs. 376-377

MONDAY 8 MAY 2017 Teaching lecture

State of the art multimodality treatment of rectal cancer ........................................................ Abs. 378 SBRT for spine and non-spine bone metastases: what role in routine practice? .......................... Abs. 379 Challenges in proton radiotherapy .................................................................................Abs. 380-381 Targeting histones and epigenetic mechanisms in radiation biology and oncology ....................... Abs. 382 State of the art and future improvements in in-room cone beam CT image quality ..................... Abs. 383 Radiomics for physicists – understanding feature extraction, modelling, performance validation and applications of radiomics ............................................................. Abs. 384

Focus on lung cancer: What a radiotherapy department should offer their patients ..................... Abs. 385 How to write a research proposal for a grant? ....................................................................... Abs. 386 Symposium Rectal cancer – prediction and individualisation ...............................................................Abs. 387-389 Radiotherapy of brain tumours . ....................................................................................Abs. 390-392 MR guided radiotherapy: the new standard of care in 10 years time ...................................Abs. 393-396 Symposium with Proffered Papers Novel approaches in head and neck tumour control .........................................................Abs. 397-400 Symposium Experimental therapies ................................................................................................Abs. 401-403 Adaptive radiotherapy (both anatomical and ‘functional’ changes) ......................................Abs. 404-406 Focus on lung cancer: What a radiotherapy department should offer their patients ...............Abs. 407-409 Education and research grants ......................................................................................Abs. 410-414 Poster Viewing Session 9: Dosimetry ..................................................................................................Abs. 415-423 Proffered Papers Upper and Lower GI ....................................................................................................Abs. 424-429 Joint Symposium ESTRO-ESR: Radiomics and imaging databases for precision radiation oncology ...................Abs. 430-433 Symposium with Proffered Papers Novel approaches in prostate tumour control ..................................................................Abs. 434-436 Proffered Papers New technologies for imaging and therapy .....................................................................Abs. 437-442 Optimatisation algorithms for treatment planning ............................................................Abs. 443-448 Planning and quality assurance .....................................................................................Abs. 449-454 Poster Viewing Session 10: RTT .........................................................................................................Abs. 456-462 Award Lecture Donal Hollywood Award ..................................................................................................... Abs. 463 Proffered Papers Highlights of proffered papers . .....................................................................................Abs. 464-467 Symposium Non-rectal GI tumours: key open questions to be answered from (and for) the radiation oncologist! .................................................................................Abs. 469-471 Joint Symposium ESTRO-RANZCR: Big data to better radiotherapy .............................................................Abs. 472-475 Symposium Locally advanced breast cancer . ...................................................................................Abs. 476-478 Symposium with Proffered Papers Novel approaches in thoracic tumour treatment . .............................................................Abs. 479-482 Proffered Papers Inter-fraction motion management ................................................................................Abs. 483-491 Symposium Focus on prostate cancer: what is the best of radiotherapy we need to treat our patients with . ...............................................................................Abs. 492-494 Young ESTRO meets ESTRO School ...............................................................................Abs. 495-501 Poster Viewing Session 11: Head and neck and CNS .............................................................................Abs. 502-511 Proffered Papers CNS ..........................................................................................................................Abs. 512-517 Symposium Patient Reported Outcomes (PROs) in radiotherapy ..........................................................Abs. 518-520 Proffered Papers Oligometastatic disease ...............................................................................................Abs. 521-526 Symposium with Proffered Papers Novel approaches in colorectal tumour control ................................................................Abs. 527-529

Proffered Papers Dosimetry and detector development . ...........................................................................Abs. 530-535 Novel methods for auditing ..........................................................................................Abs. 536-541 Patient safety and treatment outcome ...........................................................................Abs. 542-547 Poster Viewing Session 12: Gynaecology and prostate . .........................................................................Abs. 548-554

TUESDAY 9 MAY 2017 Teaching lecture

New radiotherapeutic horizons in soft tissue sarcoma treatment .............................................. Abs. 555 Clinical evidence for hypofractionation in prostate cancer what is the optimum? ......................... Abs. 556 Extracellular vesicles in radiation oncology ........................................................................... Abs. 557 Update on molecular radiotherapy ....................................................................................... Abs. 558 Basics, implementations, limitations, … of Monte Carlo dose calculation algorithms .................... Abs. 559 RTTs roles and responsibilities to support future practice ........................................................ Abs. 560 Symposium Radiotherapy in the elderly ..........................................................................................Abs. 561-564 Symposium with Proffered Papers Selection of patients and radiotherapy technique for APBI in the light of new phase III trial data . ..........................................................................................Abs. 565-569 Novel approaches in poor tumour control sites ................................................................Abs. 570-573 Symposium 4D imaging and tracked delivery ...................................................................................Abs. 574-576 Modelling and treatment customisation ..........................................................................Abs. 577-579 RT is technology driven. How to keep the patient involved? . .............................................Abs. 580-582 Hypofractionation in prostate cancer . ............................................................................Abs. 583-585 Is there any ground for boost brachytherapy in the time of high precision IGRT/IMRT? .........Abs. 586-588 Symposium with Proffered Papers Novel approaches in tumour control ..............................................................................Abs. 589-591 Symposium Applications and challenges in dosimetry for MR-linacs .....................................................Abs. 592-594 Novel approaches for combining imaging and non-imaging data for radiotherapy response predicition .............................................................................Abs. 595-597 Debate Debate: Precision in radiotherapy: mission complete! . ........................................................... Abs. 598 POSTERS Clinical track: Head and Neck .......................................................................................Abs. 603-621 Clinical track: CNS ......................................................................................................Abs. 622-644 Clinical track: Haematology ..........................................................................................Abs. 645-648 Clinical track: Breast ...................................................................................................Abs. 649-665 Clinical track: Lung .....................................................................................................Abs. 666-678 Clinical track: Upper GI (oesophagus, stomach, pancreas, liver) ........................................Abs. 679-701 Clinical track: Lower GI (colon, rectum, anus) . ...............................................................Abs. 702-707 Clinical track: Gynaecological (endometrium, cervix, vagina, vulva) ...................................Abs. 708-722 Clinical track: Prostate ................................................................................................Abs. 723-739 Clinical track: Skin cancer / malignant melanoma ............................................................Abs. 740-741 Clinical track: Sarcoma ................................................................................................Abs. 742-744 Clinical track: Palliation ...............................................................................................Abs. 745-747 Clinical track: Elderly ..................................................................................................Abs. 748-749 Clinical track: Health services research / health economics ...............................................Abs. 750-751 Clinical track: Other ....................................................................................................Abs. 752-755 Physics track: Basic dosimetry and phantom and detector development ..............................Abs. 756-784 Physics track: Dose measurement and dose calculation ....................................................Abs. 785-812 Physics track: Radiation protection, secondary tumour induction and low dose (incl. imaging) . .......................................................................................Abs. 813-815 Physics track: Treatment plan optimisation: algorithms ....................................................Abs. 816-823 Physics track: Treatment planning: applications ..............................................................Abs. 824-845 Physics track: (Radio)biological modelling ......................................................................Abs. 846-855 Physics track: Intra-fraction motion management ............................................................Abs. 856-865 Physics track: Inter-fraction motion management (excl. adaptive radiotherapy) ...................Abs. 866-874 Physics track: Adaptive radiotherapy for inter-fraction motion management ........................Abs. 875-880

Physics track: CT Imaging for treatment preparation . ......................................................Abs. 881-884 Physics track: (Quantitative) functional and biological imaging ..........................................Abs. 885-891 Physics track: Images and analyses . .............................................................................Abs. 892-906 Physics track: Implementation of new technology, techniques, clinical protocols or trials (including QA and audit) ...........................................................Abs. 907-921 Brachytherapy: Breast .................................................................................................Abs. 922-925 Brachytherapy: Prostate ..............................................................................................Abs. 926-932 Brachytherapy: Gynaecolgy . ........................................................................................Abs. 933-941 Brachytherapy: Physics . ..............................................................................................Abs. 942-947 Brachytherapy: Miscellaneous .......................................................................................Abs. 948-951 Radiobiology track: Normal tissue biology of the heart ........................................................... Abs. 952 Radiobiology track: Radiobiology of the intestinal track ....................................................Abs. 953-955 Radiobiology track: Normal tissue radiobiology (others) ...................................................Abs. 956-959 Radiobiology track: Radiobiology of proton and heavy ions ...............................................Abs. 960-963 Radiobiology track: Radiobiology of head and neck cancer ................................................Abs. 964-969 Radiobiology track: Radiobiology of prostate cancer ............................................................... Abs. 970 Radiobiology track: Radiobiology of breast cancer . ..........................................................Abs. 971-974 Radiobiology track: Radiobiology of lung cancer .................................................................... Abs. 975 Radiobiology track: Radiobiology of colorectal cancer .......................................................Abs. 976-978 Radiobiology track: Radiobiology of cancer (others) .........................................................Abs. 979-995 RTT track: Patient preparation, positioning and immobilisation ........................................ Abs. 996-1000 RTT track: Imaging acquisition and registration, OAR and target definition ...................... Abs. 1001-1006 RTT track: Treatment planning and dose calculation / QC and QA ................................... Abs. 1007-1008 RTT track: Image guided radiotherapy and verification protocols . .................................. Abs. 1009-1012 RTT track: Motion management and adaptive strategies ............................................... Abs. 1013-1017 RTT track: Patient care, side effects and communication ............................................... Abs. 1018-1020 RTT track: Risk management/quality management ...................................................... Abs. 1021-1025 ELECTRONIC POSTERS Clinical track: Head and Neck ................................................................................... Abs. 1026-1100 Clinical track: CNS .................................................................................................. Abs. 1101-1133 Clinical track: Haematology ...................................................................................... Abs. 1134-1138 Clinical track: Breast ............................................................................................... Abs. 1139-1198 Clinical track: Lung ................................................................................................. Abs. 1199-1237 Clinical track: Upper GI (oesophagus, stomach, pancreas, liver) .................................... Abs. 1238-1256 Clinical track: Lower GI (colon, rectum, anus) . ........................................................... Abs. 1257-1284 Clinical track: Gynaecological (endometrium, cervix, vagina, vulva) ............................... Abs. 1285-1307 Clinical track: Prostate ............................................................................................ Abs. 1308-1365 Clinical track: Urology-non-prostate .......................................................................... Abs. 1366-1370 Clinical track: Skin cancer / malignant melanoma ........................................................ Abs. 1371-1374 Clinical track: Sarcoma ............................................................................................ Abs. 1375-1378 Clinical track: Paediatric tumours .............................................................................. Abs. 1379-1382 Clinical track: Palliation ........................................................................................... Abs. 1383-1406 Clinical track: Elderly .............................................................................................. Abs. 1407-1411 Clinical track: Other ................................................................................................ Abs. 1412-1432 Physics track: Basic dosimetry and phantom and detector development .......................... Abs. 1433-1447 Physics track: Dose measurement and dose calculation ................................................ Abs. 1448-1513 Physics track: Radiation protection, secondary tumour induction and low dose (incl. imaging) . ................................................................................... Abs. 1514-1518 Physics track: Treatment plan optimatisation: algorithms . ............................................ Abs. 1519-1539 Physics track: Treatment planning: applications .......................................................... Abs. 1540-1592 Physics track: (Radio)biological modelling .................................................................. Abs. 1593-1615 Physics track: Intra-fraction motion management ........................................................ Abs. 1616-1639 Physics track: Inter-fraction motion management (excl. adaptive radiotherapy) ............... Abs. 1640-1657 Physics track: Adaptive radiotherapy for inter-fraction motion management .................... Abs. 1658-1671 Physics track: CT Imaging for treatment preparation . .................................................. Abs. 1672-1676 Physics track: (Quantitative) functional and biological imaging ...................................... Abs. 1677-1702 Physics track: Images and analyses . ......................................................................... Abs. 1703-1728 Physics track: Implementation of new technology, techniques, clinical protocols or trials (including QA and audit) ....................................................... Abs. 1729-1765 Brachytherapy: Breast ............................................................................................. Abs. 1766-1767 Brachytherapy: Prostate .......................................................................................... Abs. 1768-1775 Brachytherapy: Gynaecolgy . .................................................................................... Abs. 1776-1789 Brachytherapy: Anorectal . ............................................................................................... Abs. 1790 Brachytherapy: Head and neck ................................................................................. Abs. 1791-1793 Brachytherapy: Physics . .......................................................................................... Abs. 1794-1800 Brachytherapy: Miscellaneous ................................................................................... Abs. 1801-1806

Radiobiology track: Normal tissue biology of the heart ......................................................... Abs. 1807 Radiobiology track: Normal tissue radiobiology (others) ............................................... Abs. 1808-1809 Radiobiology track: Radiobiology of cancer (others) ............................................................. Abs. 1810 RTT track: Patient preparation, positioning and immobilisation ...................................... Abs. 1811-1817 RTT track: Imaging acquisition and registration, OAR and target definition ...................... Abs. 1818-1819 RTT track: Treatment planning and dose calculation / QC and QA ................................... Abs. 1820-1836 RTT track: Image guided radiotherapy and verification protocols . .................................. Abs. 1837-1843 RTT track: Motion management and adaptive strategies ............................................... Abs. 1844-1849 RTT track: Patient care, side effects and communication ............................................... Abs. 1850-1857 RTT track: Education and training/role development .................................................... Abs. 1858-1859 RTT track: Risk management/quality management ...................................................... Abs. 1860-1865

AUTHORS INDEX ............................................................................................................... page 1037

ABSTRACTS

S1 ESTRO 36 _______________________________________________________________________________________________

SATURDAY, 6 MAY 2017

• Monte-Carlo simulation makes cavity theory redundant • Today’s Dose-to-Water Codes of Practice for Reference Dosimetry make CVTY unnecessary • Burlin or ‘General’ CVTY is hopelessly approximate and ought to be abandoned • Proton beam dosimetry requires the development of a new CVTY • Spencer-Attix CVTY removes the need for the BG assumption of negligible (secondary) electron fluence perturbation • Bragg-Gray theory breaks down in small-field megavoltage beams Teaching Lecture: High tech or low tech for metastatic disease, how does one decide and what is the cost- benefit? SP-0006 High tech or low tech for metastatic disease, how does one decide and what is the cost-benefit? Y. Van der Linden 1 1 Leiden University Medical Center LUMC, Department of Radiotherapy, Leiden, The Netherlands With ongoing improvements of the technical possibilities in radiation oncology and its widespread availability, the sky seems the limit, also for patients referred for palliative indications. But are these costly and time consuming protocols really helping our patients? In this talk, the necessity for high tech in palliative radiotherapy will be searched, comparing costs and benefits in terms of goals of palliative care, treatment outcome, quality of life, time consumption, and, also real costing. SP-0007 Gene editing: How this technique can be used to study radiation responses? L. Marignol 1 1Trinity Translational Medicine Institute, Translational Radiobiology and Molecular Oncology- Applied Radiation Therapy Trinity- Discipline of Radiation Therapy, Dublin, Ireland The personalisation of radiation therapy relies on the discovery of novel biomarkers predictive of treatment outcomes. The molecular classification of cancer with microarray and next generation sequencing have reduced time and costs associated with the generation of genetic profiles - but also the amount of genetic material required. Gene editing approaches using single-stranded RNA or DNA and/or CRISPR/Cas9 to disrupt or modify the DNA sequence of selected genes are attractive: the engineering of radioresistant cancer models enables the direct evaluation of the function of specific genes and regulatory elements in the radiation response. This approach has been particularly useful in the characterisation of the radiation-induced DNA damage response. Our increased ability to transfer these models into small animals and deliver highly conformal image guided irradiation further enable the robust evaluation of candidate markers. This lecture will discuss the potential and limitations of gene editing approaches in the identification of novel biomarkers of radioresistance. Teaching Lecture: Target delineation and target definition for Partial Breast Irradiation after closed cavity surgery and oncoplastic surgery Teaching Lecture: Gene editing: How this technique can be used to study radiation responses?

Teaching Lecture: The role of radiotherapy in small cell lung cancer -current status and future developments

SP-0001 The role of radiotherapy in small cell lung cancer -current status and future developments R. Dziadziuszko 1 The Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland

Abstract not received

Teaching Lecture: Immunotherapy

SP-0002 Immunotherapy G. Coukos Centre Hospitalier Universitaire Vaudois, Lausanne Vaud, Switzerland

Abstract not received

Teaching Lecture: MRI for RO physicists: what is what? QA geometrical distortions

SP-0003 MRI for RO physicists: what is what? QA geometrical distortions E. Paulson Medical College of Wisconsin, Mlwaukee, USA

Abstract not received

Teaching Lecture: Cavity Theory: separating the facts from the myths

SP-0005 Cavity Theory: separating the facts from the myths. A. Nahum 1 1 University of Liverpool, Physics, Henley-on-Thames, United Kingdom Cavity Theory (CVTY) is intended to yield the factor converting the reading of a dose-measuring instrument (or ‘dosimeter’) placed in an irradiated medium to the dose to that medium in the absence of the instrument i.e. D med / D det . All trainee medical physicists have been subjected to lectures on CVTY and may even have had to answer exam questions on it (and possibly some radiation oncologists and radiographers too!). This talk will attempt to sort out the facts from the misconceptions about CVTY. Many of the following statements will be examined critically: • Ion chambers are the only instruments that act as Bragg-Gray (BG) cavities and they only do so in megavoltage photon beams • BG theory does not require Charged-Particle Equilibrium (CPE) – the ‘proof’ is that it also works in electron beams • The density of the detector plays no role in its response • Expressions involving ratios of mass-energy absorption coefficients cannot be classed as cavity theory • The Fano theorem is a particular type of ‘cavity theory’ • Treatment planning algorithms do not involve CVTY concepts • All analytical expressions for so-called ‘perturbation factors’ are approximate

S2 ESTRO 36 _______________________________________________________________________________________________

SP-0008 Target delineation and target definition for Partial Breast Irradiation after closed cavity surgery and oncoplastic surgery V. Strnad 1 1 University Clinic Erlangen, Dept. Radiation Oncology, Erlangen, Germany Objective: To define in CT images tissue structures inside the breast after a breast conserving surgery, which make possible reproducible delineate Clinical Target Volume (CTV) and Planning Target Volume (PTV). The results of deliberations of Breast Working Group of GEC-ESTRO and corresponding recommendations for target definition for APBI will be presented. Recommendations: The Working Group Breast of GEC- ESTRO recommend to have for the correct delineation of CTV (PTV) appropriate knowledge’s and to perform steps As follow: 1. To hold DETAILED KNOWLEDGE’ S about anatomy of the breast of patient and of the tumor, about primary surgical procedure particularly type of surgery, use - number and location of surgical clips, position of the skin scar ), of pathological report (particularly size of resection margins in at least 6 directions, of preoperative mammography, MRI and ultrasound. 2. Identification of the TUMOR LOCALIZATIO N before breast conserving surgery inside the breast and translate this information in current CT imaging data set. 3. Calculation of the size of SAFETY MARGINS needed to cover CTV in all 6 directions. The appropriate size of safety margins (surgical resection margins and adapted safety margins) should be at least 2 cm. 4. DEFINITION OF TARGET 5. DELINEATION OF THE TARGET according defined rules. We recommend following seven steps for target delineation after closed cavity surgery: a. Perform a CT. b. Delineation of clips. c. Delineation of surgical bed – whole surgical scar (WS) inside breast. d. Delineation of ImTV (Imaging correlated Target Volume). For target definition after oncoplastic surgery dissident from recommendation for target definition after “closed cavity surgery” the Clinical target volume (CTV) is defined as the sum of the relevant clipped area (RCA). Conclusion: Presented guidelines makes possible a reproducible and robust definition of CTV (PTV) for Accelerated Partial Breast Irradiation (APBI) or boost irradiation after breast conserving closed cavity or oncoplastic surgery. SP-0009 Target delineation and target definition for PBI after open cavity surgery T. Major 1 , C. Polgár 1 1 National Institute of Oncology, Radiotherapy Centre, Budapest, Hungary Objective : To present guidelines for target definition and delineations after open cavity breast conserving surgery in accelerated partial breast irradiations or boost treatments using multicatheter interstitial brachytherapy based on the consensus of the GEC-ESTRO Breast Cancer Working Group. Method: As a first step a contouring study with two phases was conducted by the Working Group. Contours of cavity and PTV on pre- and postimplant CT images were delineated. In Phase 1 nine radiation oncologists defined the target volumes of five patients without any instructions, while in Phase 2 four observers draw the contours of four patients applying simple contouring rules. The delineations were compared between the two phases, e. Delineation of ETB (Estimated Tumour Bed). f. Delineation of CTV (Clinical Target Volume). g.Delineation of PTV (Planning Target Volume).

the impact of guidelines was assessed and cavity visualization score was related to consistency of delineations. Following the study on interobserver variations of target volume delineation and a number of discussions in consensus meetings guidelines were worked out by experts on the field. Recommendations : (1) Consistent windowing has to be used for proper cavity visualization. (2) The cavity visualization score has to be at least 3 in order to minimize the interobserver variations of target definition. (3) At delineation of surgical cavity only the homogeneous part of the postoperative seroma has to be included in the contours and protrusions or sharp irregularities have to be excluded. When surgical clips are present, they have to be surrounded by the contour with close contact. (4) CTV is created from the outlined surgical cavity with a non- isotropic geometrical extension. In each direction the safety margin is calculated by taking into account the size of free resection margin. The total size of safety margin is always 20 mm which is the sum of the surgical and added safety margins. CTV is limited to chest wall/pectoral muscles and 5 mm below the skin surface. Conclusion : It has been demonstrated that simple rules on defining the lumpectomy cavity significantly increased the consistency of contouring. Reliable consistency of target volume definition can be expected only for good cavity visibility. Following the GEC-ESTRO guidelines it is expected that the target volume definition in breast brachytherapy after open cavity surgery will be accomplished with more consistent way among radiation oncologists with low interobserver variations. SP-0010 The gains to be made by combined modality treatment in NSCLC: setting the scene of new possibilities M. Stuschke 1 , C. Poettgen 1 1 Universitätsklinikum Essen, Radiotherapy, Essen, Germany Concurrent radiochemotherapy or combined modality treatments including surgery are standard options for stage IIIA NSCLC and stage IIIB patients treated with curative intent. Cumulative incidences of loco-regional recurrences approach 30% at 5 years following standard concurrent 60 Gy radiochemotherapy with conventional fractionation, while tri-modality schedules showed loco- regional recurrences of about 15%. Dose escalation using conventional fractionation and concurrent platin-based chemotherapy within the RTOG 0617 trial has failed to show a benefit in survival or local control. Passive scattering Proton therapy did not show a reduction in the rate of radiation pneumonitis in comparison to intensity modulated photon radiotherapy at the same total dose according to the NCT 00915005 trial. So where are the promising ways to improve survival of patients with locally advanced lung cancer by technological advances in radiotherapy? More sensitive methods are needed to detect tumor spread and beyond FDG-PET/CT. Systematic endobronchial ultrasound-guided transbronchial needle aspiration can improve sensitivity to detect lymph node metastases. Prognostic factors for tumor control and toxicity after concurrent radiochemotherapy are being established to individualize dose escalation. PET- response, tumor volume, and dose volume histogram parameters are examples. More selective radiotherapy techniques are being tested in large trials including gating or tracking techniques together with IMRT or intensity modulated proton therapy. Including surgery may improve the therapeutic ratio in selected patients, if lobectomy is Joint Symposium: ESTRO-ASTRO: Cutting edge combined modality therapies (Focus on NSCLC)