GEC ESTRO GYN working group and network
The GEC ESTRO gyn working group started in 2000. The task was to actively support and shape the upcoming field of image guided gynaecologic brachytherapy based on first experience from European centers actively developing this field. The aim was to find a common language for prescribing, recording and reporting image (MRI) guided cervix cancer brachytherapy (in parallel with the ICRU Report Committee on the Revision of ICRU 38 which started in 1999). The working structure was based on regular meetings and discussions in a limited group of about 10 persons. The concepts were developed and validated in the frame of clinical examples from centers with different historical traditions (Paris, Leuven, Vienna). The group then succeeded in developing the first two recommendations on MRI guided brachytherapy in cervix cancer. They were first (I) on GTV and CTV contouring elaborating the adaptive target concept (2005) and secondly (II) on dose and volume reporting including biological modelling based on the linear quadratic model.
In 2005 the gyn Working Group founded a network in order to embrace an increasing number of institutions with research and development activities within image guide gynecological brachytherapy. The GEC ESTRO gyn network met for the first time in Budapest (May 2005). A structure was established with work packages addressing the most relevant issues and challenges in image guided gyn brachytherapy: Contouring, Applicator Reconstruction, Treatment Planning, Applicator Development. The working methods were joint research and development as well as education and dissemination.
Based on this, the network developed the recommendations III and IV on applicator reconstruction (published 2010) and MR imaging (published 2012). A joint effort followed with specific focus on uncertainties related to image guided gyn brachytherapy. Multi- and mono-centric investigations were stimulated and discussed. This resulted in a special issue of Radiotherapy and Oncology in 2013 (vol 107) with a collection of papers on this topic (see references). In September 2016 Radiotherapy and Oncology published a special issue on gynecological radiotherapy, with particular focus on cervix IGABT and outcome (see references).
Task groups
Within the gyn network there are continuously a number of different active task groups / work packages. Among current task group activities are:
Task group on CT contouring in cervix cancer (coordinator Umesh Mahantshetty):
Many centers worldwide do not have access to MR at time of brachytherapy, while CT is a widely available image modality. The GEC ESTRO gyn network is working on guidelines for CT based contouring of targets and OARs based on clinical examination and CT imaging.
Task group on treatment planning recommendations (coordinator Kari Tanderup):
The GEC ESTRO recommendations I and II have provided a joint platform for contouring and reporting in MRI based brachytherapy. These recommendations have not involved guidance on treatment planning, and there is currently a wide variety of treatment approaches in terms of applicators, fractionation, dose rate and dose prescription. However, upcoming experience in image guided adaptive brachytherapy is providing an increasing amount of evidence with regard to outcome and dose effect. Based on this evidence, the GEC ESTRO gyn network is working on recommendations for treatment planning.
Task group on vaginal brachytherapy (coordinator Remi Nout):
The aims of the GEC ESTRO GYN task group on vaginal brachytherapy are to introduce a GEC ESTRO image guided brachytherapy target concept for primary vaginal cancer, vaginal recurrences and endometrial cancer. This task group was initiated during the GEC ESTRO annual meeting in Brussels, December 2013, with the following participants: Henrike Westerveld (AMC), Lars Fokdal (AUH), Max Schmid (MUW), Nicole Nesvacil (MUW), Renaud Mazeron (IGR) and Remi Nout (LEI). Activities started in January 2014 with a focus on primary vaginal cancer. For this purpose current target concepts from 5 participating centers were evaluated both by contouring and dose planning of 5 cases. Through these joint activities a common target concept is under development. Interim results have been presented during GEC ESTRO Gyn network meetings and a publication on these activities is foreseen in the near future. In addition a retrospective multicenter evaluation of outcome in IGABT in primary vaginal cancer was undertaken. So far a total of 87 patients have been included from these 5 centers and results were presented during the World Congress of Brachytherapy 2016.During the next phase the focus will be on the treatment of vaginal recurrences. In parallel the group is planning to start a prospective registration database.
Task group on image registration (coordinators Jamema Swamidas, Christian Kirisits, Kari Tanderup):
The task group on image registration is reviewing the current state of the art of registration methods and strategies for clinical use in image guided brachytherapy. The task group aims to develop guidelines for the use of registration in gyn brachytherapy.
ICRU
The ICRU/GEC-ESTRO report 89 became available in 2016. It is summarizing the state of the art in defining target volumes, organs at risk, dose and volume parameters for prescribing, recording and reporting cervix cancer brachytherapy. It contains a comprehensive update of the developments since ICRU report 38, especially with the integration of 3D volumetric imaging for brachytherapy treatment planning. The GEC ESTRO recommendations I to IV have been the basis for this report and are integrated. ICRU 89 provides comprehensive concepts with detailed terms for prescribing, recording and reporting image guided brachytherapy and covers the whole field of 3D and 2D brachytherapy. The international report committee and international consultants have agree upon this report 89 which will form the basis for further developments in this field all over the world. The report contains nine detailed clinical examples to illustrate modern gynaecological brachytherapy and state of the art recording and reporting, including also 2D (www.ICRU.org; http://jicru.oxfordjournals.org/).
Working group and network chairs:
- 2000-2005 (Working group): Christine Haie-Meder
- 2005-2007: Richard Pötter and Christian Kirisits
- 2007-ongoing: Kari Tanderup and Richard Pötter
GEC ESTRO gyn network core institutions:
Participation and contact:
The GEC ESTRO gyn network is an open network, and we welcome all colleagues who have specific interest in gyneacological brachytherapy. Please email Kari Tanderup (karitand@rm.dk) if you are interested in joining the network.
Past meetings and workshops
The GEC ESTRO gyn network arranges annual meetings. At annual meetings, current key topics in image guided gyn brachytherapy are discussed and new task groups are established as needed. Colleagues from more than 40 institutions are regularly participating in these meetings. Furthermore, specific workshops have been arranged on relevant topics (see also under references):
- Contouring: Dublin 2005, Washington, Milwaukee, Utrecht
- Image guided gyn BT and applicator reconstruction, Utrecht 2006
- Treatment planning, Ljubljana 2007
- Applicator development, Leuven 2009
- Outcome assessment in IGABT, Paris 2010
- Uncertainties in IGABT, Aarhus 2011
- Morbidity and disease outcome, Athens 2012
- EMBRACE and retroEMBRACE research: Vienna 2012, Leiden 2013, Utrecht 2014, Brussels 2015, Poznan 2016, Rome 2017
Resources