Abstract Book

ESTRO 37

20-24 April 2018 Barcelona, Spain

ESTRO 37 CONTENT

SATURDAY 21 APRIL 2018

Teaching Lecture Radiation-induced cardiac toxicity: what have we learnt?. ........................................................ (Abs. 1) Measuring the systemic immune-modulated effect of radiation ................................................. (Abs. 2) Optimal sequence in the treatment of breast cancer: RT first? .................................................. (Abs. 3) Standard of care in the treatment of bladder cancer ............................................................... (Abs. 4) Brachytherapy improvement calls for improved imaging .......................................................... (Abs. 5) Incorporating radiomic parameters into predictive models: methods for variable selection ............ (Abs. 6) Dual energy CT in radiotherapy: principles and potential ......................................................... (Abs. 7) Patient involvement and shared decision making .................................................................... (Abs. 8) Symposium Partial organ treatments to minimise late radiation effects .................................................. (Abs. 9-12) Radiotherapy combined with immunotherapy: mechanisms and biomarkers . ....................... (Abs. 13-16) More of both? Breast reconstruction and regional lymph node irradiation! ........................... (Abs. 17-19) Current issues in the treatment of muscle-invasive bladder cancer ..................................... (Abs. 20-22) Do we need adjuvant vaginal BT in endometrial cancer? ................................................... (Abs. 23-25) Is radiomics going to deliver on the promises that dose painting made? . ............................ (Abs. 26-29) Is dose calculation in proton therapy clinical practice a solved problem? ............................. (Abs. 30-32) Patient centered care and monitoring side effects: Review clinics and follow up . .................. (Abs. 33-35) Poster Viewing Poster viewing 1: Lung ................................................................................................ (Abs. 36-44) Symposium Improving radiation therapy in breast cancer by avoiding side effects ................................. (Abs. 45-48) Proffered Papers RB 1: Joint efforts in Immuno-radiobiology ..................................................................... (Abs. 49-55) CL 1: Genitourinary .................................................................................................... (Abs. 56-62) CL 2: Health services research to improve value and access . ............................................ (Abs. 63-69) BT 1: Gynaecological brachytherapy .............................................................................. (Abs. 70-76) PH 1: Dosimetry ......................................................................................................... (Abs. 77-83) PHY 2: Treatment planning in particle therapy . ............................................................... (Abs. 84-90) RTT 1: Innovative strategies for improving patient care .................................................... (Abs. 91-97) Poster Viewing Poster viewing 2: Upper GI .........................................................................................(Abs. 98-106) Presidential Symposium Presidential symposium .................................................................................................. (Abs. 107) Award Lecture Emmanuel van der Schueren Award Lecture....................................................................... (Abs. 108) Symposium Lung and dose escalation........................................................................................... (Abs. 109-112) Blood borne biomarkers............................................................................................. (Abs. 113-115) Joint Symposium ESTRO-ASTRO: The art and science of H&N radiotherapy................................................ (Abs. 116-119) ESTRO-ESGO: State of the art: new ESGO-ESTRO-ESP guidelines on management of cervical cancer.............................................................................. (Abs. 120-123) Symposium Quality assurance in brachytherapy............................................................................. (Abs. 124-126) Multi-parametric functional imaging for patient classification, RT personalisation and response monitoring........................................................................................... (Abs. 127-129) Why is fully automated image segmentation and deformable image registration not here yet?................................................................. (Abs. 130-132) Brachytherapy - RTT advanced roles............................................................................ (Abs. 133-135) Poster Viewing Poster viewing 3: Dosimetry. ..................................................................................... (Abs. 136-144) Symposium How to minimise toxicity in pelvic malignancies in the era of precision radiotherapy........... (Abs. 145-148) Proffered Papers RB 2: Biomarkers..................................................................................................... (Abs. 149-154) CL 3: Breast............................................................................................................ (Abs. 155-161)

CL 4: Upper GI......................................................................................................... (Abs. 162-168) BT 2: Brachytherapy physics and technology................................................................ (Abs. 169-175) PH 3: Functional imaging........................................................................................... (Abs. 176-182) PH 4: Inter- and intra- fractional motion...................................................................... (Abs. 183-189) RTT 2: Reproducibility optimisation in clinical practice.................................................... (Abs. 190-196) Poster Viewing Poster viewing 4: Planning applications and optimisation algorithms. ............................... (Abs. 197-205) Award Lecture Honorary Members award lectures.............................................................................. (Abs. 206-208)

SUNDAY 22 APRIL 2018

Teaching Lecture Should proton therapy clinical practice move away from a constant RBE of 1.1?....................... (Abs. 209) Pre-clinical cancer models................................................................................................ (Abs. 210) Supportive care in head and neck radiotherapy................................................................... (Abs. 211) Anal cancer: Can we individualise treatment?..................................................................... (Abs. 212) Oesophagus cancer......................................................................................................... (Abs. 213) Clinical implementation of adaptive radiotherapy................................................................. (Abs. 214) Things radiotherapy physicists need to know about good PET imaging practice........................ (Abs. 215) IGRT, SGRT, IGART, improving treatment delivery accuracy, how far can we go?. ..................... (Abs. 216) Big data: how to handle, interpret and analyse?.................................................................. (Abs. 217) Symposium European Particle Therapy Network (EPTN). ................................................................. (Abs. 218-222) Mouse Cancer Clinic: models and modalities for precision imaging and radiotherapy in small animal models. .......................................................................... (Abs. 223-225) Immunotherapy to complement chemoradiation for head and neck cancer........................ (Abs. 226-228) Novelties in organ-and function sparing treatment in rectal cancer................................... (Abs. 229-232) Cosmetic appearance after brachytherapy.................................................................... (Abs. 233-236) New developments in online adaptive MRgRT................................................................ (Abs. 237-239) What could replace the PTV?...................................................................................... (Abs. 240-243) IGRT, IGART and SGRT.............................................................................................. (Abs. 244-246) Modern learning methods. ......................................................................................... (Abs. 247-251) Poster Viewing Poster viewing 5: Pelvic brachytherapy........................................................................ (Abs. 252-260) Joint Symposium ESTRO-PROS: Is there a reason not to deliver all curative paediatric treatments with brachytherapy or protons?.................................................................................. (Abs. 261-264) Proffered Papers RB 3: Imaging Hypoxia - Biology in Clinic..................................................................... (Abs. 265-270) CL 5: Head and neck................................................................................................. (Abs. 271-277) CL 6: Lower GI......................................................................................................... (Abs. 278-284) BT 3: Brachytherapy prostate, head and neck............................................................... (Abs. 285-291) PH 5: MRI for treatment planning and delivery.............................................................. (Abs. 292-298) PH 6: Treatment planning 1. ...................................................................................... (Abs. 299-305) RTT 3: Imaging and protocols for treatment verification................................................. (Abs. 306-312) Poster Viewing Poster viewing 6: Radiobiology................................................................................... (Abs. 313-321) Award Lecture Donal Hollywood Award................................................................................................... (Abs. 322) Proffered Papers Highlights of proffered papers. ................................................................................... (Abs. 323-326) Symposium How to do good interdisciplinary science?..................................................................... (Abs. 327-332) Immuno-radiotherapy: the critical influence of radiation dose, scheduling and dose per fraction...................................................................................................... (Abs. 333-336) New strategies to target hypoxia in combination with radiotherapy.................................. (Abs. 337-339) Proton therapy in head and neck cancer: patient selection, validation and future directions. (Abs. 340-342) Debate This house believes that 5x5 Gy offers more opportunities for tailor made treatment than conventional chemoradiotherapy in rectal cancer patients. ...................................... (Abs. 343-346)

Symposium Prostate brachytherapy: LDR seeds versus HDR monotherapy......................................... (Abs. 347-350) Debate The technological advancement in radiotherapy in the last decade was driven by economics, not clinical needs................................................................................. (Abs. 351-352) Symposium Applications of machine learning in radiation oncology................................................... (Abs. 353-355) Advanced image acquisition for planning...................................................................... (Abs. 356-358) Medical writing and publishing.................................................................................... (Abs. 359-362) Poster Viewing Poster viewing 7: RTT. .............................................................................................. (Abs. 363-371) Symposium Oligometastatic disease............................................................................................. (Abs. 372-375) Proffered Papers RB 4: Targeting tumour biology.................................................................................. (Abs. 376-382) CL 7: Hematological Malignancies/Sarcoma/Palliation. ................................................... (Abs. 383-389) CL 8: Gynaecology.................................................................................................... (Abs. 390-396) BT 4 - Brachytherapy rectum and breast...................................................................... (Abs. 397-403) PH 7: Dose measurement and dose calculations............................................................ (Abs. 404-410) PH 8: 4D imaging and motion management.................................................................. (Abs. 411-417) RTT 4: Image acquisition and registration.................................................................... (Abs. 418-424) Poster Viewing Poster viewing 8: Head and neck................................................................................ (Abs. 425-433) Award Lecture Iridium Award Lecture..................................................................................................... (Abs. 434) Teaching Lecture A primer on Value Based Health Care. ............................................................................... (Abs. 435) The systematic use of patient reported outcome measures (PROM) for the improvement of radiotherapy................................................................................. (Abs. 436) DNA Repair: from mechanisms to clinical implication. .......................................................... (Abs. 437) Is stereotactic body radiotherapy an alternative to surgery in operable patients with stage I NSCLC?. ...................................................................................................... (Abs. 438) Testis............................................................................................................................ (Abs. 439) The state of affairs with ion RBE models. ........................................................................... (Abs. 440) Prospective risk analysis: basics and applications to treatment QA......................................... (Abs. 441) SBRT/SRS: Indications, side effects, outcomes. .................................................................. (Abs. 442) Symposium Value-based radiation oncology. ................................................................................. (Abs. 443-445) Radiomics – Technical and clinical challenges and opportunities....................................... (Abs. 446-448) Genomic Instability and DNA repair in cancer. .............................................................. (Abs. 449-451) The evolving role of radiotherapy in the management of lung cancer................................ (Abs. 452-455) Debate This house believes that active surveillance is a good option for the management of low risk prostate can- cer patients............................................................................................................. (Abs. 456-457) Symposium Advanced dosimetry methods for dose-volume effects modelling..................................... (Abs. 458-461) Dose mapping and dose accumulation......................................................................... (Abs. 462-464) Stereotactic RT and radiosurgery................................................................................ (Abs. 465-467) Poster Viewing Poster viewing 9: SBRT and arthritis............................................................................ (Abs. 468-476) Symposium Enhancing radiation oncology outcomes through patient involvement............................... (Abs. 477-480) Radiogenomics......................................................................................................... (Abs. 481-484) Proffered Papers RB 5: Head and neck radiobiology............................................................................... (Abs. 485-491) CL 9: Lung. ............................................................................................................. (Abs. 492-498)

MONDAY 23 APRIL 2018

CL 10: Prostate........................................................................................................ (Abs. 499-505) PH 9: Analysis of treatment outcomes......................................................................... (Abs. 506-512) PH 10: Treatment planning 2...................................................................................... (Abs. 513-519) RTT 5: Motion management and adative stratgies. ........................................................ (Abs. 520-526) Poster Viewing Poster viewing 10: Images and analyses...................................................................... (Abs. 527-535) Randomised Trials Selected randomised trials......................................................................................... (Abs. 536-538) Award Lecture Klaas Breur Award Lecture............................................................................................... (Abs. 539) Symposium Challenges in human resources in radiotherapy............................................................. (Abs. 540-543) Joint Symposium ESTRO-ESR: New imaging approaches for radiotherapy.................................................. (Abs. 544-547) Symposium Biomarker driven hypoxic modification......................................................................... (Abs. 548-550) Debate This house believes that treatment intensification in stage III is a dream rather than a reality?................................................................................................ (Abs. 551-552) Symposium What’s new in the management of high risk prostate cancer patients in 2018?. ................. (Abs. 553-555) Outcome prediction models for RT indications - development, validation, acceptance, commissioning and application................................................................................... (Abs. 556-558) Debate Is there still a place for patient specific QA?. ................................................................ (Abs. 559-560) Symposium Focus on site - BREAST. ............................................................................................ (Abs. 561-563) Poster Viewing Poster viewing 11: Emerging technologies: radiobiology and physics hand in hand............. (Abs. 564-572) Symposium Planning future global radiotherapy services................................................................. (Abs. 573-575) Normal tissue dose-response modelling across radiation modalities.................................. (Abs. 576-579) Proffered Papers RB 6: Role and impact of Normal tissue RT response biology........................................... (Abs. 580-586) CL 11: CNS. ............................................................................................................ (Abs. 587-593) CL 12: Late-breaking abstracts and practice changing trials............................................ (Abs. 594-600) PH 11: Emerging technologies.................................................................................... (Abs. 601-607) PH 12: Audits and QA. .............................................................................................. (Abs. 608-614) RTT 6: Treatment planning and quality assurance.......................................................... (Abs. 615-620) Poster Viewing Poster viewing 12: Prostate. ...................................................................................... (Abs. 621-629) Award Lecture Jens Overgaard Legacy Award.......................................................................................... (Abs. 630) Academic award: Jack Fowler University of Wisconsin Award................................................. (Abs. 631) Company Award Lectures. ......................................................................................... (Abs. 632-633)

TUESDAY 24 APRIL 2018

Teaching Lecture Navigation in the publication ethics landscape: Publish or perish or...?.................................... (Abs. 634) Risk Management: Quality and Safety New EU legislation and implementation......................... (Abs. 635) Normal tissue stem cells and cancer stem cells in radiation response. .................................... (Abs. 636) Hypofractionated external beam radiotherapy for Prostate cancer: what have we learned in the last 15 years?........................................................................ (Abs. 637) State of the art in treatment of oesophageal cancer............................................................. (Abs. 638) MRI based radiotherapy – What can go wrong and how to QA?.............................................. (Abs. 639) Photon dosimetry protocols: what is new?.......................................................................... (Abs. 640)

Treatment planning: where are we and, where are we going................................................. (Abs. 641)

Joint Symposium ESTRO-EORTC: New strategies for a clinical research partnership?................................... (Abs. 642-644) Symposium Automatic planning – the challenges for success........................................................... (Abs. 645-648) Advances in normal tissue radiobiology........................................................................ (Abs. 649-651) What is the limit of hypofractionation?......................................................................... (Abs. 652-655) Brain tumors in 2018: are there still unsolved problems?. .............................................. (Abs. 656-658) Advances in MRI simulation (MRI-only treatment planning)............................................. (Abs. 659-661) In vivo dosimetry and online dose verification............................................................... (Abs. 662-664) Advanced planning. .................................................................................................. (Abs. 665-667) Implications of the ageing population for radiation oncology........................................... (Abs. 668-671) Salvage prostate radiotherapy.................................................................................... (Abs. 672-675) Symposium Radiation induced senescence. ................................................................................... (Abs. 676-678) Immunotherapy. ...................................................................................................... (Abs. 679-682) Debate This house believes that stereotactic radiosurgery will replace whole brain radiotherapy in patients with ten brain metastases.......................................................................... (Abs. 683-686) Joint Symposium ESTRO-EFOMP: CBCT in radiotherapy: Improving and sharing best practice...................... (Abs. 687-689) Symposium Dose painting – from bench to bed(?).......................................................................... (Abs. 690-693) Debate Autoplanning, is there still a bright future for RTTs after automation?............................... (Abs. 694-695) Posters Clinical track: Head and Neck..................................................................................... (Abs. 696-710) Clinical track: CNS.................................................................................................... (Abs. 711-729) Clinical track: Haematology........................................................................................ (Abs. 730-737) Clinical track: Breast................................................................................................. (Abs. 738-745) Clinical track: Lung................................................................................................... (Abs. 746-757) Clinical track: Upper GI (oesophagus, stomach, pancreas, liver)...................................... (Abs. 758-788) Clinical track: Lower GI (colon, rectum, anus). ............................................................. (Abs. 789-801) Clinical track: Gynaecological (endometrium, cervix, vagina, vulva)................................. (Abs. 802-815) Clinical track: Prostate.............................................................................................. (Abs. 816-829) Clinical track: Urology-non-prostate............................................................................ (Abs. 831-833) Clinical track: Skin cancer / malignant melanoma.......................................................... (Abs. 834-835) Clinical track: Sarcoma.............................................................................................. (Abs. 836-838) Clinical track: Paediatric tumours................................................................................ (Abs. 839-843) Clinical track: Palliation............................................................................................. (Abs. 844-849) Clinical track: Elderly................................................................................................ (Abs. 850-857) Clinical track: Health services research / health economics............................................. (Abs. 858-859) Clinical track: Other.................................................................................................. (Abs. 860-869) Physics track: Basic dosimetry and phantom and detector development. .......................... (Abs. 870-878) Physics track: Dose measurement and dose calculation.................................................. (Abs. 879-894) Physics track: Radiation protection, secondary tumour induction and low dose (incl. imaging).. (Abs. 895-898) Physics track: Treatment plan optimisation: algorithms.................................................. (Abs. 899-910) Physics track: Treatment planning: applications............................................................ (Abs. 911-928) Physics track: (Radio)biological modelling.................................................................... (Abs. 929-933) Physics track: Intra-fraction motion management.......................................................... (Abs. 934-950) Physics track: Inter-fraction motion management (excl. adaptive radiotherapy)................. (Abs. 951-957) Physics track: Adaptive radiotherapy for inter-fraction motion management...................... (Abs. 958-965) Physics track: CT Imaging for treatment preparation. .................................................... (Abs. 966-971) Physics track: (Quantitative) functional and biological imaging........................................ (Abs. 972-985) Physics track: Images and analyses. ........................................................................... (Abs. 986-991) Physics track: Implementation of new technology, techniques, clinical protocols or trials (including QA and audit).......................................................................................... (Abs. 992-1012) Brachytherapy: Breast. ..........................................................................................(Abs. 1013-1014) Brachytherapy: Gynaecolgy. ...................................................................................(Abs. 1015-1018) Brachytherapy: Head and neck........................................................................................(Abs. 1019) Brachytherapy: Physics..........................................................................................(Abs. 1020-1023) Brachytherapy: Prostate.........................................................................................(Abs. 1024-1028) Brachytherapy: Anorectal. ..............................................................................................(Abs. 1029) Brachytherapy: Miscellaneous. ................................................................................(Abs. 1030-1034) Radiobiology track: Normal tissue biology of the heart Radiobiology track: Normal tissue biology of the lung. ........................................................(Abs. 1035) Radiobiology track: Normal tissue biology of central nervous system.....................................(Abs. 1036)

Radiobiology track: Radiobiology of the intestinal track...............................................(Abs. 1037-1040) Radiobiology track: Normal tissue radiobiology (others)..............................................(Abs. 1041-1044) Radiobiology track: Radiobiology of proton and heavy ions..........................................(Abs. 1045-1048) Radiobiology track: Radiobiology of head and neck cancer...........................................(Abs. 1049-1051) Radiobiology track: Radiobiology of prostate cancer............................................................(Abs. 1052) Radiobiology track: Radiobiology of breast cancer. .....................................................(Abs. 1053-1055) Radiobiology track: Radiobiology of lung cancer.........................................................(Abs. 1056-1057) Radiobiology track: Radiobiology of colorectal cancer..................................................(Abs. 1058-1059) Radiobiology track: Radiobiology of cancer (others)....................................................(Abs. 1060-1061) RTT track: Patient preparation, positioning and immobilisation.....................................(Abs. 1062-1063) RTT track: Imaging acquisition and registration, OAR and target definition.....................(Abs. 1064-1067) RTT track: Treatment planning and dose calculation / QC and QA. ................................(Abs. 1068-1074) RTT track: Image guided radiotherapy and verification protocols. .................................(Abs. 1075-1077) RTT track: Motion management and adaptive strategies..............................................(Abs. 1078-1082) RTT track: Patient care, side effects and communication..............................................(Abs. 1083-1095) RTT track: Education and training/role development...................................................(Abs. 1096-1097) RTT track: Risk management/quality management.....................................................(Abs. 1099-1102) Electronic Posters Clinical track: Urology-non-prostate.........................................................................(Abs. 1615-1622) Clinical track: Head and Neck..................................................................................(Abs. 1103-1183) Clinical track: CNS.................................................................................................(Abs. 1184-1239) Clinical track: Haematology.....................................................................................(Abs. 1240-1255) Clinical track: Breast..............................................................................................(Abs. 1256-1354) Clinical track: Lung................................................................................................(Abs. 1355-1409) Clinical track: Upper GI (oesophagus, stomach, pancreas, liver)...................................(Abs. 1410-1458) Clinical track: Lower GI (colon, rectum, anus). ..........................................................(Abs. 1459-1503) Clinical track: Gynaecological (endometrium, cervix, vagina, vulva)..............................(Abs. 1504-1537) Clinical track: Prostate...........................................................................................(Abs. 1538-1614) Clinical track: Skin cancer / malignant melanoma.......................................................(Abs. 1623-1625) Clinical track: Sarcoma...........................................................................................(Abs. 1626-1638) Clinical track: Paediatric tumours.............................................................................(Abs. 1639-1646) Clinical track: Palliation..........................................................................................(Abs. 1647-1662) Clinical track: Elderly.............................................................................................(Abs. 1663-1670) Clinical track: Health services research / health economics..........................................(Abs. 1671-1683) Clinical track: Communication.................................................................................(Abs. 1684-1687) Clinical track: Other...............................................................................................(Abs. 1688-1713) Physics track: Basic dosimetry and phantom and detector development. .......................(Abs. 1714-1747) Physics track: Dose measurement and dose calculation...............................................(Abs. 1748-1851) Physics track: Radiation protection, secondary tumour induction and low dose (incl. imaging)..(Abs. 1852-1865) Physics track: Treatment plan optimisation: algorithms...............................................(Abs. 1866-1898) Physics track: Treatment planning: applications.........................................................(Abs. 1899-1983) Physics track: (Radio)biological modelling.................................................................(Abs. 1984-2015) Physics track: Intra-fraction motion management.......................................................(Abs. 2016-2040) Physics track: Inter-fraction motion management (excl. adaptive radiotherapy)..............(Abs. 2041-2059) Physics track: Adaptive radiotherapy for inter-fraction motion management...................(Abs. 2060-2074) Physics track: CT Imaging for treatment preparation. .................................................(Abs. 2075-2090) Physics track: (Quantitative) functional and biological imaging.....................................(Abs. 2091-2113) Physics track: Images and analyses. ........................................................................(Abs. 2114-2151) Physics track: Implementation of new technology, techniques, clinical protocols or trials (including QA and audit).........................................................................................(Abs. 2152-2210) Brachytherapy: Breast. ..........................................................................................(Abs. 2211-2213) Brachytherapy: Gynaecolgy. ...................................................................................(Abs. 2214-2232) Brachytherapy: Head and neck........................................................................................(Abs. 2233) Brachytherapy: Physics..........................................................................................(Abs. 2234-2248) Brachytherapy: Anorectal. ..............................................................................................(Abs. 2249) Brachytherapy: Miscellaneous. ................................................................................(Abs. 2250-2255) Brachytherapy: Prostate.........................................................................................(Abs. 2256-2269) Radiobiology track: Radiobiology of skin. ..........................................................................(Abs. 2270) Radiobiology track: Normal tissue radiobiology (others)..............................................(Abs. 2271-2276) Radiobiology track: Radiobiology of proton and heavy ions..........................................(Abs. 2277-2281) Radiobiology track: Radiobiology of head and neck cancer...........................................(Abs. 2282-2297) Radiobiology track: Radiobiology of prostate cancer....................................................(Abs. 2298-2301) Radiobiology track: Radiobiology of breast cancer. .....................................................(Abs. 2302-2304) Radiobiology track: Radiobiology of lung cancer.........................................................(Abs. 2305-2307) Radiobiology track: Radiobiology of colorectal cancer..................................................(Abs. 2308-2310) Radiobiology track: Radiobiology of cancer (others)....................................................(Abs. 2311-2335) RTT track: Patient preparation, positioning and immobilisation.....................................(Abs. 2336-2347) RTT track: Imaging acquisition and registration, OAR and target definition.....................(Abs. 2348-2356) RTT track: Treatment planning and dose calculation / QC and QA. ................................(Abs. 2357-2369) RTT track: Image guided radiotherapy and verification protocols. .................................(Abs. 2370-2386) RTT track: Motion management and adaptive strategies..............................................(Abs. 2387-2390) RTT track: Patient care, side effects and communication..............................................(Abs. 2391-2395) RTT track: Education and training/role development..........................................(Abs. 1098, 2396-2400) RTT track: Risk management/quality management.....................................................(Abs. 2401-2404)

ESTRO 37 20-24 April 2018 Barcelona, Spain

ABSTRACTS

ESTRO 37 20-­‐24 April 2018 Barcelona, Spain

S1

ESTRO 37, Saturday 21 April

environment including the immune system. Especially in the era of immune checkpoint inhibition (ICI) as an effective cancer therapy the systemic immune- modulating effects of ionizing radiation (SIMEIR) are of great interest. Especially since RT is inducing immunogenic cancer cell death acting as an in situ cancer vaccine. However, only if the additional microenvironmental conditions are beneficiary, the immune system can be trained to attack the primary tumor and the metastases. The modulation of the peripheral immune system RT might picture the direction of the immune response, suppression or activation, respectively. This information should be available during the whole multimodal cancer therapy. Therefore we developed the detailed immunophenotyping of whole blood (DIoB) assay to get insights in particular on systemic changes of peripheral immune cell compositions and activation state. In several clinical trials the DIoB assay has already been used to analyze the dynamics of several immune cells (sub)types during the whole multimodal therapy of the patients. During the training course the development of the DIoB assay will be shortly presented and in particular results of the several trials will be discussed with possibilities and challenges of immunophenotyping for prediction and prognosis. An understanding of the immunologic dynamics during multimodal cancer treatment will be communicated. We conclude that knowledge on systemic immune modulations induced by ionizing radiation is important to optimize multimodal radioimmunotherapies for cancer aiming to achieve local and systemic tumor control and to define immune-related biomarkers/-matrices of radiation exposure for prognosis and prediction SP-0003 Optimal sequence in the treatment of breast cancer: RT first? C. Coles 1 1 Addenbrooke's Hospital - Oncology Centre, University of Cambridge, Cambridge, United Kingdom Abstract text Optimal sequence in the treatment of breast cancer: RT first? Dr Charlotte Coles Post-operative breast radiation therapy (RT) is of proven benefit for improving local control and survival and is indicated for the majority of patients with early breast cancer. However, there can be technical challenges with planning and delivering breast RT in the adjuvant setting. Recently, there has been renewed interest in changing the sequence of breast RT delivery and bring forward before surgery. Preoperative breast RT is not an entirely new concept, but historical research studies have not impacted on clinical practice, possibly due to perceived/actual toxicity. Advances in breast RT such as intensity modulated RT (IMRT), accelerated partial breast irradiation (APBI), simultaneous integrated boost and (SIB) and image guided radiation (IGRT) that could facilitate preoperative RT and minimise side effects. This presentation will: · 1. Summarise the results of older trials· 2. Discuss the potential benefit of preoperative breast RT in facilitating: Teaching Lecture: Optimal sequence in the treatment of breast cancer: RT first?

Teaching Lecture: Radiation-induced cardiac toxicity: what have we learnt?

SP-0001 Radiation-induced cardiac toxicity: what have we learnt? D. Cutter 1 1 Oxford University, Clinical Trial Service Unit, Oxford, United Kingdom Abstract text The success of modern multi-modality cancer therapy, combined with a general improvement in life expectancy, has resulted in an increasing number of people surviving more than 5 years from a cancer diagnosis. Whilst improvements in survival rates are obviously to be welcomed, it is increasingly recognized that many cancer survivors are at an elevated risk of morbidity and mortality from a variety of causes. Cardiac disease is one such consequence, resulting in a substantial proportion of the burden of excess illness and death observed. There is compelling evidence from a number of independent sources that ionizing radiation can give rise to an increased risk of cardiac morbidity and mortality following the successful treatment of various types of cancer. Whilst it is certain that radiation techniques from previous decades resulted in substantially elevated risks, it is less certain what risk modern treatment regimens pose. Current research is aimed at clarifying the dose- response relationships of radiation-induced cardiac disease (RICD) so that the risks of contemporary treatments can be predicted and so that the advanced radiotherapy techniques now available to Radiation Oncologists can be put to optimal use. This interdisciplinary teaching lecture will summarize what is known regarding the nature, epidemiology and mechanisms of radiation-induced cardiac disease, will give an overview of what we have learned more recently and, importantly, what we still need to know regarding RICD in order to properly take account of this important treatment toxicity when managing patients today. SP-0002 Measuring the systemic immune-modulating effects of radiation B. Frey 1 , U. Gaipl 1 1 University Clinic Erlangen, Department of Radiation Oncology, Erlangen, Germany Abstract text The description of the so called abscopal effect of radiotherapy (RT) is more than 60 years ago. However, to date the literature only reports about individual clinical cases with anti-tumor effects out-of the irradiated field. RT is a common treatment for cancer and about 60% of all cancer patients will receive it during their course of illness. RT primarily aims to locally control the tumor by stopping the proliferation of the tumor cells and ideally by killing them. The main biological effects of ionizing irradiation are the induction of DNA damage and stress responses. This was though for decades to be strongly locally restricted, but nowadays it has become obvious that ionizing radiation is additionally able to modulate the tumor micro-environment as well as the macro- Teaching Lecture: Measuring the systemic immune- modulated effect of radiation

- Breast reconstruction - Breast conservation

- Partial breast irradiation - Translational research· 3. Highlight current preoperative breast RT research

S2

ESTRO 37

studies References

different functionalities which makes benchmarking quite challenging. The main emphasis of this lecture will be on the next step of selection of features to be incorporated in predictive models. As the number of imaging features calculated is typically larger than the sample size of patients studied, it is crucial to have proper feature selection and prediction model building routines to prevent overfitting. Firstly, implications of different feature selection methods will be discussed. Dimensionality reduction is crucial to reduce the risk of overfitting by focusing the attention of subsequent classification efforts on a subset of relevant features. As most of the features, being based on the same matrix or quantities, will exhibit some correlation with each other, intelligent feature selection strategies are required. Filter-based selection techniques of the univariate and multivariate type and wrapper techniques will be discussed. Principal component analysis performs a transformation for dimensionality reduction and can highlight outliers. The dynamic range of feature values can also be an important selection criterion. Patient and clinical characteristics might be added to the input variable list as they potentially influence not only the outcome variable, but also the extracted radiomics features themselves. Ultimately, the goal of most radiomics analyses is to obtain a prognostic or predictive model with a high accuracy and efficiency. Unsupervised machine learning (ML) analyses using heat maps or clustering, summarize feature data without involving an outcome variable. Supervised ML classifiers as generalized linear models, random forests, support vector machines and neural networks separate the data with respect to an outcome variable. Combination of classifier and variable selection techniques will be discussed in terms of final model performance variation. Finally, the understandability of classification models varies significantly and should be considered, together with qualitative reporting. [1] Larue R, Defraene G, De Ruysscher D, Lambin P, van Elmpt W. Quantitative radiomics studies for tissue characterization; A review of technology and methodological procedures. Br J Radiol 2017; 90:1070. SP-0007 Dual energy CT in radiotherapy: principles and potential S. Greilich 1 1 German Cancer Research Center DKFZ, Division of Medical Physics in Radiation OncologyE040, Heidelberg, Germany Abstract text Scanning patients with two different X-ray spectra was already considered in the early years of computed tomography as a method to extract tissue information beyond photon attenuation. The advent of clinical dual energy CT units approximately ten years ago also sparked interest again in their use in radiation therapy. This lecture will first introduce the physical implications of using two (or more) X-ray spectra and the technical implementations available today. Subsequently, this will be helpful in understanding the benefits currently expected in the areas of pre-treatment imaging, dose calculation, or radiomics presented in the second part. Teaching Lecture: Dual energy CT in radiotherapy: principles and potential

Preoperative breast radiation therapy: Indications and perspectives. Eur J Cancer. 2017 Sep;82:184-192. Preoperative radiation therapy: The 'new' targeted breast cancer treatment? Eur J Cancer. 2017 Jun;78:116-117.

Teaching Lecture: Standard of care in the treatment of bladder cancer

SP-0004 Standard of care in the treatment of bladder cancer A. Choudhury 1 1 The Christie NHS Foundation Trust, Clinical Oncology, Manchester, United Kingdom Abstract text Bladder preservation with tri-modality treatment has re- emerged in recent years as an excellent alternative to radical cystectomy for organ-confined muscle-invasive urothelial cancer. This talk will outline the evidence and current practice using radiotherapy and radiosensitisation to deliver optimal treatment. The role of biomarker stratification for bladder preservation will also be addressed.

Teaching Lecture: Brachytherapy improvement calls for improved imaging

SP-0005 Brachytherapy improvement calls for improved imaging M.Schmid Medical University of Vienna, Vienna, Austria

Abstract not received

Teaching Lecture: Incorporating radiomic parameters into predictive models: methods for variable selection

SP-0006 Incorporating radiomic parameters into predictive models: methods for variable selection G. Defraene 1 1 KU Leuven, Department of Oncology - Experimental Radiation Oncology, Leuven, Belgium Abstract text Quantitative analysis of tumor characteristics based on medical imaging is an emerging field of research. In recent years, quantitative imaging features derived from CT, PET and MR scans were shown to be of added value in the prediction of outcome parameters in oncology, in what is called the radiomics field. A review of the current challenges, technical routines and protocols that are involved in quantitative imaging studies was conducted [1]. The first issue that should be overcome is the dependency of several features on the scan acquisition and image reconstruction parameters. Different settings can have an influence on the quality and reliability of the extracted radiomics features. Adopting consistent methods in the subsequent target segmentation step is evenly crucial. To further establish robust quantitative image analyses, standardization or at least calibration of imaging features based on different feature extraction settings is required, especially for texture and filter-based features. Several open-source and commercial software packages performing feature extraction are currently available, all with slightly

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has to be made. Secondly, the clinician should explain which options are available; thirdly, the clinician should try to elicit patient preferences and values, and finally patient and clinician’s preferences should be integrated into a shared decision. Unfortunately, even clinicians aware of SDM, usually do apply steps 1 and 2, but often omit step 3 and 4, leaving the patient alone with a difficult choice. Next to the teaching of clinicians, tools such as patient decision aids (PtDA) can be very helpful, to stimulate that each patient receives the same objective information. To build a good PtDA, it is recommended to follow the IPDAS roadmap [www.ipdas.ohri.ca, Elwyn et al, 2009]. One of the most important aspects in this roadmap is to involve patients at almost each step. Most PtDAs in radiotherapy will contain information on both side effects and effects on local control and survival. Patients should be involved e.g. to decide which side effects are most important to mention, and to choose how to visualize difficult terms as percentages etc. Until now, PtDAs are fairly general, and do not yet contain very individualized information. Therefore, in the current area of big data, several initiatives are ongoing to develop prognostic models to estimate the effect of a certain treatment on outcome, and to incorporate these models in the patient decision aids. Most clinicians are only willing to change their current clinical practice if 1) the is clinical evidence that SDM really is beneficial, and 2) if it fits the clinical care path. Therefore, clinicians should be involved early in projects aimed to implement SDM. Conclusion There is an increasing amount of evidence that SDM improves quality of care. Since implementation is still quite scarce, several strategies are currently being developed to increase implementation of SDM. SP-0009 Evidence for partial organ treatments R. Laing 1 1 Royal Surrey NHS Trust, Oncology, Guildford, United Kingdom Abstract text Partial organ treatment has been extensively investigated in breast cancer with over 18,000 patients randomised in 8 large trials. Whilst different techniques and patient selection were employed encouraging early results have been reported using different treatment techniques. The evidence in Prostate Cancer is much more limited with relatively little data with small patient numbers using a range of methods ranging from hemi-gland brachytherapy to ultra-focal treatments. This talk will describe the definitions used in partial organ treatments and the emerging data in Prostate Cancer as well as a brief summary of the current situation in Breast Cancer. SP-0010 Variation in dose distribution by different radiation modalities D. Georg 1 1 Medizinische Universität Wien, Division Medical Radiation Physics- Department of Radiation Oncology, Vienna, Austria Abstract text Partial organ irradiation has the potential to minimize late radiation effects, especially in light of the enormous technological progress made during the last decades. More specifically, computerized treatment plan optimi- zation and image guided beam delivery of external beam Symposium: Partial organ treatments to minimise late radiation effects

Teaching Lecture: Patient involvement and shared decision making

SP-0008 Patient involvement and shared decision making Abstract by: L. Boersma 1 1 MAASTRO Clinic, Radiation Oncology, Maastricht, The Netherlands

Speaker: C. Van Audenhove KU Leuve, Leuven, Belgium

Introduction After the introduction of evidence based medicine, patient involvement in decision-making is becoming increasingly important. The problem is that this development suffers from lack of implementation. Shared Decision Making (SDM) is the approach that most patients desire, and although clinicians may feel that they are already sharing decisions, evidence shows that they are not [Coulter 2011, Légaré 2012, Mulley 2012]. What is SDM, why, and how to measure its effect? SDM is about the health care provider eliciting patients’ needs and preferences, and deliberating together with the patient in order to make a decision about management. SDM is important in so-called preference- sensitive decisions where trade-offs exist between options that depend on patient preferences. Individuals may value treatment options differently in terms of effect sizes, treatment burden or side effects. The ultimate goal is that the patient undergoes that treatment that suits his or her preferences and values best. It is however extremely difficult to measure this goal. Therefore, quite often the decisional conflict scale is used to measure SDM. Other approaches to quantify SDM aim at measuring the process of SDM, such as the SDM-Q-9 or the OPTION scale. In spite of these measure- problems, evidence for beneficial effects of SDM is cumulating. There is e.g. level I evidence that patient decision aids (ptDAs)– either used within or outside the medical consultation - reduce decisional conflict and improve users’ knowledge and accuracy of perceived risks. This results in realistic expectations and satisfaction with their decision and the decision making process [Stacey 2014]. It also reveals that patients show a tendency to choose more conservatively compared to doctors, especially in case of elective surgery. There is insufficient evidence, yet, that this leads to overall cost savings [Walsh 2014]. For the time being PtDAs can be looked upon as effective approaches that improve the outcomes of patient encounters with their clinicians at acceptable costs [Katz 2014]. Facilitators and barriers One of the most often quoted barriers for SDM is that many clinicians think that patients are not able to make these difficult decisions, or do not want to be involved. Another often-mentioned barrier is that it increases consultation time, for which no reimbursement is foreseen. Moreover, if SDM indeed leads to less treatment, the clinician will lose revenues. Lack of skills to to perform SDM in clinical practice is another potential barrier. Higher patient satisfaction is the most natural facilitator; in addition, to stimulate implementation of SDM in daily clinical practice, it is essential that the whole SDM process nicely fits into the standard clinical care-path. How to improve implementation of SDM in clinical practice? A pre-requisite for implementation of SDM in clinical practice, is that clinicians are skilled to apply SDM. For this purpose, training modules are currently being developed. In short, four steps can be discriminated: The first step in SDM is to make patients aware that a choice