ESTRO Annual Report 2020

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2020 ANNUAL REPORT

Radiation Oncology. Together.

Optimal Health

FOR ALL,

- ESTRO VISION 2030 -

VISION 2030 STRATEGIC AREAS From research to practice Strengthening the profession

Strengthening the Society Strengthening partnerships

Table of contents

1 Editorial

4 Science

6 PAGE

PAGE

& dissemination 18 MEETINGS 20 1. ESTRO 2020 20 2. Joint events 22 3. Endorsed events 23

2 Mission

7 PAGE

PUBLICATIONS

24 24 26 29 30 30 31

1. The Green Journal 2. Open access journals 3. ESTRO newsletter

RESEARCH 1. E2-RADIatE

3 Membership

2. EPTN

PAGE

GUIDELINES

& Partnerships

8 10 10

MEMBERSHIP

1. Profile of ESTRO Members

2. Structured and diversified membership categories 3. Membership categories under the spotlight

13 16

4. Main benefits of membership

MoU’S

RTT ALLIANCE

5 ESTRO School 36 LIVE COURSES 39 1. Wide range of topics proposed 39 2. 2020 School programme at a glance 40 PAGE

7 Financial report 52 1. Treasurer’s report 55 2. EESTRO Audited Accounts 2019 56 PAGE

PRE-MEETING COURSES 1. Pre-meeting courses

42 42

8 Annex

58 PAGE

E-LEARNING 43 1. FALCON, ESTRO’s contouring platform 43 2. Online delineation workshops 44 3. Delineation workshops at the ESTRO annual congress 45 1. Clinical oncology module for the ESTRO Radiation Oncology core curriculum 46 2. Review of the core curriculum for medical physics experts in radiotherapy 47 ESTRO CORE CURRICULA 46

1. Governance & Constituent Bodies

60 63 64 64 65 66 67 71 71

2. Staff

3. Corporate members

4. Dual members 5. RTT Alliance

6. Institutional members

7. Green Journal

8. Awards

9. Newsletter

6 ESTRO Cancer Foundation

PAGE

Editorial

As we envisaged, about half the number of both delegates and exhibitors participated compared with 2019. This was amilestone in itself, considering the prevailing circumstances. We are thankful for the engagement and effort of the speakers and the scientific programme committee who made this possible, as well as for the steadfast support of our corporate partners. Our journals are in good health. There was a significant increase in the number of abstracts that were submitted to some of our Society journals. Have a look at the numbers in the science section. A repository of Covid-19 relevant publications, surveys and studies was set up by ESTRO out of necessity to meet the professional needs of the radiotherapy community in responding to the pandemic, and it has been published on the ESTRO website. Resources are available at: https://www. estro.org/https/www-estro-org/About/Newsroom/ COVID-19-and-Radiotherapy Education In 2020 the ESTRO School adapted its activity programme to full online education in order to ensure that training was continuous and to keep the radiotherapy community united. While its offerings were limited, the School still reached out to a large audience, and expanded its geographical reach. We offered 10 courses and drew over 1000 attendees, which was a good result compared with 2019 if we consider the figures in proportion to the number of courses. The ESTRO School always endeavours to review its core curriculum, to ensure that the professional skills of ourmembers are kept up to datewith recent advances. In 2020 the clinical oncology module for the ESTRO core curriculum was developed and published as an addition to the fourth edition of the ESTRO core curriculum in radiation oncology/ radiotherapy. Last year saw also the start of the review for medical physics experts in radiotherapy. Partnerships During2020,westrengthenedthedialoguewithmany oncology and radiotherapy societies worldwide. We reinforced and enlarged collaboration by signing and renewing a large number of memoranda of understanding. Partnership is a key word for ESTRO.

The publication of the annual report is an important moment for the European SocieTy for Radiotherapy and Oncology (ESTRO). It enables us to look back at the achievements of the past 12 months. Without a doubt, 2020 has been an exceptional year. With all our activities being impacted by the Covid-19 pandemic, it has been an interesting exercise to write this report, look at the figures and appreciate the challenges that we have faced. We hope you will enjoy reading the report and that you find it informative and inspirational, so that we can be ready to face the years to come with increased strength due to the experience we gained in 2020. The Covid-19 pandemic obliged us to reorganise every aspect of life and work: the activities in all radiotherapy departments had to be rethought; the format of meetings and gatherings had to be reconsidered; and so on. The very core of ESTRO activities has been deeply impacted. You will observe this both in the various sections of the report and in the financial outline. However, while we cannot deny that it has been a complicated year for ESTRO and for all of us, we can be very proud of what we have achieved and howwe have turned the complex scenario of Covid-19 into an opportunity to improve and to embrace change. With this in mind, I would like to bring to your attention some of the highlights of the year. Membership The membership base remained stable in 2020, with almost 7600 members. This was a small decrease of about 2% from the 2019 figures. There must be a special mention of the institutional membership, which continued to increase last year. Thismembership promotes both interdisciplinarity and collaboration within the departments. In 2020 we saw also an increase in joint membership agreements. We are grateful to each one of you for confirming your trust in the Society.

Science & Dissemination In 2020 ESTRO held its first online congress. This was a great challenge but also a great achievement.

Mission

The ESTROCancer Foundation (ECF) received a grant in 2020 and launched a new research initiative to identify and address barriers that impede access to radiotherapy. I would like to conclude with a heartfelt thank you to the ESTRO community. None of these achievements would have been possible without the continuous support of: our members; the Board, councils and committees; the faculties of the ESTRO School; the corporate partners; and the other organisations that we collaborate with. Finally a big thank you goes to the whole ESTRO staff, who, under these difficult circumstances, were able to adapt quickly, overcome problems and work on new ways for the future. Together we are stronger and ready to build on these changes for the future, in line with the ESTRO Vision: ‘Radiation oncology. Optimal health for all, together’.

The mission of ESTRO, a non-profit, scientific organisation, shall be to foster, in all its aspects, radiotherapy (also known as radiation oncology), clinical oncology and related subjects, including physics as applied to radiotherapy, radiation technology and radiobiology. Develop and promote standards of education in radiotherapy and clinical oncology Promote standards of practice in radiotherapy, clinical oncology and related subjects Stimulate the exchange of scientific knowledge in all related fields Strengthen the clinical specialty of radiotherapy and clinical oncology in relation to other specialties and professions involved in cancer management Encourage co-operation with international, regional and national societies and bodies representing radiotherapy, clinical oncology and related subjects Facilitate research and development in radiotherapy, clinical oncology and related subject To fulfil its mission ESTRO will:

Editorial

Mission

Best wishes, Ben Slotman ESTRO President (2020 – 2022)

MEMBERSHIP & PARTNER SHIPS

With more than 7600 radiation oncology professionals from across the world, the ESTRO membership is the heart of our organisation.

Membership & Partnerships

MEMBERSHIP

1. Profile of ESTRO Members In 2020, ESTRO continued to attract newmembers and engage with existing members by giving them the resources and tools they need to successfully navigate a career in radiation oncology and its related fields. From support for professional development to even greater access to scientific information, the membership programme is focused on giving members more of what they need and want.

Breakdown of ESTRO members by specialty

7618 Members

5 Continents

49,20% Radiation oncologist 11,41% RTT 19,64% Medical physicist 7,36% Clinical oncologist

1,09% Radiobiologist

11,30% Other medical and non-medical specialties

The ESTRO community extends far beyond these professional radiation oncology disciplines, taking in a wide range of other professions. This includes professionals from: other medical fields, such as surgeons, radiologists, medical oncologists, gynaecologists and urologists; and non-medical fields, such as public affairs specialists.

115 Countries

Geographical distribution

Top 10 countries

The Netherlands: 10%

Germany: 7%

Italy: 6% UK: 6%

Canada: 5% Belgium: 5% Australia: 5%

Membership & Partnerships

66% Europe

9% Western Pacific 10% Americas 2,5% South-East Asia

Spain: 4% USA: 3%

Switzerland: 3%

1,5% Eastern Mediterranean

1% Africa

10% No answer

Evolution of membership

Although the evolution of the membership curve was showing an increase in terms of number of members during the first months of 2020, we observed a sudden standstill as of mid-March, when the pandemic impacted Europe.

7867

7618

7281

7312

6742

6635

5830

2014

2015

2016

2017

2018

2020

2019

2. Structured and diversified membership categories

16,8% JOINT MEMBERS (1283) 10,9% Joint (827) 6% Joint in-training (456)

56,6% INDIVIDUAL MEMBERS (4315) 35,9% FULL (2737) 35% Active (2669) 0,8% Supporting ambassador (58) 0,1% Emeritus (10)

5,1% RTT ALLIANCE MEMBERS (390)

20,7% ASSOCIATE (1578) 15,3% Affiliate (1164 ) 5,3% In-training (405) 0,1% Honorary (9)

22 National societies

19,02% INSTITUTIONAL MEMBERS (1496)

1,8% CORPORATE MEMBERS (134) 37 Companies

57 Institutes

3. Membership categories under the spotlight

1. Institutional membership

The institutional membership category is designed to help hospitals, clinics or other institutions providing radiotherapy and cancer treatment to develop and support their in-house radiotherapy and oncology professionals. This category allows institutes to purchase packages of individual memberships on behalf of their employees who can enjoy all the usual advantages of individual membership at cost effective conditions. The institutions themselves receive a range of benefits, including: A dedicated institutional webpage on the ESTRO website Free online job postings An ESTRO institutional member logo A complimentary exhibitor booth at the Communities Pavilion during the annual conference.

Membership & Partnerships

57 Institutes in total (see annex for list)

1496 Employees supported through this membership category

7 New institutional members in 2020

The 7 new institutional members in 2020 were:

Hungary Bács-Kiskun County Hospital Iran Reza Radiation Oncology Center

Switzerland Kantonsspital St. Gallen

Portugal Quadrantes - Clínica Médica e Diagnóstico, Soc. Un.

UK Velindre University NHS Trust Western General Hospital, Edinburgh Cancer

Sweden Södersjukhuset AB

2. Supporting ambassador membership

This membership category is reserved for professionals in the field of radiation oncology who are strongly committed to supporting the enhancement of the radiotherapy community and wish to contribute to the Ambassador Solidarity Fund.

92 Individuals signed up

as supporting ambassadors

3. In-Training members and members under 40 years old

It is essential for ESTRO to engage the new generation of members. ESTRO consolidates its collaboration with European societies representing in-trainingmembers and encourages the newgeneration of radiation oncology professionals to join the Society. The ESTRO Joint In-Training membership is tailored to the needs of In-Training members and offers a range of specific benefits.

3343 ESTRO members are under 40 years old

Breakdown of In-Training members

ESTRO In-Trainingmembers are professionals in the field of radiation oncology who are in training or full time PhD, have obtained their diploma within the last 10 years and are under 40 years old.

405 individual In-Training 1208 In-Training members: 456 Joint In-Training 347 institutional In-Training

Illustrations of the involvement of the new generation of professionals in the ESTRO community

The Young Corner Dedicated section in the ESTRO newsletter coordinated by two editors with news from young national societies and young members sharing their experience through meetings or travel grant reports etc. The Young Track All-day session held during ESTRO’s annual Congress, which focuses specifically on topics of interest to young professionals.

4. Joint membership

This category can be granted to individual members who benefit from a joint membership agreement, signed on a case-by-case basis between ESTRO and a non–European society or a young national society active in the field of radiation oncology.

In 2020, ESTRO signed or renewed joint membership agreements with: Association of Medical Physicists of India (AMPI) New! European Society of Gynaecological Oncology (ESGO) New! Associazione Italiana di Radioterapia Oncologica (AIRO Giovani) Belgian Society for Radiation Oncology (ABRO - BVRO) Israeli Society for Clinical Oncology and Radiotherapy (ISCORT)

Membership & Partnerships

Spanish Society for Radiotherapy and Oncology (SEOR) Young Romanian Radiation Oncologists Group (YRROG)

5. Corporate members

Corporate members in 2020

Companies can opt for either ESTRO’s regular or gold corporatemembership. Gold corporate membership gives the right to a seat on the ESTRO corporate council, which works to facilitate collaboration and coordination between industry’s research and development activities, and the academic and scientific developments within ESTRO.

23 regular members 37 corporate members: 14 gold members

4. Main benefits of membership

ESTRO contributes to the day-to-day practice and career advancement of oncology professionals through the dissemination of the latest research findings and knowledge. ESTRO offers several levels of membership, with benefits tailored to the needs of each member and their level of involvement within the Society. The full range of ESTRO membership benefits includes

Belonging to a community of more than 7600 radiation oncology professionals

Online subscription to Radiotherapy & Oncology , the Society’s journal and member fees for publishing in the ESTRO OA journals

Networking opportunities and reduced fees for attending ESTRO teaching courses, online courses, workshops and conferences

Online access to scientific material, including event webcasts and delineation cases through the ESTRO e-library

Eligibility for grants, awards and ESTRO faculties and governance positions.

MoU’s

“Memoranda of Understanding on science, education and membership are a key tool to allow ESTRO to establish new collaborations and nurture existing ones with other societies in the field of oncology. In 2020, ESTRO signed Memoranda of Understanding with the following national and international societies:

Membership & Partnerships

Association of Medical Physicists of India (AMPI) Canadian Association of Radiation Oncology (CARO) European Association of Neuro-Oncology (EANO) South East Asian Radiation Oncology Group (SEAROG) West China Society of Therapeutic and Radiation Oncology (CSWOG-RTOG)”

RTT ALLIANCE

The objective of the RTT Alliance is to strengthen the collaboration with national societies representing RTTs, at both European and international level.

In 2020, ESTRO signed MoUs with the following national societies: Swiss Body of Radiology/Radio-Therapy and Nuclear Medicine (SVMTRA)

A the end of 2020, the RTT Alliance counted with a total of 22 National Societies members.

SCIENCE & DISSE MINATION

Science & Dissemination

ESTRO has a long track record of organising conferences, disseminating the latest findings and providing a platform for networking.

1. ESTRO 2020 - The Annual Congress of the European SocieTy for Radiotherapy and Oncology 28 November - 1 December 2020 | Online MEETINGS

Participation

A comprehensive programme

ESTRO 2020 offered the latest science in radiation oncology through a sophisticated virtual platform. From plenary award lectures to symposia to proffered papers highlighting results of clinical trials and late-breaking abstracts, ESTRO 2020 had something for everyone. Pre-recorded presentations allowed for viewing at ones’ convenience while a selection of live- steamed sessions offered the possibility for much valued interaction.

83% Participants 3,047 delegates:

18% Company delegates

Breakdown per specialty

Many educational activities

The educational programme included pre-meeting courses, teaching lectures and contouring sessions. The educational programme is discussed in the School section of this report.

45.15% Radiation oncologist 27,50% Medical physicist 9,08% RTTs, RT nurses 9,12% Clinical Oncologists 3,52% Other Medical Specialities

Young programme A day was dedicated to ESTRO’s

2,24% Radiobiologist 1,46% Computer Scientist

youngmembers. The programme included a teaching lecture, two symposia, a lunchtime symposium and networking activities.

0,9% Dosimetrist

0,42% Medical Oncologists 0,37% RO Industry - Corporate 0,14% Quality Manager 0,1% Other Non-Medical Specialities

275 Invited Speakers 43 Chairs

2,143 Abstracts

132 Sessions

1,422 Posters

Science & Dissemination

Evolution of participation to the ESTRO congress

Participants and Visitors Company Delegates

ESTRO 35: 5,284

4,065

1,219

ESTRO 36: 5,860

4,333

1,527

ESTRO 37: 6,211

4,856

1,355

ESTRO 38: 6,633

5,107

1,526

ESTRO 2020: 3,047

2,529

548

Top 10 countries

Exhibitors

The Netherlands: 328

53 Exhibitors

United Kingdom: 238

Main exhibition: 50 Start-ups: 3

Germany: 175

France: 165

Belgium: 149

Spain: 113 Italy: 149

Evolution of exhibitors at the ESTRO congress ESTRO 35: 103 ESTRO 36: 123 ESTRO 37: 117 ESTRO 38: 123

Switzerland: 111

USA: 93

Austria: 79

ESTRO 2020: 53

2. Joint events

EMUC - European Multidisciplinary Congress on Urological Cancers 12-14 November 2020 | Online

At the 12 th EuropeanMultidisciplinary Congress on Urological Cancers (EMUC20), experts from across and beyond Europe examined the best practices and challenges in the management of genitourinary (GU) malignancies. This leading congress on GU cancers for European medical specialists took place online from 13 to 14 November 2020.

1,996 delegates

Best attended sessions Organ preservation in challenging cases: 648

Fragments of imaging: 630

79 speakers from 16 different countries

Oligometastatic disease in genito-urinary cancers: 588

Highlights in GU cancers: 548

Refining the treatment of bladder cancer: 541

Abstracts

149 abstracts submitted

119 accepted

104 Countries represented

113 ePosters 6 oral

30 rejected

Geographical breakdown of the participants

Unique viewers 13 November: 1013 14 November: 1168

104 countries represented

42 Europe 62 Outside Europe

Top 3 countries Spain: 146

149 submitted abstracts

The Netherlands: 145 UK: 141

3. Endorsed events

ESTRO support policy The ESTRO support policy defines the ways in which ESTRO supports non-ESTRO scientific and educational events in the fields of radiotherapy and oncology. ESTRO endorsed the following events For more information (including the scheduled dates of upcoming events) please visit the ESTROwebsite.

Science & Dissemination

Organiser

Event title

Maastricht Radiation Oncology Clinic (MAASTRO) Arab African International Cancer Foundation

CT imaging workshop

Arab African International Cancer Congress (AAICC)

European School of Oncology

ESO masterclass in neuro-oncology

Oncology Institute Vojvodina, Serbian Association of Medical Physicists Belgian Society of Radiation Oncology (BeSTRO) Fondazione Policlinico Agostino Gemelli - Università Cattolica del Sacro Cuore, Rome, Italy

2nd Serbian Radiation Oncology Congress (SROC 2)

BeSTRO annual meeting. Metastases: from palliation to curative intent

30th residential course: precision oncology

Adaptation of the tumour and its ecosystem to radiotherapies: mechanisms, imaging and therapeutic approaches 16th meet the professor advanced international breast cancer course (AIBCC) Joint Abdus Salam International Centre for Theoretical Physics (ICTP) and IAEA workshop on risk assessment in advanced radiotherapy techniques Non-melanoma skin cancer course: current status in non- melanoma skin cancer treatments (basal cell and squamous cell carcinomas (BCC & SCC)): from surgery to radiotherapy (external beam radiotherapy and brachytherapy) Third International Conference on Advances in Radiation Oncology (ICARO3) Artificial intelligence for imaging SFRO annual meeting

Canceropole Grand Ouest, France

Accademia Nazionale di Medicina, Italy

Société Franc̨aise Radiation Oncology (SFRO)

International Atomic Energy Agency (IAEA)

Maastricht University

Spanish Society of Radiation Oncology (SEOR)/ Spanish Society for Medical Physics (SEFM)

IAEA

Breast & Gynaecological International Cancer Society (BGICS) 13th Breast Gynaecology Immunology International Cancer Conference (BGIICC) University of Pavia and San Matteo Hospital, Italy Radiomics toolbox workflow and quality management St Gallen Oncology Conferences, Switzerland 17th St. Gallen International Breast Cancer Conference European School of Oncology Advanced Breast Cancer Sixth International Consensus Conference (ABC6) ESTRO gave ‘in collaboration with’ support to the following event For more information (including the scheduled dates of upcoming event/s) please visit the ESTROwebsite.

Organiser

Event title

IAEA

ICARO3

PUBLICATIONS

1. The Green Journal

Radiotherapy & Oncology, known as the Green Journal, is the flagship publication in ESTRO’s family of journals. Led by editor-in-chief, Michael Bauman (Heidelberg, Germany), it covers all aspects of radiation oncology, publishing themed issues, editorials and correspondence, as well as original research and review articles.

Article transfer service to CtRO, PhiRO and TipsRO For manuscripts not selected for publication in Radiot herapy & Oncology, authors may be provided with the option of having their manuscript transferred to an ESTRO Open Access publication.

Manuscript submissions

Most popular articles

Geographic distribution of accepted papers

Most downloaded articles from ScienceDirect, 2020 1. Relationship between dosimetric leaf gap and dose calculation errors for high definition multi-

leaf collimators in radiotherapy Kim J.,Han J.S.,Hsia A.T.,Li S.,Xu Z.,Ryu S.

2. Deep learning-based auto-segmentation of targets and organs-at-risk for magnetic resonance imaging only planning of prostate radiotherapy Elguindi S.,Zelefsky M.J.,Jiang J.,Veeraraghavan H.,Deasy J.O.,Hunt M.A.,Tyagi N.

72 accepted papers:

49 Europe

2 Asia 12 North & Central America

9 Oceania

Technical innovations & patient support in Radiation Oncology (tipsRO) Technical Innovations & Patient Support in Radiation Oncology (tipsRO)is edited by Sara Faithfull (Guildford, UK) and Michelle Leech (Dublin, Ireland). The journal offers radiation therapists, nurses and allied health professionals a forum for the publication of original research, case reports, practice development and health evaluation articles, reviews, short communications, technical notes and correspondence on topics including treatment planning and workflows, treatment delivery and verification, supportive care, psycho-oncology, education and training. tipsRO is an Open Access journal. All members of ESTRO are eligible for a discounted fee and the fees vary depending on whether the manuscript is a full- length original research article, a short-format case report, technical note or short communication. All correspondence commenting on previously published work is published free of charge. Most downloaded articles from ScienceDirect, 2019 1 . The impact of bladder preparation protocols on post treatment toxicity in radiotherapy for localised prostate cancer patients Yat Man Tsang, Peter Hoskin 2. Treatment of symptomatic splenomegaly with low doses of radiotherapy: Retrospective analysis and review of the literature Carolina de la Pinta, Eva Fernández Lizarbe, Ángel Montero Luis, José Antonio Domínguez Rullán, Sonsoles Sancho García 3. Meeting the challenges imposed by COVID-19: Guidance document by the ESTRO Radiation TherapisT Committee (RTTC) Yat Tsang, Aileen Duffton, Michelle Leech, Maddalena Rossi, Philipp Scherer Most popular articles

Breakdown of submissions types

4 Review articles 5 Short communications and technical notes 20 Research articles 51 submitted articles:

3 Correspondence 2 Practice development and health evaluation articles 14 Other 3 Case reports and case series

Geographic distribution of accepted papers

31 accepted papers:

18 Europe

5 North & Central America

7 Oceania

1 Asia

3. ESTRO newsletter

The ESTRO newsletter provides a more informal space for members to read about the latest developments in the radiation oncology field and its community.

In each issue expert editors, selected from the membership, curate contents for themed disciplinary ‘Corners’ or report on specific topics. The newsletter typically includes information on the latest advances in research and practice, interviews with key opinion leaders, conference findings, a selection of research papers and paper reviews.

Find all the articles on the ESTRO Website. www.estro.org/About/Newsroom/Newsletter

Science & Dissemination

Top five most read corners in 2020 (online) 1 . Read it before your patients 2 . Physics 3 . Brachytherapy 4 . RTT 5 . Young ESTRO

RESEARCH

ESTRO is committed to support research that is relevant to its members. The scope of ESTRO involvement varies with the research topic, the type of research activity, and the level of support requested. On the next pages are explanations of research activities in which ESTRO was involved in 2020.

1. E 2 -RADIatE - EORTC-ESTRO radiation infrastructure for Europe programme

E²-RADIatE (EORTC 1811 study) is a platform that collects real-world data through prospective data registries in radiotherapy. It is a collaboration between EORTC and ESTRO that is in- tended to be an efficient pan-European infrastructure framework across the field of radiation oncology to generate robust data in cancer treatment and to develop and integrate the discipline further into therapeutic strategies.

E²-RADIatE comprises two innovative cohorts, OligoCare (EORTC 1822-RP) and ParticleCare (EORTC 1833-RP). A third cohort on Re-irradiation ReCare (EORTC 2011-RP) was initiated in 2020. E²-RADIatE (EORTC 1811) COUNTRY & SITE ACTIVATION As of 14 December 2020, 20 sites in six countries had been activated for E²-RADIatE and had opened for enrolment in OligoCare. Another 30-40 sites in 13 countries are planned for activation by the first half of next year. If you are interested in participating, please go to the website for more information. OligoCare (EORTC 1822-RP) Since June 2020, OligoCare has had a monthly enrolment of 30-40 patients. The aim is to enrol patient number 500 by March 2021.

2. European Particle Therapy Network (EPTN)

EPTN, a task force of ESTRO, was created to promote clinical and research collaboration between the members of European particle therapy (PT) centres, whose numbers are increasing rapidly, and to ensure that PT became integrated into the overall radiation oncology community. The 6 th EPTN workshop took place virtually on 23 October 2020. The workshop was attended by 55 participants. Since the last EPTN annual meeting, three new centres have joined the network: the Zuid-Oost Nederland Protonen Therapie Centrum (ZON- PTC, the South-East Netherlands Proton Therapy Centre), in Maastricht, The Netherlands; the Particle Therapy Interuniversity Centre Leuven (ParticLE), Belgium; and a new Rutherford Cancer Centre, UK. Report fromEuropeanCommissiondirectorate- general on health and food safety (DG Santé) and the European Investment Bank (EIB) On 21 October 2020, there was a virtual meeting of the sub-group on proton therapy of the European Commission (EC) steering group on health promotion, disease prevention andmanagement of non-communicable diseases, which is co- chaired by DG SANTE and the EIB. The mandate of the sub-group is to examine the current state of play of availability and use of proton therapy centres across the European Union (EU) and to identify options through which willing member states can cooperate sustainably to improve information exchange and avoid duplication of effort. The meeting was attended by approximately 40 participants who represented member states’ health authorities, the EPTN, the EIB and DG SANTE. A report on this meeting is available here.

HIGHLIGHTS OF THE 2020 ACTIVITIES OF THE EPTN WORKING PARTIES WP1: Clinical The first objective of WP1was to assess the content of the prospective data registration programmes for the most important indications for proton therapy. The current status is that this has been completed for cancers of the central nervous system, head and neck, breast, oesophagus, lung and prostate. For paediatric patients, EPTN will eventually follow the recommendations of the project entitled health effects of cardiac fluoroscopy and modern radiotherapy in paediatrics (HARMONIC). A recent survey among EPTN members showed that they were broadly committed to the collection of data that were integrated in the E2-RADIatE project (ParticleCare), which is coordinated by EORTC. WP2: Dose assessment, quality assurance, dummy runs, technology inventory As of October 2020, 28 centres in 12 different countries were contributing to WP2. A dedicated quality assurance (QA) workshop was organised in autumn 2019. The event was hosted by the Holland Particle Therapy Center (HollandPTC) in Delft, The Netherlands. It was a two-day gathering (23-24 October) with the scope to share and compare experiences of QA procedures as currently carried out at different European centres. In the framework of WP2 activities, two projects were submitted in 2019 to the infrastructure in proton international research (INSPIRE) programme and were approved to receive support through the transnational access (TNA) infrastructure. WP3: Education The working group decided to develop site- specific workshops to meet the increasing need for education and training in the field of particle therapy. These will be two-day events that will be hosted by institutions that have solid clinical experience of treating a specific disease site with protons.

Science & Dissemination

The workshops are intended to complement the ESTRO school course on clinical particle therapy. The first workshop will be on brain and skull-base tumours and will be hosted by the Paul Scherrer Institute (PSI). It is tentatively scheduled for the autumn of 2021. WP4: Image guidance in particle therapy (IGPT) The aimof this working party is to gain insight into the current practice parameters of IGPT and to drive harmonisation through the establishment of body-site-specific consensus guidelines. The current standard of practice from the EU particle centres has been investigated, via detailed surveys specific to each body site. EPTN-WP4 will continue to focus on the completion of data collection from surveys and on the analysis of the data that have been collected already. The fourth annual workshop of the EPTN-WP4 was cancelled due to the Covid-19 pandemic and replaced by an online session that took place on 26 June 2020. The main topic of this meeting was the presentation and evaluation of four IGPT projects that have the potential tomake a significant impact on the particle therapy community. WP5: Treatment planning systems in particle therapy Treatment planning systems (TPSs) are essential for accurate and effective particle therapy and are an important part of the particle therapy workflow. In this working group, the aim is to review and to provide recommendations on numerous aspects of the treatment-planning process. The WP has formulated several sub-groups to cover the most important aspects of treatment planning systems: i. Collective TPS specifications; ii. Planning standards and case solutions; iii. TPS commissioning and validation; iv. Alternatives to patient-specific verifications; v. CT/ Hounsfield units calibration; vi. Robustness analysis; vii. The role of linear energy transfer (LET); viii. 4D planning. WP6: Radiobiology and relative biological effectiveness In February 2020, WP6 held a workshop in Manchester, UK, which was open to everybody with an interest in the clinical impact of the

relative biological effectiveness (RBE) in proton therapy and experimental particle radiobiology. A total of 44 participants from eight countries, who represented 13 centres, were present at the two-day meeting. WP6 and the coordinator of the INSPIRE WP9 on mathematical modelling and simulation are conducting a survey on current clinical practice regarding RBE in European proton therapy centres. The data will be published after they have been collected and analysed. WP7 : Health economy Health economic profiling of particle therapy is pivotal for its positioning within the portfolio of alternative radiotherapeutic modalities. However, so far, no assessment has been completed on a European level as it seems to be difficult to obtain the permission of centres to disclose the relevant financial and operational data. TheWP7 teamhas developed a methodological inventory that can be used for various assessments. This inventory can be adapted to national health technology assessment (HTA) requirements if needed. An online meeting of WP7 was held in December 2019 to investigate whether there was interest to collaborate on the evaluation of the ESTRO health economics in radiation oncology (HERO) costing model in the context of proton beam therapy (PBT). A first collaboration between ESTRO-HERO/ EPTN WP7 and the University of Manchester will be set up to evaluate the applicability of themodel to PBT, before enlarging the collaboration with other partners in EPTN WP7.

EPTN COLLABORATIVE EFFORTS INSPIRE

The INSPIRE project (Grant agreement 730983) is funded through the EU’s Horizon 2020 research and innovation programme and the aimof it is to integrate proton therapy research activity across Europe. For more information visit INSPIRE’s website. Like all integration activities, INSPIRE provides TNA so that researchers across Europe can access the facilities of its beneficiaries. INSPIRE also conducts joint research activities to enhance further its research capabilities and it makes them available to its users. INSPIRE’s networking activities are designed to enhance collaboration, training and innovation opportunities across Europe and to ensure that potential users of INSPIRE’s research capabilities are kept informed of what is on offer. For more information on the activities of the EPTN please visit the website.

Science & Dissemination

GUIDELINES

The following guidelines were developed under the auspices of the Advisory Committee on Radiation Oncology Practice (ACROP) in 2020. Surface brachytherapy: Joint report of the American Association of Physicists in Medicine (AAPM) and the Groupe Européen de Curiethérapie (GEC)‐ESTRO task group No. 253 GEC-ESTRO/ACROP recommendations for quality assurance of ultrasound imaging in brachytherapy ESTRO intraoperative radiotherapy (IORT) task force/ACROP recommendations for intraoperative radiation therapy in unresected pancreatic cancer Defining oligometastatic disease from a radiation oncology perspective: an ESTRO-American Society for Radiation Oncology (ASTRO) consensus document ESTRO IORT task force/ACROP recommendations for intraoperative radiation therapy in borderline- resected pancreatic cancer ESTRO IORT task force/ACROP recommendations for intraoperative radiation therapy with electrons (IOERT) in breast cancer ESTRO/ACROP IORT recommendations for intraoperative radiation therapy in locally recurrent rectal cancer ESTRO ACROP guidelines for target volume definition in the thoracic radiation treatment of small-cell lung cancer IORT for soft tissue sarcoma – ACROP-ESTRO IORT task force recommendations ESTRO/ACROP IORT recommendations for intraoperative radiation therapy in primary locally advanced rectal cancer

ESTRO ACROP guidelines for target volume definition in pancreatic cancer ESTRO ACROP guideline for target volume delineation of skull base tumours

Guidelines endorsed by ACROP in 2020

European Association of Nuclear Medicine/Society of Nuclear Medicine and Molecular Imaging (EANM/ SNMMI) practice guideline for [18F]-fluorodeoxyglucose (FDG) positron emission/computed tomography (PET/CT) external beam radiotherapy treatment planning in uterine cervical cancer v1.0 Radiation therapy for small-cell lung cancer: an ASTRO clinical practice guideline Radiation therapy for cervical cancer: executive summary of an ASTRO clinical practice guideline Radiation therapy for rectal cancer: executive summary of an ASTRO clinical practice guideline

Science & Dissemination

ESTRO SCHOOL

ESTRO School

The ESTRO School’s mission is to: improve, professionalise and harmonise knowledge and practice in radiation oncology and associated professions in Europe and beyond support the implementation of the European core curricula, with education and training programmes that target both young and senior radiation oncology professionals offer a wide range of live educational activities and online educational resources that enable professionals worldwide to acquire the knowledge, skills and competencies to deliver high-quality treatment and care to cancer patients.

In 2020 the ESTRO School adapted its activity programme to offer online education in order to ensure that training was continuous and to keep the radiotherapy community united. The school offered a wide array of educational activities, which included:

Annual live and online teaching courses that covered the basic and continuing medical educational needs of all professionals who worked in the field of radiation oncology

Pre-meeting courses, contouring workshops and teaching lectures during congresses

Online tools

LIVE COURSES

1. Wide range of topics proposed

ESTRO School

The portfolio of live teaching courses includes basic and more advanced courses that are targeted at the various radiation oncology professions.

The topics cover the main areas of radiation oncology and multidisciplinary cancer treatment.

courses on imaging

courses on radiotherapy treatment planning and delivery: external beam and brachytherapy

courses on multimodal cancer treatment, in general, and also site- specific treatment

courses on best practice

courses on research

course on biological aspects of radiation oncology

2. 2020 School programme at a glance

European courses: Breakdown participants per continent

1108 Participants 761 In Europe 347 Outside Europe

73,94% Europe

3,95% Americas 8,18% South-East Asia 9,50% Western Pacific

2,45% Africa

1,98% Eastern Mediterranean

3 Live courses 2 In Europe 1 Outside Europe

Participants to live courses: top 10 countries

The Netherlands: 94

India: 73

UK: 61

Germany: 52

Belgium: 49

Australia: 45 Switzerland: 46

7 Online courses

Sweden: 44

Spain: 38

Norway: 36

We thank the course directors and teachers for their flexibility in providing education to the ESTRO community throughout a very challenging year. Thanks to their continuous support, the ESTRO School was able to adapt the educational offer by providing online courses. This explains the reduction in courses in 2020.

ESTRO School

Growth in the number of courses and participants over the years

34 33

28 30 31

14 16

Courses

Participants

1,434

1,826

1,976

2,611

2,745

2,836

2,843

3,015

2,858

2,561

2,490

2,822

2,576

2,761

2,805

1,108

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

Growth in the number of participants over the years

Courses held: In Europe

Outside Europe

1,921

1,800

1,773

2,026

2,149

2,042

1,970

761

937

761

717

796

427

719

835

347

2013

2014

2015

2016

2017

2018

2019

2020

PRE-MEETING COURSES

1. Pre-meeting courses

ESTRO offers one-day teaching courses that occur on the day before the start of its annual congress. This year, in the frame of the online meeting, three pre-meeting courses took place online, each of which combined pre- recorded lectures, live workshops and live discussion sessions.

Number of participants per pre-meeting course

Radiobiology - Interaction between the tumour ecosystem and radiation

Interdisciplinary – Health services research (HSR) and health economics in HERO

Radiotherapy - Research for radiotherapists

E-LEARNING

1. FALCON, ESTRO’s contouring platform

ESTRO School

Variability in anatomical contouring is an important contributor to uncertainty in radiation oncology. This is why, a few years ago, ESTRO developed the contouring programme FALCON*, which is based on the EduCase software, with the aim to improve contouring skills and to compare individual contours with thosemade by delineation experts and with the ESTRO / international guidelines. FALCON* is ESTRO’s web-based contouring programme, which is de- voted to the improvement of the contouring skills of radiation oncology professionals.

The FALCON online contouring platform is integrated into the portfolio of educational ESTRO activities such as:

Live courses

Workshops at ESTRO meetings

Online virtual workshops

Support services for clinical trials and development of guidelines

Delineation workshops for other societies (IAEA, national societies or other societies active in the field of oncology)

*Fellowship in Anatomic deLineation and CONtouring

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