The GEC ESTRO Handbook of Brachytherapy - Introduction

The GEC ESTRO Handbook of Brachytherapy

Editors Bradley Pieters Erik Van Limbergen Richard Pötter

Peter Hoskin Dimos Baltas

Table of contents

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TABLE OF CONTENTS

Introduction to the electronic book version

PART I: THE BASICS OF BRACHYTHERAPY

Chapter 1: General aspects (EVL, RP, PH, NN (physicist)) - 1 st edition 2002 Chapter 2: Brachytherapy physics and dosimetry - 2 nd edition 2014 Chapter 3: Radiation protection - 2 nd edition 2014 Chapter 4: Brachytherapy equipment and quality assurance - new Chapter 5: Radiobiology of LDR, HDR, PDR and VLDR brachytherapy - 2 nd edition 2015 Chapter 6: Modern imaging in brachytherapy - 1 st edition 2002 Chapter 7: Principles of brachytherapy planning systems - new Chapter 8: Treatment planning, evaluation and reporting in brachytherapy - new Chapter 9: Breast - 1 st edition 2002 Chapter 10: Head and Neck: general aspects - 2 nd edition 2019 Chapter 11: Head and Neck: lip and buccal mucosa - 2 nd edition 2019 Chapter 12: Head and Neck: oral tongue and floor of mouth - 1 st edition 2002 Chapter 13: Head and Neck: oropharynx - 2 nd edition 2021 Chapter 14: Head and Neck: nasopharynx - 2 nd edition 2019 Chapter 15: Gyneacology: General aspects - new Chapter 16: Cervix cancer - 2 nd edition 2023 Chapter 17: Endometrial cancer - 2 nd edition 2016 Chapter 18: Primary vaginal cancer and vaginal recurrences - 2 nd edition 2023 Chapter 19: Vulva - new Chapter 20: Prostate cancer - 2 nd edition 2014 Chapter 21: Urinary bladder cancer - 2 nd edition 2015 Chapter 25: Oesophageal cancer - 2 nd edition 2019 Chapter 26: Bile duct cancer - 2 nd edition 2017 Chapter 27: Bronchus cancer - 2 nd edition 2017 Chapter 28: Primary and secondary liver malignancies - 2 nd edition 2022 Chapter 29: Skin cancer - 2 nd edition 2017 Chapter 30: Paediatric malignancies - 2 nd edition 2023 Chapter 31: Uveal melanoma - 2 nd edition 2020 Chapter 32: Keloids - 1 st edition 2002 Chapter 33: Pterygium - 2 nd edition 2023 Chapter 34: Uncommon indications for brachytherapy - new Chapter 22: Penis cancer - 2 nd edition 2022 Chapter 23: Anal cancer - 2 nd edition 2023 Chapter 24: Rectal cancer - 2 nd edition 2014 PART II CLINICAL PRACTICE

List of authors and abbreviations

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LIST OF AUTHORS (status 01/08/2022)

Bacorro, Warren, Manila, Phillipines Baltas, Dimos, Offenbach, Germany Blasi, Maria Antonietta, Rome, Italy Budrukkar, Ashwini, Mumbai, India Chargari, Cyrus, Paris, France

Nout, Remi, Leiden, The Netherlands Pagliara, Monica Maria, Rome, Italy Papagiannis, Panagiotis, Athens, Greece Pérez-Calatayud, José, Valencia, Spain Pieters, Bradley, Amsterdam, The Netherlands Peiffert, Didier, Vandœuvre-lès-Nancy , France Pötter, Richard, Vienna, Austria Ricke, Jens, Munich, Germany Rottler, Maya, Munich, Germany Schmid, Maximilian, Vienna, Austria, Schulz-Jürgenlienk, Ina, Utrecht, The Netherlands Seidensticker, Max, Munich, Germany Serban, Monica, Toronto, Canada Skowronek, Janusz, Poznan, Poland Strnad, Vratislav, Erlangen, Germany Sun Myint, Arthur, Liverpool, United Kingdom Tagliaferri, Luca, Rome, Italy Tan, Li Tee, Cambridge, United Kingdom Tanderup, Kari, Aarhus, Denmark Van der Kogel, Albert, Nijmegen, The Netherlands Van der Steen-Banasik, Elzbieta, Arnhem, The Netherlands Van Limbergen Erik, Leuven, Belgium Van Vulpen, Marco, Utrecht, The Netherlands Venselaar, Jack, Tilburg, The Netherlands Walter, Franziska, Munich, Germany Wee, Joseph T.S., Singapore, Singapore Westerveld, Henrike, Rotterdam, The Netherlands

Chua, Melvin, L.K., Singapore, Singapore Corradini, Stefanie, Munich, Germany Creutzberg, Carien, Leiden, The Netherlands Crook, Juanita, Kelowna, Canada Dörr, Wolfgang, Vienna, Austria Eder-Nesvacil, Nicole, Vienna, Austria, Fionda, Bruno, Rome, Italy Galalae, Razvan, Kiel, Germany Gehin, William, Vandœuvre-lès-Nancy , France Gerard, Jean Pierre, Nice, France Guinot, José Luis, Valencia, Spain Haie-Meder, Christine, Paris, France Hass, Peter, Magdeburg, Germany Heilemann, Gerd, Vienna, Austria Hellebust, Taran, Oslo, Norway Hoskin, Peter, London, United Kingdom Jaberi, Ramin, Teheran, Iran Joiner, Michael, Detroit, Michigan, USA Kovács, György, Lübeck, Germany Kroon, Petra, Utrecht, The Netherlands Lee, Chris D, Liverpool, United Kingdom Lindegaard, Jacob, Aarhus, Denmark Martínez-Monge, Rafael, Pamplona, Spain Mejia, Michael, Manila, Phillipines Meknaci, Émilie, Vandœuvre-lès-Nancy , France

Mohnike, Konrad, Berlin, Germany Mühlmann, Marc, Munich, Germany Nierer, Lukas, Munich, Germany

Introduction

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INTRODUCTION TO THE INTERNET EDITION

The first edition of the GEC-ESTRO Handbook of Brachytherapy was released in 2002 at the 21st ESTRO annual meeting in Prague. It consisted of chapters on the basis of brachytherapy related to physics, radiobiology, imaging, and reporting, and clinical chapters related to specific organ sites in the field of brachytherapy. The editors and chapter authors were those experts in the field, who had been teaching for many years as a faculty in the (GEC-) ESTRO course on Modern Brachytherapy. The book was a result of these joint educational efforts and was designed as a systematic modern handbook for tumour and target assessment, individualised brachytherapy techniques and advanced treatment planning and dose prescription, reflecting the long standing GEC ESTRO experience. The book served furthermore as a comprehensive tool to support the teaching activities of the ESTRO School as an advanced course book. The first 1500 printed editions were quickly distributed at the annual courses in Europe and additional courses in Eastern Europe, North Africa and South America. Further distribution was successful through ESTRO conferences and ESTRO School activities so that an extra 1500 copies had to be reprinted in 2007. The handbook was posted on the homepage of ESTRO for free download worldwide. In the meantime, major new developments have taken place in the field of radiation oncology and brachytherapy and have been integrated into the growing educational activities of the ESTRO School. These have been reflected in the further development of the annual “Comprehensive and Practical Brachytherapy” (formerly “Modern Brachytherapy Techniques”) Teaching Course as well as in the Teaching Courses on “Brachytherapy for Prostate Cancer” (since 2001) and “Image Guided Adaptive Gynaecologic Brachytherapy” (since 2004) which evolved to “Image guided radiotherapy and chemotherapy in gynaecological cancers: focus on MRI based adaptive brachytherapy for cervical cancers”. In close cooperation with teachers from the Indian continent AROI together with ESTRO introduced since 2017 in a similar format as the European edition the annual course “3D radiotherapy with a special emphasis on the implementation of MRI/CT based brachytherapy in cervical cancer” focussing more on general image guidance and CT. Last to mention advanced brachytherapy course is the now well established successful Teaching Course on “Advanced Brachytherapy Physics” (since 2014). There was first the introduction of various forms of 3 D imaging into the field of brachytherapy, following the successful implementation of CT imaging in external beam radiotherapy: then ultrasonography in prostate cancer, MRI and CT guided brachytherapy in gynaecology and rectum and anal cancer, and liver (metastatic) cancer, CT imaging in breast, skin, bladder and other sites. There was secondly the need to create a common language between brachytherapists practicing in the fields of traditional LDR brachytherapy with a large amount of clinical evidence and the newer forms of HDR or PDR brachytherapy. Out of these discussions within the different GEC-ESTRO working groups came the proposal established in the Gyn GEC ESTRO recommendations 2005/2006 to use the linear-quadratic model as a communication tool and to “translate” the huge variation of different treatment

schedules with different dose rates, pulse and fraction sizes for target and OARs into the common language of equi-effective doses (“EQD2”). The international spread and acceptance of this concept has resulted in the joint new GEC-ESTRO/ICRU report 89 on “Prescribing, Recording and Reporting Brachytherapy for Cancer of the Cervix” which was released in 2016. Such equi effective dose concept is work in progress for other tumour sites with many challenging issues to become resolved. There is increasing evidence, particularly in the field of 3D image based gynaecologic and prostate brachytherapy to show large variations between “treatment schedules” and the final prescribed or delivered dose. Therefore, the concept of the “Planning Aim Dose” was recently introduced into brachytherapy for cervix cancer brachytherapy (ICRU report 89 (following ICRU reports 78 and 83), which has to be clearly differentiated from the “Prescribed Dose”. This differentiation allows for complex reporting of treatment schedules (along traditional lines) and actual prescribed doses after advanced 3D treatment planning both for CTV, GTV and OAR. Many more recommendations have been designed and published by GEC ESTRO working groups during the last decade reflecting various aspects of the developing field of brachytherapy, particularly for breast, cervix and vagina, head and neck, prostate, skin and physical aspects of brachytherapy. Such new insights - as partly addressed here - have demanded the complete revision of the old edition of the GEC ESTRO Handbook of Brachytherapy (2002), which is now mostly outdated. This need has been long recognized. As this task has turned out to be huge, a new template was finally chosen by the editors in agreement with ESTRO and the GEC ESTRO Committee, taking into account emerging forms of book production and publication. This template also reflects the growing complexity and the continuously changing situation in the field of brachytherapy in general with much diversification, and also the growth of educational activities within the ESTRO School. There are at present four teaching courses dedicated to brachytherapy and there is even wider representation of brachytherapy in other educational activities of the ESTRO School and beyond. Continuous publication of the book, chapter by chapter, on the internet has been chosen to allow rapid publication and general availability of the chapter contents, keeping within the overall frame of the GEC ESTRO Handbook. This Internet GEC ESTRO Handbook of Brachytherapy will grow with time and will become both comprehensive and up to date. This is possible through the ESTRO’s E-Library. This Internet template enables furthermore the use of the various advantages of electronic publishing, to provide additional educational material where indicated. This Internet template can be easily used for the various educational activities within the ESTRO School and beyond, and allows for chapter updates as necessary according to upcoming evidence. This format will also facilitate contributions from across the GEC ESTRO working groups which is necessary for building some chapters such as those on treatment planning and reporting where common concepts have still to be agreed.

Introduction

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The enlarged and renewed author group comprises experts in the various fields of brachytherapy, in particular those who have been active within GEC ESTRO and the various educational activities of the ESTRO School and ESTRO. Also the editor group has recently been adapted and extended with some “refreshment”. Those chapters that are considered ready for publication will become available on the ESTRO’s E-Library, the first in December 2014. A printed paper edition may be considered as appropriate when all the chapters are finished. An overview of all planned chapters is provided in the “Table of Contents” which will be continuously available on the E-Library. The chapters as published on the Internet are in bold letters with the publication date indicated. They are directly accessible through the “Table of Contents”. Access to the Handbook remains open to anyone with a MyESTRO account. There is no need to be ESTRO member to create a MyESTRO account. We hope that this GEC ESTRO publication initiative based on the new ESTRO’s E-Library for on line education will grow and mature with time and will contribute to further strengthen GEC ESTRO and ESTRO educational activities in order to support continuously the further development of brachytherapy and radiotherapy in Europe and all over the world.

Brussels, December 2014/March 2022 (revised)

Editors - Acknowledgements

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EDITORS OF “THE GEC ESTRO HANDBOOK OF BRACHYTHERAPY” 2ND EDITION

Bradley Pieters Course director basic ESTRO Teaching Course “Comprehensive and Practical Brachytherapy” Erik Van Limbergen Former course director basic ESTRO Teaching Course “Modern Brachytherapy Techniques”

Richard Pötter Former course director advanced ESTRO Teaching Course “Image-Guided Radiotherapy and Chemotherapy in Gynaecologic Cancer – Focus on Adaptive Brachytherapy”

Peter Hoskin Course director advanced ESTRO Teaching Course “Brachytherapy for Prostate Cancer” Dimos Baltas and Panagiotis Papagiannis Course directors advanced ESTRO Teaching Course “Advanced Physics for Brachytherapy”

ACKNOWLEDGEMENTS

This second edition of the GEC-ESTRO Handbook of Brachytherapy is developed out of the strong roots of the first edition. Therefore, we wish to express our gratitude to all the authors and editors that have contributed to this standard work on brachytherapy and spe cially to those who retired or left the field to explore other (professional) challenges of life: Alain Gerbaulet (“father” of the first edition), Jean-Jacques Mazeron and Harm Meertens as editors; Dan Ash, Edith Briot, Eric Lartigau and Pierre Scalliet as contributors. Their work formed the base for new developments in the brachytherapy world. These new developments have been growing through the different working groups of GEC-ESTRO: Braphyqs (chair Frank–André Siebert following Jack Venselaar), the Gynaecologic Working Group/Gyn GEC ESTRO network (chair Kari Tanderup and Richard Pötter following Christine Haie-Meder and Christian Kirisits), UroGEC (formerly “Probate”) chair Peter Hoskin following György Kovács, Jan Battermann and Dan Ash, the Breast Working Group (chair Jean-Michel Hannoun-Levi following Vratislav Strnad, Csaba Polgár and Erik Van Limbergen), the GI-GEC (formerly Anorectal Working Group) (chair Alexandra Stewart following Arthur Sun Myint and Didier Peiffert), the Head and Neck and Skin Working Group (chair Luca Tagliaferri following György Kovacs and Jean Jacques Mazeron), Brachy-HERO Working group (chair Peter Niehoff following Li-Tee Tan) and two working groups which were active for a limited time period, the Pattern of Care Working Group (chaired by Ferran Guedea) and the Endovascular Working Group (chaired >20 years ago by Richard Pötter). Without their continuous activities in research and development, in scientific discussion and dissemination, in education and training and in the design of recommendations and guidelines many of the develop. as elaborated in this book would not have become possible. We also thank all those who have been teaching modern brachytherapy in the different (GEC)-ESTRO brachytherapy Courses over the last 30 years. The input through so many people, coming from different places from North to the South and from the East to the West of Europe and abroad needed an extra editing input to arrive at a common and correct “native” English language throughout all chapters. Our sincere thanks go to Professor Ann Barrett who is doing this job like for the first edition in an extraordinary meticulous way. Finally, we want to express our gratitude to Daneel Bogaerts who is responsible for the layout of the book and Essi Saarto (formerly Melissa Vanderijst) who handles the book on the ESTRO’s E-Libraray, both working in the ESTRO office.