The GEC ESTRO Handbook of Brachytherapy - Introduction

Introduction

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THE GEC ESTRO HANDBOOK OF BRACHYTHERAPY Version 4 - 01/09/2023

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.