Course Report

4th AROI-ESTRO Gynaecology Teaching Course: 3D radiotherapy with a special emphasis on implementation of MR/CT based brachytherapy in cervical cancer - PDF Version
4 - 7 March 2020, Mumbai, India 

AROI course directors:
Umesh Mahantshetty, Radiation Oncologist, Tata Memorial Hospital, Mumbai, India
Jamema Swamidas, Medical Physicist, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Mumbai, India 

ESTRO course directors:
Richard Pötter, Radiation Oncologist, Medical University Hospital, Vienna, Austria
Kari Tanderup, Medical Physicist, University Hospital, Aarhus, Denmark 

Could you please briefly introduce yourself? 

My name is Amit Grover and I am a radiation oncologist working at Shri Siddhivinayak Ganapati Cancer Hospital, Miraj, Maharashtra, India. My primary interests are head and neck malignancies and cervical cancer, since these constitute our major cancer burden. I am also actively involved in palliative care, which I have helped to develop in my institute. 

Why did you choose to attend this course? 

I found the European SocieTy for Radiotherapy and Oncology (ESTRO) teaching course in palliative medicine and stereotactic body radiation therapy (SBRT) extremely useful. I am also interested in brachytherapy for cervical cancer and we have recently procured computed tomography  CT) / magnetic resonance imaging (MRI) compatible applicators. Therefore, we thought this course would be ideal to help us through the transition to 3D brachytherapy. 

What aspects of the course were most interesting to you and why? 

The contouring sessions were unique. The delineation exercises gave insights into 3D image-based target concepts. I enjoyed the Skype sessions with the ESTRO faculty. They helped to troubleshoot practical problems in daily clinical practice. 

Did the course activities improve your knowledge and skills in the relevant subject? 

Absolutely. Although I have been practising brachytherapy for the past 20 years, I am still new to MRI-based adaptive brachytherapy. During the course, I also ironed out conceptual difficulties that surfaced during the workshop.  

Did your course meet your expectations? If so, how?  

It did. Excellent quality of speakers, content that was relevant to practical situations, impeccable organisation and an environment conducive to learning made this one of the best courses I have attended. I wish to offer kudos to Drs Mahantshetty and Swamidas and to the ESTRO team.  

List three important takeaways following the course  

• Accurate clinical mapping with a 3D diagram that is performed prior to external beam radiation therapy and brachytherapy is vital to treatment.  
• Conceptual understanding of target volumes is essential for 3D image-based response-adaptive brachytherapy.  
• Dose and volume reporting should follow the International Commission on Radiation Units and Measurements guideline ICRU 89 to adhere to at least a minimum standard of reporting (Level 1). 

How will what you have learned be implemented in your daily clinical practice? 

This course will help me to approach 3D (CT-based) brachytherapy systematically. We have just started this method of treatment. I plan to inculcate the 3D clinical diagrams; to give attention to simple practical processes such as bladder filling protocols, while streamlining planning and reporting. It may take us a while to implement MR brachytherapy; we are considering using trans-rectal ultrasound in the near future. What I have learnt will be invaluable when we shift to a target-volume-based approach.  

How would you encourage someone who has never been to an ESTRO course to join this course next year?  

In our forthcoming local academic meeting, I plan to share my experiences during this course and explain how it has impacted my practice. I expect to show how the course is relevant to the Indian scenario, which I think will encourage participation. 

Physicists’ perspective  

Our team at the course included two physicists. It was their first ESTRO workshop. They found the hands-on exercise elucidating the approach to optimising a brachytherapy plan useful. We are in the process of adopting it in our practice. Practical nuances regarding applicator commissioning and reconstruction in a MRI/CT environment and its impact on dose distribution were another important takeaway. Last, but not least, the social event with all the networking was a huge hit. 

Dr Amit Grover
Consultant radiation oncologist
Shri Siddhivinayak Ganapati Cancer Hospital
Miraj (Maharashtra) India
amgroovy2000@yahoo.com