7th AROI - ESTRO Teaching Course on

Gynaecological Cancer
3D Radiotherapy with a Special Emphasis on Implementation
of MRI/CT Based Brachytherapy in Cervical Cancer
14th to 17th March 2024
Varanasi, India
Organized by
Department of Radiation Oncology,
Mahamana Pandit Madan Mohan Malaviya Cancer Center
&
Homi Bhabha Cancer Hospital,
Varanasi
Venue:
Inter University Centre for Teacher Education (IUCTE)
Mini Auditorium, Nariya Sunderpur Road, Varanasi, UP, India
Visit https://aroiestrogyn2024.com/
For Information Regarding Registration, Scientific Program,
Travel, Accommodation and Contact Details
7th AROI - ESTRO Teaching Course on Gynaecological Cancer

Dr. Satyajit Pradhan Dr. Ashutosh Mukherji

Organizing Chairperson Organizing Secretary

Dr. Manoj Gupta Dr. Rajesh Vasishta Dr. V Srinivasan Dr. S N Senapati
President Chair Secretary General President Elect
AROI AROI AROI AROI

Dr. Kari Tanderup Dr. Remi Nout Dr. Supriya Chopra

Course Director Course Director Course Director
ESTRO ESTRO AROI
7th AROI - ESTRO Teaching Course on Gynaecological Cancer

Dear Friends,

It gives me immense pleasure that our institute is hosting the 7th ESTRO
AROI GYN Teaching Course here at Varanasi. The ESTRO-AROI GYN teaching
course was started with an aim to enhance current standards of Gynec-
oncology, develop uniform protocols and develop a breed of Young Radiation
Oncologists adept in the art of Radiotherapy for Gynecological sites, in
India. The earlier six courses have been conducted by Ramaiah Advanced
Learning Centre, Bengaluru in 2017, Dr Ram Manohar Lohia Institute of
Medical Sciences, Lucknow in 2018, AIIMS, Rishikesh in 2019, Tata Memorial
Hospital, Mumbai in 2020, Burdwan Medical College, Kolkata in 2022 and
Indo-American Cancer Hospital and Research Institute, Hyderabad in 2023.
We have made significant advancements with each course. This is reflected
by the fact that the first course had the theme “Transition from
conventional 2D to 3D brachytherapy in cervical cancers” and the theme for
the current course is “3D Radiotherapy with A Special Emphasis On
Implementation of MRI / CT Based Brachytherapy in Cervical Cancer”. The
7th ESTRO-AROI GYN Teaching Course 2024 at Varanasi, India is aimed to
further refine the concepts of image guided brachytherapy with special
emphasis on reporting parameters and to develop protocols for future
research. Hope to see you soon at this academic feast at Varanasi!

Dr. Satyajit Pradhan

Organizing Chairman
Professor, Radiation Oncology & Director,
MPMMCC and HBCH (Units of Tata Memorial Centre), Varanasi
 7th AROI - ESTRO Teaching Course on Gynaecological Cancer
Course Faculty
AROI Course Director:
Dr. Supriya Chopra, Radiation Oncologist
Advanced Centre for Treatment Research and Education in Cancer,
Tata Memorial Centre, Navi Mumbai, India (IN)

ESTRO Course Directors & Faculty:

Dr. Kari Tanderup, Medical Physicist, University Hospital, Aarhus (DK)
Dr. Remi Nout, Radiation Oncologist, Erasmus University Medical Centre,
Rotterdam (NL)

AROI Faculty:
Dr. Manoj Gupta, Radiation Oncologist, AIIMS, Rishikesh (IN)
Dr. Umesh Mahantshetty, Radiation Oncologist, HBCH, Vishakhapatnam (IN)
Dr. Supriya Chopra, Radiation Oncologist, ACTREC, Tata Memorial Centre, Navi
Mumbai (IN)
Dr. Bhavana Rai, Radiation Oncologist, PGIMER, Chandigarh, (IN)
Mr. Yogesh Ghadi, Medical Physicist, Tata Memorial Hospital, Mumbai (IN)
Dr. Abhishek Basu, Radiation Oncologist, Burdwan Medical College, Purba
Bardhaman, (IN)
Dr. Ajeet Gandhi, Radiation Oncologist, Dr Ram Manohar Lohia Institute of
Medical Sciences, Lucknow, (IN)
Dr. Arun Oinam, Medical Physicist, PGIMER, Chandigarh, (IN)

Local Organizing Faculty:

Dr. Satyajit Pradhan, Radiation Oncologist, MPMMMC & HBCH, Varanasi (IN)
Dr. Ashutosh Mukherji, Radiation Oncologist, MPMMMC & HBCH, Varanasi (IN)
Dr. Abhishek Shinghal, Radiation Oncologist, MPMMMC & HBCH, Varanasi (IN)

ESTRO Coordinator:
Mr. Miika Palmu, ESTRO, Brussels (BE) (Online)
7th AROI - ESTRO Teaching Course on Gynaecological Cancer
Scientific Program- Day 1
Day 1- Thursday EBRT Details: CTV, PTV, OAR & Treatment Planning EBRT
14th March Contouring & Planning Workshops for EBRT

Session 1 Anatomy and Imaging of Cervix Cancer/ Evidence and Preparation for EBRT

08.30 – 08:50 Welcome address & Inauguration

(30 min) Presentation on Pre-workshop Questionnaire Results
08:50 - 09.15 Anatomy, Gynaecological examination, Staging (TNM, FIGO) Of Ca Cervix & Clinical
(20+5 min) Drawings at Baseline (Clinical Examination)
09.15- 09.40
Imaging at Diagnosis: MRI, CT, and Ultrasound Including TRUS-Radiology Perspective
(20+5 min)
09:50-10:30 MRI Acquisition for EBRT and BT planning: Clinical Perspective
(15+15+5 min) Physicist Perspective
10.30 -10:50 Tea/Coffee Break

Session 2 EBRT: GTV-D, HRCTV, CTE-E, ITV, Adaptive Planning

10:50-11:10
Evidence and Rationale for IG-IMRT in Cervical Cancer
(15+5 mins)
11:10-11:25 Patient Preparation for IG-IMRT Including Immobilization, Organ Filling and
(15+5 min) Reproducibility.
11.25 – 11:50 GTV, HRCTV, LRCTV and Risk-stratified CTV-E in EBRT Including EMBRACE II and Ongoing
(20+5 min) Trials.
11:50 - 12.15
Strategies to Manage Target Motion: ITV, Adaptive Replanning.,
(20+5 min)
12.15 – 12:40 Para-aortic Nodal Radiation – Indications, Contouring, Prescription & EBRT Planning
(20 +5 min) Techniques
12:40-13:40 Group Photograph/Lunch

EBRT for Cervix Cancer: Physics, Treatment Planning and Radiobiology of

Session 3
Brachytherapy Fractionation
13:40 – 14:05
IG-IMRT– Physics Aspects and Plan Quality Criteria
(20+5 min)
14.05 - 14.30
EMBRACE II Planning Aims for EBRT Including Future EMBRACE Studies
(20+5 min)
14.35 - 15.00 EBRT Nodal Boost: Coverage Probability Planning, Dose Prescription and Alternate
(20+5 min) Techniques.
15.00 - 15.40 Radiobiology Relevant to Cervical Cancer Brachytherapy with Special Emphasis on cervix
(35+5 min) Cancer
15.40 – 16.00 Coffee break
Physician’s EBRT Workshop: (ACT TATA 01 EBRT CT) CTVs, Nodal Target Volume
16.00 -17.30
[Introduction (15 mins), Contouring (30 mins), Discussion Including Evaluation of
(90 min)
Homework EBRT Case (45 mins)]

Physicists EBRT Planning Workshop (ACT TATA 01 EBRT CT): [Introduction (15 mins),
16.10 - 17.30
Discussion Including Evaluation of Homework EBRT Case And Concept of Nodal Coverage
(90 min)
Probability (90 mins)]
Parallel Track for Experienced group Parallel Track for Physic

Parallel Track for Experienced group Parallel forParallel

TrackTrack
Parallel for Track
Experiencedforgroup
Physicians
Physicists/RTTs/Dosimetrists Parallel Track for Physicians
7th AROI - ESTRO Teaching Course on Gynaecological Cancer
Scientific Program- Day 2
Principles & Selection of BT Techniques, Clinical Drawings, Patient
Day 2 - Friday
Preparation, Procedure videos, Techniques, Target Concepts,Commissioning
15th March for BT, Contouring and Commissioning Workshops for BT

Session 1 BT Techniques, Sources and Applicators

08:30-08:55 Evolution of Standard Intracavitary Brachytherapy: Clinical Perspective: Strength and

(20+5) Limitations.
08:55-09:20
(20+5) Principles of Standard Intracavitary Planning: ICRU Basics and Point A

09:20-09:45
(20+5) Sources for Cervical Cancer Brachytherapy (Ir Vs Co Sources)

09:45-10:15
(25+5) Newer Gynecological Applicators for IC-IS Brachytherapy

10:15-10:45 Tea/Coffee Break

Disease evaluation and mapping at BT, Patient Preparation/IC-IS procedure videos/

Session 2
Comissioning / BT Techniques
10:45-11:05
(15+5) Disease Evaluation at Brachytherapy and Clinical Diagrams for Cervical Cancer.

11:05-11:30
(20+5) Patient Preparation, Applicator and Technique Selection and Including Anaesthesia.

11:30-12:30 Video Presentation (IC+IS) Ring Based IC-IS; Ovoid Based IC-IS.

10:45-11:15 Introduction to Physical Aspects of Brachytherapy Applicators

11:15-11:45 Commissioning and QA of HDR Brachytherapy Unit Including TPS

Commissioning & QA of BT Applicators Including Standard and Advanced Brachytherapy
11:45-12:30
Applicators
12:30-13:00 Cervix Cancer BT techniques: IC, IC+IS, IS Applicators & Indications

13:00-14:00 Lunch

Session 3 Target and OAR delineation and Applicator Commissioning Workshop

14:00 – 14.45 ICRU-GEC-ESTRO Recommendation: GTV, CTVs at Diagnosis and at Time of Brachytherapy
(35+10) (GTV-BT, HRCTV-BT, IRCTV) for Cervix Cancer
14.45-15:10
(20+5 min) ICRU OAR Points & 3D Delineation of Organs at Risk: Rationale and Practical tips

15:10-15:40 Coffee Break

Feedback on ACT-Tata-03-MR (25 mins)

15:40-17:00
All Physicians: BT Contouring Workshop (75mins) ACT-Tata-04 MR diag-MR at BT

Commissioning / Autoradiography Video

15:40-17:00 IC Applicator Reconstruction (Ovoid/Ring) and Placement of ICRU Reference Points.
Planning Workshop on CTTrack
Parallel (ACT-Tata 02 BT CT)
for Experienced (ICRU Level 1 Reporting)..
group Parallel Track for Physician

Parallel Track for Experienced group Parallel Track

Parallel forParallel
Track for Track
Experiencedforgroup
Physicians
Physicists/ RTTs/ Dosim etrists Parallel Track for Physicians
7th AROI - ESTRO Teaching Course on Gynaecological Cancer
Scientific Program- Day 3
Target Concept on CT, Principles of BT planning of IC , IC+IS & IS
Day 3 - Saturday
Applicator reconstruction, Radiobiology, Workshops: Contouring
16th March
(MDs), Applicator reconstruction

Session 1 CT Based IC-IS Brachytherapy and Treatment Planning Recommendations

08:30 - 08:55
Considerations for CT imaging for Brachytherapy Planning
(20+5 min)

08.55 - 09.45 CT Contouring for Brachytherapy (including Ultrasound)

(40+10 min) (MR Diagnosis-CT BT) (CT Diagnosis-CT BT)

09.45 - 10.40 ICRU-GEC-ESTRO Treatment Planning Recommendations on Dose Points &

(40+10 min) Volume Reporting (MRI/CT)

10.40 – 11.00 Coffee Break

Applicator Reconstruction and Principles of IC/IC-IS /IS planning

Session 2

11.00 - 11.40
IC-IS Applicator Reconstruction on MRI and CT Including Applicator Fusion
(30+10 min)

11.40 - 12.20 Principles of Treatment Planning IC +/- IS Techniques in Cervix Cancer

(30+10 mins) including EMBRACE II

12:20 – 12:45 Physics Aspects of Treatment Planning of Pure Interstitial Techniques in Cervix
(20+5 min) Cancer

13:00-14:00 Lunch
Brachytherapy Fractionation and Dose Summation in EQD2; CT Based BT workshop and IC-IS
Session 3 reconstruction and Treatment Planning

14:00-14:25
HDR Fractionations for Cervix Cancer and Clinical Outcomes
(20+5 min)
14:25-14:50 Use of EBRT+BT EQD2 Sheets in Treatment Plan Optimization: Clinical Tips
(20+5) with Examples

14:50-15:15 Coffee break

Physicists Workshop:
IC-IS Reconstruction & IC-IS Treatment Planning
ACT-04 MR , ACT-xx-CT , ACT-xx- (IC-IS+ vaginal cap)
15.15 – 17:30 1.(Different vendor environments)
(135 minutes)

Physicians Workshops:
1. ACT-xx-MRdiag- CT BT (60 mins)
2. HBCH 03: -CTDG - CTBT + TRUSBT Environments (60 mins)

15:15-17:15 Experienced Track presentations

19:00 onwards Course

Parallel Track for Experienced group Dinner Parallel Track for Physicia

Parallel Track for Experienced group Parallel forParallel

TrackTrack
Parallel for Track
Experiencedforgroup
Physicians
Physicists/RTTs/Dosimetrists Parallel Track for Physicians
7th AROI - ESTRO Teaching Course on Gynaecological Cancer
Scientific Program- Day 4
Day 4 – Sunday
Feedback, Vulvovaginal Cancers,
17th March

Session 1 Homework Feedback and Vulvovaginal Cancers.

08.30-09:10 Feedback and Discussion on EBRT+ BT Treatment Planning Homework and During
(35+5) the course

09:10-09:50
Target Delineation for Primary and Recurrent Vaginal Cancers and Outcomes
(35+5 min)

09:50-10:25
Brachytherapy Techniques in Vulva Cancer
(30+5 min)

10:25-10:45 Coffee break

Session 2 EMBRACE studies, Reirradiation, Feedback/Discussion

10:45 – 11:10
EMBRACE Studies and Future Studies Initiatives
(20+5 min)

11:10 – 11:45
Reirradiation for Gynecological Cancers and Ongoing Initiatives
(30+5 min)

11:45-12:15 pm AROI Gyn Research Network

(15+15 min) Making the Transition: Practical Tips and Tricks
12:15-12:45 Participant Feedback
(30 mins) Final Remarks and Valedictory function

12:45 onwards Lunch

7th AROI - ESTRO Teaching Course on Gynaecological Cancer
Course Overview
TARGET GROUP:
The course is aimed at teams consisting of radiation oncologists and medical
physicists from institutions with concrete plans to implement 3D radiotherapy
for cervical cancer, with a special interest in MR/ CT Image Based
Brachytherapy. The Institutions which participated in previous editions of
Gynaecology AROI ESTRO teaching course are encouraged to register and will
be selected on priority for the course. Also, Institutions who have the necessary
infrastructure for 3D brachytherapy (afterloader, access to 3D (US/ CT/ MR)
imaging, CT/MR compatible applicators and a relevant treatment planning
system) to facilitate the initiation of implementation of 3D techniques after the
course can apply. The course is conducted on regular basis every year and this
will be 7th Edition which will focus on feedback, hurdles, progress and further
development of a network to systematically work on research and
implementation issues specific to India and other developing countries. The
workshop involving both the advanced track and freshers should be prepared
to invest time in implementation of 3D techniques in between courses and to
take part in homework / feedback efforts. A finite number of teams from
various set-ups and geographical locations in India will be invited by AROI.
Participants from neighboring countries and other Asia Pacific (APAC) Region
(max 5-10) may also apply to participate.

AIM OF COURSE:
• Learn about principles of 3D image-based EBRT and brachytherapy including
techniques and treatment planning.
• Provide understanding of commissioning, quality assurance, principles of
planning, plan evaluation and reporting of 2D and 3D brachytherapy in
cervical cancer.
• Introduce 3D image-based target concepts of GTV, CTV and PTV including both
EBRT and brachytherapy in cervical cancer.
• Enable practical implementation of 3D techniques in EBRT and brachytherapy
in cervical cancer.
• Provide an overview on the radiation therapy (external radiation and
brachytherapy) in cervical cancer.
• Enhance the practical implementation and logistics in the existing
environment.
• Further roadmap and steps of intervention to improve the existing standards.
• Provide a platform to implement and develop an Indian network for future
research and development in cervical cancer radiotherapy.
 7th AROI - ESTRO Teaching Course on Gynaecological Cancer
Course Overview
LEARNING OUTCOMES:
By the end of this course participants should be able to:
• Understand the rationale of 3D and apply concepts of advanced
brachytherapy techniques in clinical practice.
• Understand and apply ICRU 89 concepts: GTV, CTV, PTV at diagnosis and at
time of brachytherapy for 2D and 3D brachytherapy.
• Perform contouring and treatment planning for 3D image guided EBRT and
brachytherapy in clinical practice.
• Implement procedures for 3D image guided brachytherapy in cervical cancer
in own department.
• Implement advanced EBRT techniques in cervical cancer in own department.

COURSE CONTENT:
• Normal and pathologic anatomy of female pelvis.
• Image based anatomy including US, CT, MRI and conventional radiography at
diagnosis and at BT.
• CTV/ITV/PTV for external irradiation.
• IMRT/VMAT, IGRT and treatment planning for external irradiation.
• Combination of external irradiation and brachytherapy.
• Dose, dose-rate and fractionation and overall treatment time.
• Radiobiological effects from combined external irradiation and
brachytherapy, linear quadratic model.
• Prescribing, recording and reporting including ICRU- GEC-ESTRO 89
recommendations.
• Therapeutic outcome: radio-chemotherapy, image based EBRT and
brachytherapy.
• Introduction to EMBRACE studies.
• Commissioning and Quality Assurance of various processes involved 3D
brachytherapy treatment planning.
• Feedback and review of hurdles in implementation.
• Workshops with hands-on contouring and treatment planning.
 AROI - ESTRO Teaching Course on Gynaecological Cancer

Course Overview
PREREQUISITES
Before commencing this course participants should have:
• Basic knowledge of principles and experience with multi-modality
management of cervical cancer
• Basic knowledge of and experience with radiological patho-anatomy relevant
to cervical cancer
• Experience with existing external beam and brachytherapy workflows and
processes in cervical cancer.
• Basic infrastructure in your department which facilitates post-course
implementation of 3D image guided brachytherapy (afterloader, access to
volumetric imaging, MRI/CT compatible applicators, and treatment planning
system).

TEACHING METHODS
• Lectures / tutorials: 16 hours
• Practical workshop: 8 hours
• Applicators commissioning and reconstruction: 6 hours – Physicists
• Video presentations: 2 hours - Clinicians

Description: The tutorials include discussions of basics, evidence-based

treatments, contouring guidelines, various processes involved in advanced
EBRT and brachytherapy techniques and quality assurance. The practical
hands on demonstration covers a direct learning process involved in
approach, brachytherapy techniques, contouring exercises, evaluation and
discussions on 3D radiotherapy.

METHODS OF ASSESSMENT
Contouring (FALCON tool) and dose planning exercises (pre- and post-course
homework)
• Interactive feedback through audience voting on specific questions during
lectures.
• MCQ (interactive session at the end of the course).
• ESTRO teaching course evaluation form.
• Exclusive feedback sessions for “Experienced track” participants.
7th AROI - ESTRO Teaching Course on Gynaecological Cancer

Course Fee
Physician or Team (Physician &
Category
Physicist Physicist)

Indian Delegates*
INR 12000 INR 18000
(AROI Member)

Indian Delegates
INR 13000 INR 19000
(Others)

Foreign Delegates** USD 450 USD 800

*Late fee after 15th Feb 2023: Increase in fee by INR 500 per person
(for Indian Delegates Only).
**Sponsored participants from IAEA should register through ESTRO and
ESTRO rates will apply.
Last date for Registration is 25th February, 2024.

Registration
Website
aroiestrogyn2024.com

Mailing Address
[email protected]
7th AROI - ESTRO Teaching Course on Gynaecological Cancer

Organizing Committee

Organizing Chairman: Dr Satyajit Pradhan

Organizing Secretary: Dr Ashutosh Mukherji

Treasurers: Dr Sambit S. Nanda

Dr Abhishek Shinghal

Scientific Registration Accommodation &

Travel
Dr Satyajit Pradhan Dr Lincoln Pujari Dr Ajay K. Choubey
Dr Umesh Mahantshetty Dr Ajay S Krishnan Dr Sambit S. Nanda
Dr Supriya Chopra Dr Zarmina Alam Mr. Sanjay Barman
Dr Ashutosh Mukherji Mr. Abhishek Singh
Dr Lincoln Pujari
Dr Prashanth G Website Design Kits & Memento
Dr Abhishek Shinghal
Dr Ankita R. Kapoor Dr Abhishek Shinghal Dr Ajay Krishnan
Mr. Vinay Saini Dr Ninad H Patil Dr Zarmina Alam

Stage & Audiovisual Food & Hospitality

Dr Prashanth G Dr. Lincoln Pujari

Dr Ninad H. Patil Local Contact Dr. Abhishek Shinghal
Dr Ankita R. Kapoor
Mr. Narender Kumar Dr Ashutosh Mukherji
Mr. Vinay Saini Mob: +919489146747
Mr. Epili Dandapani
Dr Abhishek Shinghal
Mob: +919559551013
7th AROI - ESTRO Teaching Course on Gynaecological Cancer
Places to visit and things to do in & around Varanasi

Kashi Vishwanath Corridor

The Ghats of Ganges

Sarnath

Bodh Gaya

Kushinagar

Banarasi Silk Sarees

Ramnagar Fort

Chaat and Street Foods

7th AROI - ESTRO Teaching Course on Gynaecological Cancer
Travel and Accommodation
Airport: Lal Bahadur Shastri International Airport, Varanasi
Distance from MPMMCC: 28Km

Railway:
1.Varanasi Junction (Cantonment) Railway Station (BSB)
Distance from MPMMCC: 8 Kms
2.Banaras (Manduadih) Railway Station (BSBS)
Distance from MPMMCC: 4 Kms
3.Pt. Deen Dayal Upadhyaya Junction (DDU) [Former Mughalsarai Junction]
Distance from MPMMCC: 19 Kms

Suggested Hotels
Distance from
(Click the Link to Check Availability and
Conference Venue
Rates)
Hotel Uday Palace 1.5km
Hotel Ozas Grand 1.5km
Le Lotus Grand 2.7km

Hotel Four Element 3.6km

Hotel Crescent Villa 3.6km

Madhuvan Palace 2.7km

Taj Ganges 9.9km

Ramada Plaza, The Mall Cantonment 11km

Hotel Surya Kaiser Palace 11km

Hotel Madin, The Mall Cantonment 11km

The Clarks Varanasi 11km

Hotel Diamond 3.4 km

Hotel Broadway 4 km