The GEC ESTRO gyn working group started in 2000. The task was to actively support and shape the upcoming field of image guided gynaecologic brachytherapy based on first experience from European centers actively developing this field. The aim was to find a common language for prescribing, recording and reporting image (MRI) guided cervix cancer brachytherapy (in parallel with the ICRU Report Committee on the Revision of ICRU 38 which started in 1999). The working structure was based on regular meetings and discussions in a limited group of about 10 persons. The concepts were developed and validated in the frame of clinical examples from centers with different historical traditions (Paris, Leuven, Vienna). The group then succeeded in developing the first two recommendations on MRI guided brachytherapy in cervix cancer. They were first (I) on GTV and CTV contouring elaborating the adaptive target concept (2005) and secondly (II) on dose and volume reporting including biological modelling based on the linear quadratic model.

  

In 2005 the gyn Working Group founded a network in order to embrace an increasing number of institutions with research and development activities within image guide gynecological brachytherapy. The GEC ESTRO gyn network met for the first time in Budapest (May 2005). A structure was established with work packages addressing the most relevant issues and challenges in image guided gyn brachytherapy: Contouring, Applicator Reconstruction, Treatment Planning, Applicator Development. The working methods were joint research and development as well as education and dissemination. 

Based on this, the network developed the recommendations III and IV on applicator reconstruction (published 2010) and MR imaging (published 2012). A joint effort followed with specific focus on uncertainties related to image guided gyn brachytherapy. Multi- and mono-centric investigations were stimulated and discussed. This resulted in a special issue of Radiotherapy and Oncology in 2013 (vol 107) with a collection of papers on this topic (see references). In September 2016 Radiotherapy and Oncology published a special issue on gynecological radiotherapy, with particular focus on cervix IGABT and outcome (see references).

Task groups

Within the gyn network there are continuously a number of different active task groups / work packages. Among current task group activities are:

Task group on CT contouring in cervix cancer (coordinator Umesh Mahantshetty)

Task group  on treatment planning recommendations (coordinator Kari Tanderup)

Task group on vaginal brachytherapy (coordinator Remi Nout)

Task group on image registration (coordinators Jamema Swamidas, Christian Kirisits, Kari Tanderup)

EMBRACE Studies

The GEC ESTRO gyn network has designed and initiated the EMBRACE studies which evaluate clinical outcome of image guided radiotherapy in cervix cancer. The EMBRACE I study was initiated in 2008 with the aim of evaluating and benchmarking image guided brachytherapy in a prospective multicentre study (see link). In parallel to initiating the EMBRACE I study, a retrospective data collection was carried out for the retroEMBRACE study (see link). The EMBRACE I study finalised successfully accrual in 2015, and in 2016 the EMBRACE II study was initiated (see link). The EMBRACE II study defines a number of interventions which address local, nodal and systemic treatment as well as exposure of organs at risk.

ICRU

The ICRU/GEC-ESTRO report 89 became available in 2016. It is summarizing the state of the art in defining target volumes, organs at risk, dose and volume parameters for prescribing, recording and reporting cervix cancer brachytherapy. It contains a comprehensive update of the developments since ICRU report 38, especially with the integration of 3D volumetric imaging for brachytherapy treatment planning. The GEC ESTRO recommendations I to IV have been the basis for this report and are integrated. ICRU 89 provides comprehensive concepts with detailed terms for prescribing, recording and reporting image guided brachytherapy and covers the whole field of 3D and 2D brachytherapy. The international report committee and international consultants have agree upon this report 89 which will form the basis for further developments in this field all over the world. The report contains nine detailed clinical examples to illustrate modern gynaecological brachytherapy and state of the art recording and reporting, including also 2D (www.ICRU.org; http://jicru.oxfordjournals.org/).

Working group and network chairs:

2000-2005 (Working group): Christine Haie-Meder

2005-2007: Richard Pötter and Christian Kirisits

2007-ongoing: Kari Tanderup and Richard Pötter

GEC ESTRO gyn network core institutions:

 

Participation and contact:

The GEC ESTRO gyn network is an open network, and we welcome all colleagues who have specific interest in gyneacological brachytherapy. Please email Kari Tanderup if you are interested in joining the network.

Past meetings and workshops

Resources:

Selection of publications from the Gyn GEC ESTRO network and   EMBRACE