- Email: [email protected]
SP-0009: Leopold Freund and Guido Holzknecht - fathers of new medical and scientific disciplines
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ESTRO 33, 2014 References [1] O'Connor JP, et al. Lancet Oncol 2008;9:766-76. [2] Morgan B. Nat Rev Clin Oncol 2011; 8: 517-27. [3] Sourbron S. Eur J Radiol 2010; 76:304-13. [4] Jackson A et al. Clin Cancer Res 2007; 13: 3449-59. [5] Zahra MA, et al. Lancet Oncol 2007; 8: 63-74. [6] Loncaster JA,et al. Int J Radiat Oncol Biol Phys 2002; 54: 759-67. [7] Jansen JF, et al. Int J Radiat Oncol Biol Phys 2010;77(5):1403-10. [8] Donaldson SB, et al. Int J Radiation Oncology Biol Phys 2011; 81: 1176-83. [9] Gulliksrud K, et al. Radiother Oncol 2001; 98: 360–364. [10] Egeland TAM, et al. Magn Reson Med 2012; 67: 519–530. [11] Shukla-Dave A, et al. Int J Radiat Oncol Biol Phys 2012; 82:1837-44. [12] Ceelen W, et al. Int J Radiation Oncology Biol Phys 2006; 64: 118896. [13] CaoY, et al. Int J Radiation Oncology Biol Phys 2008; 72: 1287-90. [14] Semple SI, et al. Int J Radiat Oncol Biol Phys 2009;75:611-7. [15] Søvik S, et al. Radiother Oncol 2009;93:618-24. [16] Houweling AC, et al. Radiother Oncol 2011; 100: 386–389. [17] Røe K, et al. Radiat Oncol. 2011; 8:6-65. [18] Chikui T, et al. Eur Radiol 2011; 21: 1699–1708. [19] deLussanet QG, et al. Int J Radiat Oncol Biol Phys 2005;63(5):130915. [20] Kershaw LE, et al. Radiother Oncol 2008; 88: 127-34. [21] Moman MR, et al. Int J Radiat Oncol Biol Phys 2010;76:741-6. [22] Fatterpekar GM, et al. Am J Roentgenol 2012;198:19-26. [23] Bentzen SM. Lancet Oncol 2005; 6: 112-7. [24] Quon H, et al. Semin Radiat Oncol 2012; 22:220-32. [25] Søvik A, et al. Int J Radiat Oncol Biol Phys 2009;73:650-8.
TEACHING LECTURE SP-0008 Clinical validation of autocontouring tools L. Boldrini1 1 Università Cattolica del Sacro Cuore, Radiation Oncology, Rome, Italy Growing attention has recently beenpaid to the application of the new advanced imaging and autocontouring softwarein everyday clinical practice. These software represent a proposalfor individualizing anatomical atlases, propagating reliable contours on the single patient images, theoretically lowering the contouring time burden,allowing a more accurate adherence to the existing guidelines and strongly reducing the inter observer variability which still represents a major source oferror in radiotherapy. Aim of this talk is to present the existing state of art, to support those who intend to report their experiences with autocontouring software and to describe the principal aspects and variables that must be considered and analyzed when setting up a research study directed to efficaciously evaluate these software. Four principal moments will be highlighted: - Ontology definition : choice oft he reference prior knowledge about volumes and subvolumes to be irradiated and presentation of propagation methods - Benchmark assessment : definition of benchmark values to obtain reliable comparisons - Evaluation methods choice : presentation of tools to quantify the amount of similarity between the proposed contours and others recognized as gold standards - Clinical benefit achievement : description of the achievable benefits in everyday clinical practice The other primary goal of this talk is to present and analyze the existing lack of consensus about the various aspects of this topic and propose methods to reduce it.
SYMPOSIUM: VIENNA SCHOOL OF RADIOTHERAPY AND ITS IMPACT ON 100 YEARS OF RADIOTHERAPY SP-0009 Leopold Freund and Guido Holzknecht - fathers of new medical and scientific disciplines J. Widder1 1 University Medical Center Groningen, Department of Radiation Oncology, Groningen, The Netherlands
In November 1895, Wilhelm Conrad Röntgen discovered x-rays, the potential of which for medical diagnostics was immediately realized by himself and the anatomist Albert von Köllicker. His seminal paper “On a new kind of radiation” is dated 28 December 1895, leading to the first Nobel prize for physics in history in 1901. On 5 January 1896, a Viennese daily newspaper published a front-page note suggesting a sensational discovery for physics and medicine, and this note was the source for incredibly fast communication and implementation of the discovery around the world. In summer of 1896, Leopold Freund (1868 – 1943), a just graduated young physician, realized the eventual therapeutic potential of x-rays. A newspaper report on hair loss and dermatitis as unintended side effects while attempting to make x-ray photographs was the triggering occasion to experimentally treat the first patient, a 5 year old girl with an extensive hairy naevus on her back. First, the upper back and neck were “illuminated” for 2 hours daily, until the intended effect – epilation – was observed. Freund repeated illuminations at other parts of the naevus, laid an aluminium plate on the skin to rule out electrical discharge as the effective agent, and illuminated on more days than in the first series. The girl suffered severe toxicity requiring multiple surgeries in the years to come, but was even seen for follow-up 70 years post treatment. Already in 1903, Freund published the first comprehensive book on what was then called radiotherapy, which was translated into English in 1904. He described effects of X-rays on superficial skin affections in the first place, hypertrichosis, infectious conditions including skin tuberculosis, and stressed the social significance of their getting curable with x-rays. Malignant tumours were only mentioned in passing. Freund clearly described the cumulative effect of x-rays on tissues, the increased sensitivity of skin to reirradiation, and remained an advocate of fractionated application of xrays in order to avoid excessive toxicity. He considered the finding that a strong fractionated irradiation may not be continued until the full reaction is visible as the “basic law of radiotherapy” – likely concluded from the very first case. In 1938, Freund emigrated to Belgium. Guido Holzknecht (1872 – 1931) together with Robert Kienböck wrote a memorandum advocating medical radiology as an independent branch of medical science in 1903. This marks the beginning of a life-long struggle for establishing radiology at the university, which failed during his lifetime. Besides developing diagnostic radiology and especially fluoroscopy, Holzknecht addressed the problem of measurability of Röntgen-light and developed a chromometer in 1901, which however could only measure high doses. This was one of the reasons, why he advocated high single dose treatment (he called radiosurgery) for a couple of years, before he developed an approach tailoring the dose to the possibility of cure, especially for cancer: only cervical cancer with high (i.e., about 10 %) cure rates should be treated with high dose. Other tumours should receive lower dose in order to avoid “kakothanasia.” His writings reflect a search for the right dose and a correct understanding of biological effects, for instance by refuting the then popular ArndtSchultz hypothesis, which postulated a stimulating effect of low x-ray doses on tumours. This is an excellent example in the history of medicine showing how a hypothesis explained a phenomenon (“tumours are not cured by x-rays”) by proposing the wrong causes (“low doses stimulate tumour growth”). Holzknecht died having lost his hands from radiation induced cancer. During the very first years of radiotherapy, as can be shown, the most basic elements of this treatment modality were shaped. The struggle to attain intended effects while limiting toxicity started at Freund’s very first radiation treatment in 1896. It is a prime-time topic still at the dawn of particle therapy. SP-0010 Robert Kienbˆck and Gottwald Schwarz - Pioneers of radiobiology and clinical radiotherapy J Overgaard Aarhus University Hospital, Experimental Oncology, Aarhus, Denmark Abstract not received SP-0011 Austron - origin of today's ion beam setting in Europe R. Pötter1 1 Medical University of Vienna, Department of Radiation Oncology and Christian Doppler Laboratory for Medical Research in Radiation Oncology, Vienna, Austria In today’s radiation oncology practice, particle beam therapy with protons and/or light ions is considered as a highly innovative and promising dose delivery method. Several cyclotron based proton centers are in clinical operation in Europe and worldwide. However, for accelerating light ions for medical purposes the (accelerator) physics community preferred a synchrotron based solution. Light ions such as carbon ions offer the advantage of a higher biological effectiveness -
ESTRO 33, 2014 References [1] O'Connor JP, et al. Lancet Oncol 2008;9:766-76. [2] Morgan B. Nat Rev Clin Oncol 2011; 8: 517-27. [3] Sourbron S. Eur J Radiol 2010; 76:304-13. [4] Jackson A et al. Clin Cancer Res 2007; 13: 3449-59. [5] Zahra MA, et al. Lancet Oncol 2007; 8: 63-74. [6] Loncaster JA,et al. Int J Radiat Oncol Biol Phys 2002; 54: 759-67. [7] Jansen JF, et al. Int J Radiat Oncol Biol Phys 2010;77(5):1403-10. [8] Donaldson SB, et al. Int J Radiation Oncology Biol Phys 2011; 81: 1176-83. [9] Gulliksrud K, et al. Radiother Oncol 2001; 98: 360–364. [10] Egeland TAM, et al. Magn Reson Med 2012; 67: 519–530. [11] Shukla-Dave A, et al. Int J Radiat Oncol Biol Phys 2012; 82:1837-44. [12] Ceelen W, et al. Int J Radiation Oncology Biol Phys 2006; 64: 118896. [13] CaoY, et al. Int J Radiation Oncology Biol Phys 2008; 72: 1287-90. [14] Semple SI, et al. Int J Radiat Oncol Biol Phys 2009;75:611-7. [15] Søvik S, et al. Radiother Oncol 2009;93:618-24. [16] Houweling AC, et al. Radiother Oncol 2011; 100: 386–389. [17] Røe K, et al. Radiat Oncol. 2011; 8:6-65. [18] Chikui T, et al. Eur Radiol 2011; 21: 1699–1708. [19] deLussanet QG, et al. Int J Radiat Oncol Biol Phys 2005;63(5):130915. [20] Kershaw LE, et al. Radiother Oncol 2008; 88: 127-34. [21] Moman MR, et al. Int J Radiat Oncol Biol Phys 2010;76:741-6. [22] Fatterpekar GM, et al. Am J Roentgenol 2012;198:19-26. [23] Bentzen SM. Lancet Oncol 2005; 6: 112-7. [24] Quon H, et al. Semin Radiat Oncol 2012; 22:220-32. [25] Søvik A, et al. Int J Radiat Oncol Biol Phys 2009;73:650-8.
TEACHING LECTURE SP-0008 Clinical validation of autocontouring tools L. Boldrini1 1 Università Cattolica del Sacro Cuore, Radiation Oncology, Rome, Italy Growing attention has recently beenpaid to the application of the new advanced imaging and autocontouring softwarein everyday clinical practice. These software represent a proposalfor individualizing anatomical atlases, propagating reliable contours on the single patient images, theoretically lowering the contouring time burden,allowing a more accurate adherence to the existing guidelines and strongly reducing the inter observer variability which still represents a major source oferror in radiotherapy. Aim of this talk is to present the existing state of art, to support those who intend to report their experiences with autocontouring software and to describe the principal aspects and variables that must be considered and analyzed when setting up a research study directed to efficaciously evaluate these software. Four principal moments will be highlighted: - Ontology definition : choice oft he reference prior knowledge about volumes and subvolumes to be irradiated and presentation of propagation methods - Benchmark assessment : definition of benchmark values to obtain reliable comparisons - Evaluation methods choice : presentation of tools to quantify the amount of similarity between the proposed contours and others recognized as gold standards - Clinical benefit achievement : description of the achievable benefits in everyday clinical practice The other primary goal of this talk is to present and analyze the existing lack of consensus about the various aspects of this topic and propose methods to reduce it.
SYMPOSIUM: VIENNA SCHOOL OF RADIOTHERAPY AND ITS IMPACT ON 100 YEARS OF RADIOTHERAPY SP-0009 Leopold Freund and Guido Holzknecht - fathers of new medical and scientific disciplines J. Widder1 1 University Medical Center Groningen, Department of Radiation Oncology, Groningen, The Netherlands
In November 1895, Wilhelm Conrad Röntgen discovered x-rays, the potential of which for medical diagnostics was immediately realized by himself and the anatomist Albert von Köllicker. His seminal paper “On a new kind of radiation” is dated 28 December 1895, leading to the first Nobel prize for physics in history in 1901. On 5 January 1896, a Viennese daily newspaper published a front-page note suggesting a sensational discovery for physics and medicine, and this note was the source for incredibly fast communication and implementation of the discovery around the world. In summer of 1896, Leopold Freund (1868 – 1943), a just graduated young physician, realized the eventual therapeutic potential of x-rays. A newspaper report on hair loss and dermatitis as unintended side effects while attempting to make x-ray photographs was the triggering occasion to experimentally treat the first patient, a 5 year old girl with an extensive hairy naevus on her back. First, the upper back and neck were “illuminated” for 2 hours daily, until the intended effect – epilation – was observed. Freund repeated illuminations at other parts of the naevus, laid an aluminium plate on the skin to rule out electrical discharge as the effective agent, and illuminated on more days than in the first series. The girl suffered severe toxicity requiring multiple surgeries in the years to come, but was even seen for follow-up 70 years post treatment. Already in 1903, Freund published the first comprehensive book on what was then called radiotherapy, which was translated into English in 1904. He described effects of X-rays on superficial skin affections in the first place, hypertrichosis, infectious conditions including skin tuberculosis, and stressed the social significance of their getting curable with x-rays. Malignant tumours were only mentioned in passing. Freund clearly described the cumulative effect of x-rays on tissues, the increased sensitivity of skin to reirradiation, and remained an advocate of fractionated application of xrays in order to avoid excessive toxicity. He considered the finding that a strong fractionated irradiation may not be continued until the full reaction is visible as the “basic law of radiotherapy” – likely concluded from the very first case. In 1938, Freund emigrated to Belgium. Guido Holzknecht (1872 – 1931) together with Robert Kienböck wrote a memorandum advocating medical radiology as an independent branch of medical science in 1903. This marks the beginning of a life-long struggle for establishing radiology at the university, which failed during his lifetime. Besides developing diagnostic radiology and especially fluoroscopy, Holzknecht addressed the problem of measurability of Röntgen-light and developed a chromometer in 1901, which however could only measure high doses. This was one of the reasons, why he advocated high single dose treatment (he called radiosurgery) for a couple of years, before he developed an approach tailoring the dose to the possibility of cure, especially for cancer: only cervical cancer with high (i.e., about 10 %) cure rates should be treated with high dose. Other tumours should receive lower dose in order to avoid “kakothanasia.” His writings reflect a search for the right dose and a correct understanding of biological effects, for instance by refuting the then popular ArndtSchultz hypothesis, which postulated a stimulating effect of low x-ray doses on tumours. This is an excellent example in the history of medicine showing how a hypothesis explained a phenomenon (“tumours are not cured by x-rays”) by proposing the wrong causes (“low doses stimulate tumour growth”). Holzknecht died having lost his hands from radiation induced cancer. During the very first years of radiotherapy, as can be shown, the most basic elements of this treatment modality were shaped. The struggle to attain intended effects while limiting toxicity started at Freund’s very first radiation treatment in 1896. It is a prime-time topic still at the dawn of particle therapy. SP-0010 Robert Kienbˆck and Gottwald Schwarz - Pioneers of radiobiology and clinical radiotherapy J Overgaard Aarhus University Hospital, Experimental Oncology, Aarhus, Denmark Abstract not received SP-0011 Austron - origin of today's ion beam setting in Europe R. Pötter1 1 Medical University of Vienna, Department of Radiation Oncology and Christian Doppler Laboratory for Medical Research in Radiation Oncology, Vienna, Austria In today’s radiation oncology practice, particle beam therapy with protons and/or light ions is considered as a highly innovative and promising dose delivery method. Several cyclotron based proton centers are in clinical operation in Europe and worldwide. However, for accelerating light ions for medical purposes the (accelerator) physics community preferred a synchrotron based solution. Light ions such as carbon ions offer the advantage of a higher biological effectiveness -