S2976
Invited Speaker
ESTRO 2026
5242 Under pressure: Clinical needs and research focus in brachytherapy Christian Kirisits Radiation Oncology, Medical University, Vienna, Austria During the past 25 years brachytherapy treatment concepts, application techniques, imaging and treatment planning were tremendously developed. Patient specific treatment increased the clinical potential of the technique, but also workload and need of infrastructure. While some technological advancements have become commercially available, others, especially concerning workflow optimization are still pending. There is a lack of training facilities. In parallel, research identifies an even increasing amount of more sophisticated technologies and methods. 5243 Breur Award - From bending isodose lines to optimal patient treatments: Insights gained on my journey in radiation oncology Thomas R. Bortfeld Radiation Oncology, Massachusetts General Hospital, Boston, USA How can we effectively bend isodose lines around critical structures to deliver highly conformal dose distributions? This question sparked the development of modern IMRT and VMAT, uniting clinicians, physicists, radiation therapists, computer scientists, and mathematicians. The result was better outcomes and the establishment of IMRT as a disruptive innovation with economic impact. This process exemplifies how answering a significant question - rather than merely deploying technology - can drive transformative progress. This lecture reflects on the author’s personal insights gained from the development of IMRT and extends them toward a broader vision of moving from optimizing spatial dose distributions to optimizing entire multimodal patient treatments. Today, our field faces new challenges that demand a shift in perspective. Rising global cancer incidence and increasing therapeutic complexity require more efficient, personalized treatment strategies. Automation and artificial intelligence offer powerful tools to streamline workflows, reduce variability, and improve reproducibility, particularly in areas such as target definition. However, they must remain guided by clearly defined clinical objectives. The guiding principle remains unchanged: Algorithms should identify optimal solution spaces, and clinicians should determine the most appropriate choices within them.
5241 From imaging to biology: Unlocking crossroads of disciplines in radiotherapy Heidi Lyng Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway Medical imaging is a cornerstone in radiotherapy planning, guiding clinicians in defining targets and understanding disease extent through CT, MRI, and PET. Yet a major step forward in precision radiation oncology lies not only in visualizing where a tumor is, but understanding what it is : its aggressiveness, growth dynamics, oxygenation status, vascularization, and metabolic activity. These biological attributes influence therapeutic response and resistance and can ultimately inform more tailored use of radiotherapy and combination treatments. In recent years, the field has embraced the idea that standard medical images may encode far more information than previously assumed, serving as a bridge between imaging and tumor biology. Realizing this potential depends on deeply interdisciplinary collaborations. Radiation oncologists, biologists, physicists, radiologists, pathologists, computer scientists, and bioinformaticians must work side by side, developing shared tools, datasets, and a common scientific language. Building on a strong collaborative radiotherapy research environment in Norway and internationally, my team has used existing clinical workflows for imaging and tumor biopsy sampling to extract biology- informed imaging features and integrate them into radiotherapy decision-making. Our most fruitful advances have emerged from investigating tumor hypoxia, a major driver of treatment resistance. We have shown that imaging-based markers can reliably identify hypoxic tumors, guide selection of patients for intensified or adapted treatments, and provide a noninvasive tool for monitoring hypoxia dynamics during combination therapy trials. By linking imaging patterns with molecular data, we are beginning to uncover the biology underlying these imaging signatures. This knowledge is already helping us to identify rational drug partners for radiotherapy in ongoing clinical collaborations. In this talk I will present these efforts, highlighting how the integration of imaging and tumor biology can support precision radiotherapy. Interdisciplinary collaboration is key to unlocking this future, for which the environment of ESTRO provides a great opportunity.
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