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To our knowledge, this is the largest case series of synchronous rectal and prostate cancers treated with curative intent. This article contributes to the understanding of how best to approach definitive treatment in these patients.

Highlights Recently, highly-conformal target volumes for flank delineation were defined. Delineation variation of this target volume was assessed in an international setting. Ten radiation oncologist delineated the GTV and CTV of six individual cases. ‘Unacceptable’ delineation variation was found in a large number of participants. This indicates the need for central target volume review before radiotherapy onset.

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