We demonstrated a relevant dose exposure of the axilla in SRT that should substantially reduce local recurrences. Furthermore, we demonstrated a significant increase in lung and heart exposure when including the axillary lymph nodes regions in the tangential radiotherapy field set-up.

MN and RMH contributed to the conception, design, analysis and interpretation of data and helped with the final approval of the version to be published. MN, RMH and NT helped with the drafting of the article. WB and MB contributed to the statistics of the main study. DW contributed to the acquisition of data. AK contributed to the statistics of pre-study. NT helped with the planning and implementation of radiotherapy.Objective: The objective of this retrospective planning study was to find a contouring definition for the rectum as an organ at risk (OAR) in curative three-dimensional external beam radiotherapy (EBRT) for prostate cancer (PCa) with a predictive correlation between the dosevolume histogram (DVH) and rectal toxicity. Methods: In a pre-study, the planning CT scans of 23 patients with PCa receiving definitive EBRT were analyzed. The rectum was contoured according to 13 different definitions, and the dose distribution was correlated with the respective rectal volumes by generating DVH curves. Three definitions were identified to represent the most distinct differences in the shapes of the DVH curves: one anatomical definition recommended by the Radiation Therapy Oncology Group (RTOG) and two functional definitions based on the target volume. In the main study, the correlation between different relative DVH parameters derived from these three contouring definitions and the occurrence of rectal toxicity during and after EBRT was studied in two consecutive collectives. The first cohort consisted of 97 patients receiving primary curative EBRT and the second cohort consisted of 66 patients treated for biochemical recurrence after prostatectomy. Rectal toxicity was investigated by clinical investigation and scored according to the Common Terminology Criteria for Adverse Events. Candidate parameters were the volume of the rectum, mean dose, maximal dose, volume receiving at least 60 Gy (V 60 ), area under the DVH curve up to 25 Gy and area under the DVH curve up to 75 Gy in dependence of each chosen rectum definition. Multivariable logistic regression considered other clinical factors such as pelvine lymphatics vs local target volume, diabetes, prior rectal surgery, anticoagulation or haemorrhoids too.

Background: In the multimodal breast-conserving curative therapy of some high-risk breast cancer patients, extended external beam radiotherapy (EBRT) not only to the breast but also to the supraclavicular fossa and the internal mammary chain (parasternal region (PSR)) is indicated. We report a dosimetric study on the EBRT of the breast (“B”) and the breast including PSR (“B + PSR”), comparing the supine and the laterally tilted prone patient positions in free breathing. Methods: The planning CT scans of 20 left- and 20 right-sided patients were analyzed. EBRT plans were calculated with 3D conformal EBRT (3D) and with intensity-modulated EBRT (IMRT) for “B” and “B + PSR” in the prone and supine positions. The mean and threshold doses were computed. The quality of EBRT plans was compared with an overall plan assessment factor (OPAF), comprising three subfactors, homogeneity, conformity, and radiogenic exposure of OAR. Results: In the EBRT of “B”, prone positioning significantly reduced the exposure of the OARs “heart” and “ipsilateral lung” and “lymphatic regions”. The OPAF was significantly better in the prone position, regardless of the planning technique or the treated breast side. In the EBRT of “B + PSR”, supine positioning significantly reduced the OAR “heart” exposure but increased the dose to the OARs “ipsilateral lung” and “lymphatic regions”. There were no significant differences for the OPAF, independent of the irradiated breast side. Only the IMRT planning technique increased the chance of a comparatively good EBRT plan. Conclusion: Free breathing prone positioning significantly improves plan quality in the EBRT of the breast but not in the EBRT of the breast + PSR.

Exact reproduction of patient position is crucial in radiotherapy. We evaluated the reproducibility of a CT based treatment simulation with the PICTOR 3D® system (LAP, Lüneburg, Germany) and examined its influence on workflow in daily routine.Ulterior motive to introduce such a simulation system is to save time at the radiation treatment machine (LINAC). Normally, treatment simulations are directly done at the LINAC (so called "virtual simulation"). However, this procedure is time consuming, and opportunity costs are much higher for the LINAC than for the treatment planning CT scanner. This explains the efforts to switch the simulation process from the LINAC to the planning CT.

The present paper employs the anisotropic explicit algebraic subgrid‐stress model (EASM), proposed by Marstorp et al. J. Fluid. Mech. 639, 403 ‐ 432 (2009), developed in the spirit of an earlier explicit algebraic RANS‐model for statistical closures. The EASM in its elementary, computationally efficient non‐dynamic version is used for Large Eddy Simulation of three‐dimensional flows over a backward‐facing step at a bulk Reynolds number of 4805 and a square duct at 2205. Its performance is assessed by comparison with experimental data and an own Direct Numerical Simulation. Furthermore, a set of eddy‐viscosity models, including the recent σ‐model, is employed for comparison. Various statistical quantities are evaluated to assess the respective performance of the different models showing, that the anisotropic EASM compares favorably to the other models. (© 2016 Wiley‐VCH Verlag GmbH & Co. KGaA, Weinheim)