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@ARTICLE{Duma:305582,
      author       = {M. N. Duma and K. Borm$^*$ and T. Hehr and M. D. Piroth and
                      F. Gerd and R. Baumann and S. E. Combs$^*$ and S. Corradini
                      and J. Dunst and D. Krug and J. Hörner-Rieber and C.
                      Matuschek and L. C. Schmeel and R. Fietkau and V. Strnad and
                      W. Budach},
      title        = {{R}egional nodal irradiation in breast cancer patients: {A}
                      treatment planning study of the breast cancer working group
                      of the {G}erman society of radiation oncology.},
      journal      = {Medical dosimetry},
      volume       = {nn},
      issn         = {0958-3947},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {DKFZ-2025-02241},
      pages        = {nn},
      year         = {2025},
      note         = {epub},
      abstract     = {The aim of the study was to analyze the interinstitutional
                      differences in the planning process/approach of regional
                      nodal irradiation (RNI) in breast cancer patients in expert
                      centres. Based on a predefined risk constellation, the left
                      breast and the axillary, periclavicular and internal
                      mammarian lymph node areas had to be irradiated. The study
                      focused on left-sided RNI. One CT dataset (free breathing)
                      each of a regular (R) adipose (A) and a slender patient (S)
                      were centrally selected and all target volumes (CTV: level
                      II, III, IV + internal mammary artery chain region-IMC, left
                      breast, PTV and OARs) were contoured according to the ESTRO
                      recommendations. A total dose of 50.4/1.8 Gy was set as the
                      dosage with free choice of technique/inclinic constraints.
                      Dose files were analyzed centrally as DICOM files (CTV:
                      $D95\%,$ $D50\%,$ $D1\%$ and $V95\%;$ OAR: $D1\%,$ Dmean,
                      V20Gy, V30Gy, V40Gy and the absolute $V95\%$ of normal
                      tissue outside the PTV). A total of 18 data sets were
                      analyzed. Differences of almost 10 Gy in TV coverage were
                      significant (p < 0.05). This was evident between patients
                      e.g., for $CTV_IMC$ $D95\%/D50\%$ S:47.1Gy ± 1.9/50.1Gy ±
                      0.6; R:39.4Gy ± 8.4/47.6Gy ± 4; A:38.3Gy ± 10.4/47.9Gy ±
                      4.4) and $PTV_IMA$ $D95\%/D50\%$ (S:37.6Gy ± 3.9/49.7Gy ±
                      0.8; R:27.9Gy ± 7.8/46.9Gy ± 3.3; A:25.6Gy ± 9.7/47.5Gy
                      ± 2.8). Patient-related dose differences were also
                      significant for OAR`s: Dmean heart (S:4.6Gy ± 1.1; N:6.1Gy
                      ± 1.2; A:7.9Gy ± 2.1), humeral head (S:8.3Gy ± 2.7;
                      N:3.8Gy ± 0.7; A:6.4Gy ± 1.7), and thyroid (S:17.7Gy ±
                      2.7; N:14.3Gy ± 1.6; A:27.9Gy ± 4.5). Patient anatomical
                      factors and institutional planning differences create
                      significant dosimetric variations in breast cancer radiation
                      therapy, emphasizing the need for personalized planning
                      approaches that incorporate patient-specific constraints and
                      age-dependent risk considerations.},
      keywords     = {Breast cancer (Other) / Lymphatics (Other) / RNI (Other)},
      cin          = {MU01},
      ddc          = {610},
      cid          = {I:(DE-He78)MU01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41168045},
      doi          = {10.1016/j.meddos.2025.09.006},
      url          = {https://inrepo02.dkfz.de/record/305582},
}