0 mm. A total of 139 of 385 patients (37.4%) with large tumors or positive lymph nodes were treated in addition with EBRT with a median dose of 55 Gy. The median for the time interval between EBRT and brachytherapy was 9 days. All patients were treated with PDR-iBT with 192Ir. All implants were done under general anesthesia using plastic tubes and respecting the rules of International Commission on Radiation Units and Measurements 58 (19) as described by us in detail earlier [20] and [21]. A dose per pulse (dp) with a median value of 0.55 Gy (range, 0.4–0.7 Gy) was

used, delivered for 24 h per day with a time interval of 1 h between pulses. The median volume of the 85% isodose (reference isodose) was 23.4 cm³. The median values for the dose homogeneity index and the dose nonuniformity ratio were 0.76 and 0.27,

respectively. For 113 of the 385 (29%) patients treated PLX-4720 order since 2007, a delineation of the clinical target volume (CTV) and the organs at risk using CT-based treatment planning has also been performed. The CTV encompassed the macroscopic tumor/tumor bed (gross tumor volume) and a 5–10-mm safety margin in all directions respective of natural, anatomic borders such as bone, the lingual edge, and the skin. In postoperative cases, the tumor bed contour (gross tumor volume) included all clinically visible and palpable surgical scars. For CT-based planning, the dose distribution was normalized on reference points in the central plane according to International Commission on Radiation

Units and Measurements 58. Thereafter, a geometric optimization was done to achieve the best possible Fulvestrant research buy dose homogeneity. In a last step, the dwell times were adjusted manually or using graphical optimization aiming to achieve a satisfactory coverage of the CTV. Here also, the coverage index V100 (median, 93.3%) and D90 (median, 103.8%) were documented. A total of 246 of the 385 patients (63.9%) received iBT procedures alone using a median total dose of 57 Gy. In combination with EBRT, PDR-iBT was performed with a median total dose of 24 Gy. The median time interval between external irradiation and brachytherapy was 9 days. The EBRT was performed up to a median reference dose of 55 Gy. Patients with T4 tumors or positive lymph nodes with extracapsular tumor extension (47/385, 12.6%) additionally received simultaneous chemotherapy in the first and fifth weeks of EBRT using Cis-/Carboplatin GBA3 and 5-fluorouracil. The statistical analysis was performed with the SPSS 18.0 software (IBM Corp., New York). The actuarial curves were calculated according to the Kaplan–Meier method (22). The comparisons were made using the log-rank test or Cox regression analysis or the Kruskal–Wallis test as appropriate. All patients were followed closely to analyze local control, survival, as well as acute and late toxicity. The analysis was performed after a median followup of 63 months. The followup was calculated from the first day of radiation therapy to the date of last followup.