Society for Cardiovascular Magnetic Resonance 2019 Case of the Week series.

The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). The SCMR web site ( https://www.scmr.org ) hosts a case series designed to present case reports demonstrating the unique attributes of CMR in the diagnosis or management of cardiovascular disease. Each clinical presentation is followed by a brief discussion of the disease and unique role of CMR in disease diagnosis or management guidance. By nature, some of these are somewhat esoteric, but all are instructive. In this publication, we provide a digital archive of the 2019 Case of the Week series as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar search engine.

Outcome and prognostic factors of uterine sarcoma in 59 patients: single institutional results.

PURPOSE: Uterine corpus sarcomas are rare heterogeneous tumors characterized by rapid progression and poor response to treatment. This series investigated treatment options, relapse pattern, survival and prognostic factors. PATIENTS AND METHODS: A total of 59 patients were treated in the National Cancer Institute, Cairo University, (2000-2007). Leiomyosarcoma accounted for 42.2% followed by carcinosarcoma (35.5%) and endometrial stromal sarcoma (18.6%). 40.7% had FIGO stage I disease, 30.5% were II, 16.9% were III and 11.9% were IV. Surgery was the primary line of treatment for all cases with total abdominal hysterectomy and bilateral salpingoophorectomy in 88% of cases and 12% had less extensive surgery. Twenty-four (40.7%) patients had surgery alone, 24 (40.7%) had surgery and radiotherapy, 7 (11.9%) had surgery and chemo-irradiation and 4 (6.7%) had surgery and chemotherapy. RESULTS: After 27.4 months mean follow-up (range: 2-69), relapses were detected in 32 patients (59.2%) including 19 (59%) systemic metastases. Stage, adjuvant irradiation, tumor size, myometrial invasion, vascular and cervix invasion were significant factors in univariate analysis; nevertheless, multivariate prognostic factors were only stage (p=0.04) and adjuvant irradiation (p=0.01). 5-year cumulative disease free survival for stage I was 63.6%, 41.2% for stage II, 10% for stage III and 0% in stage IV. Neither extent of surgery, chemotherapy, histologic type or grade had significant effect on survival. Adjuvant radiotherapy offered 62% 2-year cumulative overall survival versus 22% for surgery alone and surgery with chemotherapy. Salvage surgery for isolated relapses was performed for 9/32 recurrent patients (28%) including 5 lung metastatectomies and 4 local pelvic resections. Mean survival after pulmonary resections was 7.4 months (6-14). CONCLUSION: Diagnosis of uterine sarcoma is in itself a poor prognostic factor. Complete cytoreductive surgery and adjuvant radiotherapy is essential for local control, provided tumor is limited to the uterus. Adjuvant irradiation showed survival benefit. KEY WORDS: Uterine cancer - Uterine sarcoma - Uterine sarcoma treatment - Sarcoma irradiation - Sarcoma prognosis.

A Comparative Dosimetric Study of Adjuvant 3D Conformal Radiotherapy for Operable Stomach Cancer Versus AP-PA Conventional Radiotherapy in NCI-Cairo.

PURPOSE: This study was to compare this multiplefield conformal technique to the AP-PA technique with respect to target volume coverage and dose to normal tissues. MATERIALS AND METHODS: Seventeen patients with stages II-III denocarcinoma of the stomach were treated with adjuvant postoperative chemoradiotherapy presented to radiotherapy department in National Cancer Institute, Cairo in period between February 2009 to March 2010 using 3D conformal radiotherapy technique that consisted of a monoisocentric arrangement employing 4-6 radiation fields. For each patient, a second radiotherapy treatment plan was done using an antroposterior (AP-PA) fields, the two techniques were then compared using dose volume histogram (DVH) analysis. RESULTS: Comparing different DVHs, it was found that the planning target volume (PTV) was adequately covered in both (3D & 2D) plans while the left kidney and spinal cord demonstrate lower radiation doses on using the conformal technique. The liver doses is higher in the 3D tecq, but still well below liver tolerance. CONCLUSIONS: Both 3D conformal radiotherapy and AP-PA conventional techniques doses are within range of normal tissues tolerance. Regarding the left kidney and spinal cord the 3D conformal radiotherapy is superior than the AP-PA conventional techniques but with higher doses to the liver in the 3D conformal radiotherapy compared to the AP-PA conventional techniques. KEY WORDS: Dosimetric study in cancer stomach.

Shielding for scattered radiation to the testis during pelvic radiotherapy: is it worth?

OBJECTIVES: To assess the value of external shielding of the testis during pelvic radiotherapy. MATERIAL AND METHODS: Nineteen patients, receiving radiotherapy to the pelvis with the lower border of the field at the obturator foramen, were randomly selected. A 5 half value layer cerrobent shield was positioned at the inferior border of the field. The dose to the testis was measured with and without the shield. Observations were made regarding the reflex cremaster contraction and phantom measurements were done at different distances from the perineum. RESULTS: The mean radiation dose to the testis for patients receiving treatment with no shield was 7.4cGy (1.3) and it was 5.7cGy (-/+2.5) for patients with external shield, this difference was statistically significant by the paired t test p<0.0001. This accounted for a 22 % decrease in the dose received by the testis. The position of the testis with the contraction of the cremaster muscle and the dartos fascia after manipulation of the testis during diodes placement changed up to 3.5 cm (mean 1.5). Phantom measurements showed 37% increase in the dose with 2cm change in the position of the testis to the pelvic direction. CONCLUSION: External shield at the inferior border of the pelvic field is a simple, easy reproducible, convenient shielding method. Clam-shell scrotal shield is not free of drawbacks, but still its benefits overweigh its harms and should be used with caution.