Introduction: Psychological consequences of the COVID-19 pandemic include pandemic triggered feelings of fear, uncertainty, and anxiety added to the effects of restricting the population's activities in lockdown. Aim: We aimed to study the effect of COVID-19 pandemic on sexual satisfaction of females and males in Egypt and to evaluate possible predictive factors. Methods: Married men and females in Egypt were invited to respond to an online questionnaire. The questionnaire addressed medical history, socioeconomic status, sexual performance satisfaction before and during the lockdown in addition to validated Arabic questionnaires for depression, sexual function in males and females, and sexual satisfaction (Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Female Sexual Function Index, International Index of Erectile Function-5, Index of Sexual Satisfaction, respectively). Main outcome measure: The main outcome measures were frequency of depression, anxiety, sexual dysfunction, and sexual satisfaction in males and females during COVID-19 lockdown. Results: A total of 479 females and 217 males completed the questionnaire. Sexual satisfaction was significantly higher before (91.2%, 73.5%) than during lockdown (70.5%, 56.2%) in both males and females, respectively. During lockdown, significantly more males (70.5%) reported being satisfied with their sexual performance than females (56.2%) (P < .001). More than half of the male subjects (68.2%) had no erectile dysfunction while 97.3% females scored 26.5 on the Female Sexual Function Index scale suggestive of sexual difficulties. Sexual stress was significantly greater in females (70.8%) than males (63.1%). Educational level, occupation, anxiety, and erectile dysfunction were independently associated with sexual stress in males. Being a housewife or unemployed, husband's age >35 years, marriage duration of 5-10 years, anxiety, and female sexual dysfunction were predictors of sexual relation stress in females. Conclusion: COVID-19 pandemic was associated with lower sexual satisfaction in both genders. Females however suffered more anxiety and depression and thereby greater risk of sexual function difficulties and sexual dissatisfaction. Intervention strategies in order to lessen the suffering of affected individuals particularly after the pandemic are recommended.

Purpose: The present study is aiming to correlate between different radiotherapy techniques, fractionations and doses received by each axillary LN level and axillary vessels with the development of breast cancer related lymphedema (BCRL). Methods and materials: We retrospectively studied 181 female breast cancer patients who were diagnosed and treated by radiation therapy during the period from January 2012- December 2017. The radiotherapy treatment plans were recalled from the archives. The axillary LN levels I, II, III, supraclavicular LN were contoured as well as axillary vessels. New dose volume histograms (DVHs) were generated to correlate between the radiotherapy dose t and the development of BCRL. Results: The study included 162 patients treated with 3D radiotherapy technique and 19 treated with 2D technique radiotherapy. 124 patients underwent MRM while 57 patients underwent BCS. 117 patients treated with hypofractionated technique while 64 patients treated with conventional radiotherapy technique . The cumulative incidence of BCRL after radiotherapy was 20.4%. There was a statistically significant relation between 2D radiotherapy technique compared with 3DCRT and development of lymphedema 55% vs 16.6% respectively(p<0.001). Patients who were treated with conventional radiotherapy had significantly higher rates of lymphedema (42.2%) compared with hypofractionated radiotherapy (8.5%) (p<0.001). There was non-significant relation between mean radiotherapy dose to axillary levels or the axillary vessels and development of lymphedema. Conclusion Breast cancer radiotherapy with 2D technique and conventional fractionation protocol might increase the risk of BCRL. No correlation was observed between radiotherapy dose to each axillary LN level, axillary vessels and BCRL.

Purpose: Organs at risk sparing without compromising adequate coverage to the target volumes is the main challenge during left breast cancer adjuvant radiation therapy. Advanced radiotherapy techniques have been investigated to improve the dose distributions and to reduce toxicities. These techniques includes deep inspiration breath hold, accelerated partial-breast irradiation, Intensity Modulated Radiation Therapy. Supine positioning (SP) is the most commonly used and the standard tangent set-up for breast radiotherapy. Our purpose is to compare the Semi-lateral decubitus position(SLDP) versus SP regarding the dose distribution to the left Chest wall/Whole breast (WB), ipsilateral left axilla, contra-lateral breast, thyroid, spinal cord, ipsilateral lung, heart, LAD (Left Anterior Descending Artery), as well as determining the reproducibility of the Alexandria left breast board-16 (ALB-16) by portal image verification. Methods: We invented a new breast board ALB-16 to induce SLDP allowing tilting the patient towards the right side, elevating the patient's left side at a certain angle adjusted according to the patient’s body surface area and the gantry width of the CT simulator. Simulation process was performed in two different positions whilst the patients were freely breathing, the first scan in SLDP and the second in SP. Fifty women with a left sided breast cancer who underwent either mastectomy or lumpectomy were enrolled in this study for dosimetric comparison between the SLDP and the SP. The mean radiotherapy dose to the CW/WB, axilla, thyroid, left lung, heart, LAD, Spinal cord and the contra-lateral right breast in SLDP and the SP for the same patient were compared. Secondly, analysis was conducted on the fifty patients who were treated in SLDP by ALB-16 in comparison with a control group treated in SP to determine ALB-16 reproducibility. Results: On dosimetric analysis of the two positions, SLDP was found to significantly decrease the mean dose to the heart when compared with SP (2.2Gy vs. 2.9Gy respectively), LAD (5.4Gy vs. 7.2Gy) and the Spinal cord Dmax (7.5Gy vs. 12.6Gy) with a (p&lt;0.01), while maintaining a similar coverage to the axillary lymph nodes levels I, II and III and the SCV group (91.13%, 89.9%, 88.9% and 93.9% vs. 91.3%, 90.2%, 89.5% and 94.1% respectively)(p =0.73, 0.37, 0.29 and 0.67) SLDP improved coverage to the target PTV mean dose (95.2% vs. 94.2%, p&lt;0.01). SLDP decreased the mean dose to the contralateral breast (2.27Gy vs. 2.52Gy, p= 0.08). However, it achieved slightly a higher mean dose to the thyroid gland (79.8Gy vs. 16.8Gy, p= 0.56). The mean dose to the ipsilateral lung was slightly higher than SP (22.5% vs. 20.3%) with a statistically significant difference (p&lt;0.01). For the secondary analysis, setup error in lateral (x) direction was higher in SLDP (0.66cm vs.0.49cm, p=0.028), setup error in vertical (y) direction in SLDP was lower than SP (0.39cm vs. 0.55cm, P=0.013). For the changes in longitudinal direction (Z), there was a slight difference between both positions (0.49cm vs. 0.39cm, p= 0.56). The length of deviation vector (3D vector) was (0.95cm in SLPD vs.0.87 in SP), the mean difference between vector lengths was only (0.08 cm) and this difference wasn’t statistically significant (p= 0.441) indicating the overall reproducibility of the ALB-16 breast board in comparison to standard supine breast board. Conclusions: ALB-16 Breast board is considered a reproducible method of setup for patients receiving left breast cancer adjuvant radiotherapy. It is comparable with the conventional supine breast board in regards of setup errors variability. SLDP spared the heart, LAD and the spinal cord, with a better WB/CW PTV coverage. SLDP can be used in patients whom regional nodal irradiation is indicated while maintaining low contralateral breast dose. Citation Format: Omar Saeed Emam, Mohamed Abouegylah, Rasha Elsaka, Amr Munir, Fady Aziz, Abdelsalam Attia Ismail, Amr Abdelaziz Elsaid. Semi-lateral decubitus position using Alexandria left breast board-16. A prospective study regarding dose distribution and reproduciblity [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-19-21.