; the 80-degree collimator angle arc is fixed for all plans. The use of jaw tracking technique is chosen during the optimization process, which is commercially available. The two prescription dose levels of the planning target volumes were 70 Gy and 63 Gy in 35 fractions, using SIB. Results: The mean PTV 70 Gy and PTV 63 Gy doses were 65.83 Gy and 61.3 Gy for all plans respectively, extracted from the dose-volume histogram (DVH). Although the (60, 300 , and 80) plan shows slightly the lowest CI (0.96 and 0.94 for both PTV 70 Gy and PTV 63 Gy, respectively) and HI (0.06 and 0.14 for both PTV 70 Gy and PTV 63 Gy, respectively); the average values of conformity and homogeneity indexes were not significantly different for all plans. In addition, in terms of sparing of normal structures, the average DVHs showed that the maximum doses received by organs at risk were in the plan with highest collimator angles (60, 300 , and 80), and the minimum doses were in favor of the plan with the lowest collimator angles (15 , 345 , and 80). The averaged body integral doses were almost equivalent in all plans ranged between 130.38 Gy.L to 132.01 Gy.L. Conclusion: The dosimetric results for this study; indicated that the DVH parameters for the normal organs are dependent on the chosen collimator angles for all VMAT fields. As the collimator angle increases, the normal tissue doses slightly increase consequently. The PTVs HI and CI of all plans were almost the same, regardless of the collimator angles. The 80degree collimator angle arc gives additional sparing of OAR and more homogeneous PTV doses. Therefore, in order to improve the plan quality in NPC VMAT with SIB the planning physicist must select the optimal collimator angles that provide the best PTV coverage with that clinically acceptable OAR doses.

A 33-year-old parturient experienced seizures, then an ischaemic stroke after caesarean section, while undergoing an epidural blood patch for dural puncture. A diagnosis of normotensive late postpartum eclampsia, with either a posterior reversible encephalopathy syndrome or postpartum vasculopathy, leading to stroke, was made-based primarily on a temporal relationship to the postpartum period and consistent findings on magnetic resonance imaging and angiography scans and an electroencephalogram. The difficulties in definitively elucidating the cause of seizures and cerebral infarction in the postpartum period and the impact of anaesthetic interventions in this case are discussed.

Reconstruction failure (RF) is defined as any unplanned implantation/ replacement/adjustment of implants, or complete loss/necrosis of autologous flaps. Severe capsular contracture (CC) is defined as requiring capsulotomy or capsulectomy. Univariate and multivariate analysis were performed using logistic regression analysis. Results: In total, 265 patients undergoing 274 IBR were reviewed, including 262 breasts receiving retro-pectoral IBR-i with or without latissimus dorsi flaps and 12 autologous flaps only. The median age was 40 years. A total of 55 breasts received RT and CTV was defined to include entire implants or flaps. In total, RF events occurred in 15 (5.5%) breasts and the most common cause (60%) of RF was implant exposure and/or infection. Univariate analysis showed that adjuvant chemotherapy (CT) and BMI were both significant risk factors for RF while RT was not (OR 0.995, 95% CI 0.271-3.656, p Z 0.994). Multivariate analysis showed that only adjuvant CT was the significant risk factor for RF (OR 6.283, 95% CI 1.332-29.643, p Z 0.02). CC was evaluated in 262 breasts with IBR-i. Severe CC occurred in 11 patients, with 7 in the RT group. Multivariate analysis showed that RT was the only significant risk factor for developing severe CC (OR 4.000, 95% CI 1.017-15.738, p Z 0.047). After a median follow-up of 44 months, 6 LRR events were observed, including 2 in chestwall, 1 in nipple-areolar and 3 in axilla. No recurrence in pectoral muscles, ribs or intercostal muscles was observed. None of recurrence occurred outside the border of ESTRO CTV-chest wall recommendation. The 5-year recurrence from survival (RFS), local-regional RFS and overall survival were 93.0%, 98.2% and 98.7%, respectively. Conclusion: IBR after BC surgery yields a low rate of RF and severe CC. Adjuvant CT was associated with increased risk of RF. Post-operative RT remains a risk factor for severe CC. Pattern of LRR in our study supports the oncological safety of ESTRO delineation guideline. Further study is needed to confirm if the new delineation will help to decrease the RTrelated complications in patients with IBR.

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