Low-grade malt lymphoma of the nasopharynx in young adults: Successful treatment of a rare diagnosis at a rare site by radiotherapy.

INTRODUCTION: Mucosa Associated Lymphoid Tissue (MALT) lymphoma is the third most common subgroup of Non-Hodgkin's lymphoma and is the most common type of primary extranodal lymphoma. They are rarely found in the nasopharyngeal region and their mean age at presentation is the sixth decade of life. MATERIALS AND METHODS: We present the clinical, pathological, treatment and 5-year follow-up data of 5 cases of nasopharyngeal MALT lymphoma treated with definitive radiotherapy at our hospital, between 2009 and 2011. RESULTS: The average age of diagnosis was 27 years which is more than a decade earlier than what has been reported previously. Clinical symptoms included nasal obstruction, tinnitus and hearing loss. All five patients had locoregional disease. They were treated by definitive radiotherapy to a dose between 30 to 40 Gy. At 5 years of follow-up, 4 patients were in complete remission while one had disease relapse. CONCLUSION: The younger age of presentation compared to older reports in this rare subsite was an interesting finding in our study. The authors speculate that rising levels of particulate air pollution may have played a part in the etiology in this younger population. Our series shows that despite the younger age, the disease displays an indolent course and responds well to radiotherapy alone as the primary treatment. Recurrence or disseminated disease is also highly treatable with systemic chemotherapy.

A decade of treating brain stem gliomas: Single institutional experience.

INTRODUCTION: Brainstem is a rare yet challenging site for primary brain tumors. We present the patient characteristics, treatment-related details, and survival outcomes of patients with brain stem gliomas treated over a decade, from August 2010 to July 2022, at a tertiary care center in northern India. MATERIALS AND METHODS: Twenty-seven patients of brainstem gliomas were treated in our hospital from August 2010 to July 2022. All of these patients were treated with radiation therapy based on a radiological diagnosis only. Data were collected and analyzed from patient registration, treatment, and follow-up records. RESULTS: Of the 27 patients, 18 were male and 9 were female. Fourteen patients (51.85%) were in the pediatric age group (<12 years). The most common symptom at onset was hemiparesis, seen in 62.96%. The majority of the patients (24; 88.88%) had pontine involvement at the time of treatment. Overall survival at a minimum 2-year follow-up post-treatment was 22.22% in the entire cohort. Age, sex, or size of tumor at presentation was not seen to have any significant impact on survival of patients. CONCLUSION: With the advancement in surgical techniques and molecular analysis of brain tumors, there is likely to be a change in the management of brainstem gliomas; however, radiation therapy has been used for the management of these tumors for decades now. Radiation therapy continues to show rapid and significant radiological and clinical improvement in the majority of such patients, and it would continue to play an important part in multi-modality management.

Utility of 18-Flurodeoxyglucose Positron Emission Tomography-Computed Tomography ( 18 FDG PET-CT) in Gallbladder Cancer: Experience from a Tertiary Care Hospital.

Introduction Gallbladder cancer (GBC) is one of the most common and aggressive malignancies of the Indo-Gangetic plains. Despite its widespread use in GBC cases, the role of 18-flurodeoxyglucose positron emission tomography-computed tomography ( 18 FDG PET-CT) in the management of this disease is not well defined. In our study, we present the practice trends of the utilization of this investigative modality in our hospital and its benefits in aiding diagnosis, staging, and surveillance for recurrence. Materials and Methods All cases of suspected and biopsy-proven GBCs who underwent PET-CT at our institute between 2016 and 2019 were retrospectively evaluated for the indication of PET-CT testing and its impact on the management of the case. The indications were classified into three categories: (i) staging and metastatic workup, (ii) response assessment post-chemotherapy, and (iii) post-therapy surveillance of patients. Results A total of 79 PET-CT scans were carried out during the study period. PET-CT was used for less than one-third of the total patients of GBC presenting at our center. Initial staging and workup (49%) was the most common indication followed by surveillance (28%) and response assessment (23%). PET-CT had a substantially better sensitivity in detecting distant metastases compared to conventional imaging in both initial workup and during follow-up. PET-CT provided additional information in 42% scans that led to change in the management of the patient. As a response assessment tool PET-CT aided not only in evaluating efficacy of therapy but also for documenting progressive disease for patients on therapy. Conclusion PET-CT is a valuable tool to not only rule out metastatic disease while selecting patients for surgery but also for post-therapy surveillance for recurrence in patients of GBC. Larger prospective studies may help in finally elucidating the exact role of PET-CT in this disease.

Corneal blindness and eye banking: Current strategies and best practices.

Corneal blindness (CB) is one of the leading causes of blindness in India and globally, affecting around 8 million population worldwide. Many of these corneal blind patients may be visually rehabilitated by corneal transplantation (CT). Eye banking plays a crucial role in facilitating CT and ocular research. Many countries have adopted regulatory frameworks, quality assurance programs, and technological advancements to enhance the efficacy and safety of CT. Various infrastructural and organizational frameworks of eye banks (EBs) in India, according to the Eye Bank Association of India (EBAI), aid in establishing guidelines and standards for EB practices. Initiatives such as the National Programme for Control of Blindness (NPCB) have significantly contributed to eye donation rates and improved access to donor corneas. This review article discusses the established eye banking networks in countries such as India, the United States (USA), and Europe, where dedicated EB organizations work collaboratively to ensure efficient procurement, processing, and distribution of corneal tissue. It also highlights specific strategies employed in India and global countries to address EBs' challenges. These challenges include the shortage of donor corneas, improving donor screening and tissue processing techniques, ensuring timely distribution of corneal tissue, and maintaining high-quality standards. Interestingly, the comparative analysis between India and other developed countries highlights the similarities and differences in eye banking strategies. By understanding the strategies employed by different regions, EBs can learn from each other's experiences and work toward achieving optimal outcomes in CT and ocular research worldwide. It underscores the importance of knowledge sharing and collaborative efforts in addressing common challenges and implementing best practices in eye banking.

A case of dermatofibrosarcoma protuberans of the scalp treated with surface mould brachytherapy.

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive soft tissue tumor with a high propensity of local recurrence after surgery. Radiotherapy as an adjuvant therapy has been shown to reduce recurrent rates of this disease. Surface mould brachytherapy is an effective and safe modality for the delivery of radiotherapy in soft tissue tumors, though its utilization and popularity have decreased in recent years. Here, we presented a case of a recurrent DFSP of the scalp who was treated with surgery followed by adjuvant surface mould brachytherapy to avoid dose inhomogeneity likely to occur in this anatomic region with external beam radiotherapy in the absence of intensity-modulated radiotherapy. The treatment was delivered successfully with minimal adverse reactions, and the patient is disease-free at 18 months post-treatment with no treatment toxicity.

Impact of COVID-19 pandemic on older cancer patients: Proposed solution by the International Geriatric Radiotherapy Group.

Older cancer patients are disproportionally affected by the Coronavirus 19 (COVID-19) pandemic. A higher rate of death among the elderly and the potential for long-term disability have led to fear of contracting the virus in these patients. This fear can, paradoxically, cause delay in diagnosis and treatment that may lead to a poor outcome that could have been prevented. Thus, physicians should devise a policy that both supports the needs of older patients during cancer treatment, and serves to help them overcome their fear so they seek out to cancer diagnosis and treatment early. A combination of telemedicine and a holistic approach, involving prayers for older cancer patients with a high level of spirituality, may improve vaccination rates as well as quality of life during treatment. Collaboration between health care workers, social workers, faith-based leaders, and cancer survivors may be crucial to achieve this goal. Social media may be an important component, providing a means of sending the positive message to older cancer patients that chronological age is not an impediment to treatment.

Mitochondrial DNA Levels in Trophectodermal Cells Show No Association with Blastocyst Development and Pregnancy Outcomes.

Background: In patients undergoing assisted reproduction, levels of mitochondrial DNA (mtDNA) in the trophectodermal cells of the developing blastocyst are suggested to be associated with its ability to implant. However, discrepancies exist regarding the use of mtDNA levels as a reliable biomarker to predict outcomes of assisted reproduction. Aims: The aim of the study is to explore the association of trophectodermal mtDNA levels to determine blastocyst quality, implantation potential of blastocyst and clinical outcomes in couples who have undergone pre-implantation genetic testing for aneuploidy (PGT-A). Study Setting: Private fertility centre. Study Design: Retrospective analysis. Materials and Methods: We analysed mtDNA levels in the trophectodermal cells of 287 blastocysts from 61 couples undergoing PGT-A. The levels of mtDNA were estimated by next-generation sequencing method. mtDNA levels were correlated with maternal age, blastocyst morphology, ploidy status, implantation rates, miscarriage rate and live birth rate. Statistical Analysis Used: Linear regression and one-way ANOVA with Tukey's all column comparison test. Results: The trophectodermal mtDNA levels did not correlate with maternal age. There were no significant differences in their levels in grade 1 and grade 2 blastocysts. No significant differences were seen between mtDNA levels of implanted and non-implanted blastocysts or those blastocysts that resulted in miscarriage or live birth. However, significantly lower amounts of mtDNA were seen in euploid blastocysts as compared to that in aneuploid blastocysts. Conclusion: mtDNA levels in the trophectodermal cells of the blastocyst do not associate with blastocyst quality (grade 1 and grade 2), implantation potential and clinical outcomes but can differentiate between aneuploid and euploid blastocysts. Our study does not support the use of trophectodermal mtDNA levels as a biomarker for blastocyst quality and predictor of clinical outcomes.

Impact of Surface States and Aluminum Mole Fraction on Surface Potential and 2DEG in AlGaN/GaN HEMTs.

The presence of surface traps is an important phenomenon in AlGaN/GaN HEMT. The electrical and physical properties of these surface traps have been analyzed through the study of 2DEG electron concentration along with the variation of aluminum percentage in the barrier layer of HEMT. This analysis shows that from deep to shallow donors, the percentage change in electron density in 2DEG gets saturated (near 8%) with change in aluminum concentration. The depth of the quantum potential well below the Fermi level is also analyzed and is found to get saturated (near 2%) with aluminum percentage when surface donor states energy changes to deep from shallow. The physics behind this collective effect is also analyzed through band diagram too. The effect of surface donor traps on the surface potential also has been discussed in detail. These surface states are modeled as donor states. Deep donor (EC - ED = 1.4 eV) to shallow donor (EC - ED = 0.2 eV) surface traps are thoroughly studied for the donor concentration of 1011 to 1016 cm-2. This study involves an aluminum concentration variation from 5 to 50%. This paper for the first time presents the comprehensive TCAD study of surface donor and analysis of electron concentration in the channel and 2DEG formation at AlGaN-GaN interface.

Dehydroepiandrosterone (DHEA) role in enhancement and maintenance of implantation (DREAM): randomised double-blind placebo-controlled trial-study protocol.

INTRODUCTION: Dehydroepiandrosterone (DHEA) is an important precursor of androgen and has been studied and researched extensively for improving the various outcome measures of ovarian stimulation in women with advanced age or poor ovarian response. Androgens also play an important role in the enhancement of endometrial and decidual function by regulating both the transcriptome and secretome of the endometrial stromal cells and have a positive effect on various factors like insulin-like growth factor binding protein 1, homeobox genes (HOXA10, HOXA11), secreted phosphoprotein 1, prolactin which are necessary for implantation. It is well-known that the circulating 'precursor pool' of DHEA declines with age more so in poor ovarian reserve patients and exogenous supplementation may be beneficial in such cases. This double-blinded randomised controlled trial (RCT) aims to test the hypothesis whether transient targeted supplementation of DHEA as an adjuvant to progesterone in frozen embryo transfer (FET) cycles, for women with low serum testosterone, helps in improving live birth rate. METHODS AND ANALYSIS: This study is planned as a double-blinded, placebo-controlled randomised trial and the sample size, calculated for the primary outcome measure-live birth rate, is 140. All participants will be having a flexible antagonist protocol for controlled ovarian stimulation and an elective freeze-all policy for the embryos as per the hospital protocol after written informed consent. For FET, the endometrium will be prepared by hormone replacement treatment protocol. During the FET cycle, the intervention group will be receiving DHEA 25 mg two times a day for 15 days from the day of starting progesterone supplementation and the control group will be receiving a placebo. ETHICS AND DISSEMINATION: The approval of the study was granted by the Clinical Trials Registry-India and the Institutional Ethical Committee of CRAFT Hospital and Research Center. All participants will provide written informed consent before being randomised into allocated treatment groups. The results will be disseminated to doctors and patients through conference presentations, peer-reviewed publications, social media and patient information booklets. TRIAL REGISTRATION NUMBERS: CTRI/2020/06/025918; ECR/1044/Inst/KL/2018.

Use of a Checklist Approach on a Telecobalt in an Attempt to Reduce Human Errors in Radiotherapy Delivery and Improve Therapeutic Ratio.

BACKGROUND: The process of radiotherapy treatment planning and delivery involves multiple steps and professionals causing it to be prone to errors. Radiotherapy centers equipped with old telecobalt machines have certain peculiar challenges to workflow. We designed and tested a checklist for radiotherapy technicians (RTTs) to reduce chances of error during treatment delivery on a telecobalt machine. MATERIALS AND METHODS: A physical checklist was designed for RTTs to use in the pretreatment pause using a template advocated by the American Association of Physicists in Medicine. It was tested on 4 RTTs over 1000 radiotherapy delivery sittings. RESULTS: The checklist helped to rectify 41 documentary lapses and 28 errors in radiotherapy treatment parameters while also identifying 12 instances where treatment plan modifications were due and 30 where the patient was due for review by the radiation oncologist. The average time to go through the checklist was between 2.5 and 3 min. CONCLUSIONS: The development and use of the checklist has helped in reducing errors and also improving workflow in our department. It is recommended to utilize such physical checklists in all radiotherapy centers with telecobalt machines. The success of the checklist depends upon leadership, teamwork, acceptance of a need to inculcate a "safety culture," with voluntary error-reporting and a willingness to learn from such errors.

Genuine Empty Follicle Syndrome: Role of Double Trigger and Delayed Oocyte Retrieval (DTDO).

BACKGROUND: Empty follicle syndrome (EFS) is a condition of undetermined etiology where no oocytes are retrieved in an ART cycle despite adequate response to ovarian stimulation and diligent follicular aspiration. Because of the rarity of this condition, no much published strategies are available to tackle this. AIM: The aim of this study was to evaluate whether sequential administration of gonadotropin-releasing hormone agonist (GnRHa) and human chorionic gonadotropin (hCG) as a trigger at 40 h and 36 h, respectively, before oocyte retrieval (OCR) could correct genuine empty follicle syndrome (GEFS). STUDY SETTING AND DESIGN: This retrospective observational cohort study was conducted in a tertiary fertility center over a period of 6 years from January 2014 to December 2019. Patients with a history of GEFS were administered GnRHa and recombinant hCG subcutaneously at 40 h and 36 h, respectively, before OCR, i.e., double trigger and delayed oocyte retrieval (DTDO) (n = 13). The primary outcome measures studied were number of mature oocytes retrieved, oocyte maturation index (OMI), number of fertilized oocytes, and number of embryos available for embryo transfer. The secondary outcome measures were clinical pregnancy rate (CPR), miscarriage rate (MR) and live birth rate (LBR) per first frozen embryo transfer (FET) cycle, incidence of inadvertent premature ovulation, and ovarian hyperstimulation syndrome. STATISTICAL ANALYSIS: Comparison between the groups was analysed by Fisher's exact test and paired t-test. RESULTS: Patients in the DTDO group showed a significant improvement (P < 0.01) in the number of mature oocytes retrieved, OMI, number of fertilized oocytes, and number of embryos available for embryo transfer. In the first FET cycle, CPR (44.44%), LBR (44.44%), and MR (11.11%) were observed in the DTDO group. CONCLUSION: Our findings implicate that double trigger and delayed OCR (DTDO) is a safe and efficacious treatment strategy for GEFS.

A comparative evaluation of subendometrial and intrauterine platelet-rich plasma treatment for women with recurrent implantation failure.

OBJECTIVE: To compare the effectiveness of treatment with autologous activated platelet-rich plasma (PRP), administered to either the subendometrium (SE-PRP) or endometrial surface (intrauterine; IU-PRP), against controls. DESIGN: Prospective observational cohort study. SETTING: Tertiary fertility unit. PATIENTS: Women aged <40 years with a history of recurrent implantation failure undergoing frozen embryo transfer (FET) (n = 318). INTERVENTIONS: In SE-PRP, PRP was injected into the subendometrial space transvaginally in the luteal phase of the previous cycle of embryo transfer under ultrasound guidance (n = 55). In IU-PRP, PRP was administered during the index FET cycle when the endometrium was approximately 7 mm (n = 109). Both SE-PRP and IU-PRP groups were administered 300 µg of granulocyte colony-stimulating factor (G-CSF) subcutaneously once a day for 3 days to boost white blood cells (WBC) and growth factor production in the PRP sample. The control group consisted of women who did not choose PRP treatment and underwent standard FET with no intervention (n = 154). MAIN OUTCOME MEASURES: Ongoing pregnancy rate or live birth rate (OPR/LBR) per transfer cycle, clinical pregnancy rate (CPR) per transfer cycle, and miscarriage rate. RESULTS: As a result, OPR/LBR was higher in the SE-PRP (22/55, 40%) and IU-PRP (45/109, 41.3%) groups than that in the control group (34/154, 22.1%). It was similar between the SE-PRP and IU-PRP groups. Moreover, CPR showed a similar trend with a higher rate in the SE-PRP (28/55, 51%) and IU-PRP (57/109, 52.3%) groups than that in the controls (52/154, 33.8%). No statistical difference in the CPR was noted between the SE-PRP and IU-PRP groups. The miscarriage rate was similar in all three groups (14/55, 25.45%; 25/109, 22.23%; and 34/154, 22.07%, respectively). CONCLUSION: In women with a history of recurrent implantation failure, PRP treatment appears to improve FET outcome with an increase in OPR/LBR. However, SE-PRP treatment does not offer any advantage over lesser invasive IU-PRP treatment.

Weight Loss as a Nutritional Indicator in Head and Neck Cancer Patients Undergoing Chemoradiotherapy: Contributing Factors and Its Impact on Disease Outcome.

This is a retrospective study carried out at a tertiary care cancer center to assess weight loss in patients of head and neck cancers (HNCs) during treatment with chemoradiotherapy (CRT) and study various factors affecting it. Treatment and follow-up records of 77 patients of HNCs were studied and assessed for demographic, disease-specific variables, treatment parameters, weight loss during CRT, as well as survival at 2 years after treatment completion. A statistical analysis was conducted to assess the association of study variables with weight loss. It was also assessed if a correlation existed between weight loss during treatment and patient survival at 2 years. Of the study patients, 62.3% (48) suffered 5% or more weight loss during CRT while 23.4% (18) suffered a weight loss of 10% or more. No particular factor was identified having a statistically significant association with weight loss. Nutritional impairment is an important factor affecting the morbidity and possibly the mortality of patients of HNCs undergoing CRT. More robust studies are required to identify which factors affect weight loss during treatment and whether weight loss can be used as a parameter to prognosticate patients.

Incidence of Otitis Media with Effusion in Cases of Head and Neck Malignancies Undergoing Radiotherapy: A Prospective Observational Study.

This study was done to evaluate the incidence of otitis media with effusion (OME) in cases of head and neck malignancies who undergo irradiation, excluding nasopharyngeal malignancies. This prospective observational study was done at a tertiary care hospital. Adult patients of head and neck malignancies treated with radiotherapy (RT) with or without concurrent chemotherapy as definitive or adjuvant therapy from September 2017 to August 2018 were included. Cases of nasopharyngeal malignancies and cases of malignancies of other sites extending to nasopharynx causing mechanical obstruction to ET were excluded. The otoscopy, tympanometry and pure tone audiometry findings of these patients were recorded pre RT, immediately after completion of RT and at 6 months post RT. The pre and post RT data were analysed to determine the incidence of OME. 39.3% of ears had retracted tympanic membrane (TM) and 7.1% had air-fluid levels in middle ear at first follow up (FFU). At second follow up (SFU), 13% of ears continued to have retracted TM while none had air-fluid levels. At FFU, 23.2% of ears had 'B' curve on tympanometry, indicative of OME while 19.6% of ears had 'C' curve, indicative of Eustachian tube (ET) dysfunction. At SFU, 1.8% had B curve while 14.3% had C curve, indicating improvement in ET function as compared to that at FFU. There is a considerable percentage of non-nasopharyngeal head and neck malignancy cases who develop OME post RT, however, in most of them it resolves spontaneously.

Malignant peripheral nerve sheath tumor of thigh with sphenoid and brain metastases: Extremely rare occurrence with dismal prognosis despite significant response to palliative chemoradiotherapy.

Malignant peripheral nerve sheath tumor (MPNST) is a neurogenic tumor arising from peripheral nerves or nerve sheaths. MPNSTs are highly aggressive sarcomas mainly associated with neurofibromatosis type-1 (NF-1) with high rates of local recurrence and distant metastasis carrying a dismal prognosis. Lung is the most common metastatic site. Bone metastasis although documented in the literature is still very rare, while dissemination to brain without the involvement of lungs and that too in a non-NF-1 case is extremely unusual. A 48-year-old female was diagnosed with a case of non-NF-1 MPNST left thigh with bone metastases including sphenoid. Despite showing complete resolution of skeletal and primary lesions postpalliative chemoradiotherapy, she developed brain metastases and succumbed to her disease. This case is discussed to highlight an unusual scenario we encountered, the clinical course of the disease with its management, and overall poor prognosis. To the best of our knowledge, this may be the earliest case of MPNST with sphenoid metastases detected by 18-fluorodeoxyglucose positron-emission computed tomography scan and a sporadic case of brain metastases reported in the world literature.

Radiation Fibrosis Syndrome: the Evergreen Menace of Radiation Therapy.

Fibrosis is a descriptive appellation referring to the obliteration of normal tissue components replaced by matrix and disorganized and varied collagen fibrils that result in the loss of organ function and frequent tissue contraction leading to death or significant deterioration in the quality of life. Radiation fibrosis syndrome (RFS) is a progressive fibrotic tissue sclerosis with various clinical symptoms in the irradiation field. It is usually a late complication of radiation therapy and may occur weeks or even years after treatment. It may affect the musculoskeletal, soft tissue, neural tissue, and cardiopulmonary systems. RFS is a serious and lifelong disorder that, nevertheless, may often be prevented when identified and rehabilitated early. Genetic factors likely play a significant role in the development of chronic fibrotic response to radiation injury that persists even after the initial insult is no longer present. Management of this syndrome is a complex process comprising medication, education, rehabilitation, and physical and occupational therapy. A bibliographical search was carried out in PubMed using the following keywords: "radiation fibrosis," "radiation fibrosis syndrome," and "radiation-induced fibrosis." We also reviewed the most relevant and recent series on the current management of RFS, and the reviewed data are discussed in this article. This review discusses the pathophysiology, evaluation, and treatment of neuromuscular, musculoskeletal, and functional disorders as late effects of radiation treatment.

The Impact of Positron Emission Tomography/Computed Tomography Addition to Contrast-Enhanced Computed Tomography Findings during Radiation Treatment Planning of Locally Advanced Carcinoma Esophagus.

INTRODUCTION: Does metabolic imaging help in better definition of target during radiation treatment planning by bringing about changes in dimensions of the primary tumor in terms of diameter, length, and picking up new skip lesions or nodal stations which in turn prevents geographic misses by including more 18F-fluorodeoxyglucose avid regions not visible on conventional imaging? MATERIALS AND METHODS: We compared the length and radial dimensions of the primary tumor as well as changes brought about due to addition of new nodal stations, involved structures, and skip lesions in 50 patients of carcinoma esophagus treated between 2011 and 2013, as seen on contrast-enhanced computed tomography (CT) thorax and positron emission tomography (PET)/CT and drew conclusions regarding the technical changes brought about in treatment planning by the additional input of PET/CT. RESULTS AND CONCLUSIONS: PET-CT tremendously changes treatment plans by expanding the gross tumor volume and including regions which might otherwise have been missed on purely CT-based plans. Of the 50 patients, it changed the contouring and treatment planning of 35 patients and did not impact the remaining 15. Whether this translates into better long-term controls requires further validation by randomized controlled trials, which was not our present objective.

Using positron-emission tomography-computed tomography for predicting radiotherapy-induced tumor regression in carcinoma esophagus in an Indian population.

Carcinoma esophagus is a common malignancy of the Indian subcontinent. The role of positron-emission tomography-computed tomography (PET-CT) in the assessment of response to radiotherapy has been widely studied and accepted. However, its precise use as a predictive tool for actual histopathological response to radiotherapy needs further evaluation, especially in an Indian population. The aim of this study was to identify a quantum of metabolic response on PET-CT that can also predict for a good pathological response. Forty-four patients of carcinoma esophagus treated with neoadjuvant chemoradiotherapy followed by surgery were included in the study. All patients underwent a PET-CT before starting treatment as well as at 4-6 weeks after completion of radiotherapy. The percentage change in pre and posttreatment maximum standardized uptake value (SUVmax) value (ΔSUV%) of the primary tumor was correlated against histopathological tumor regression grade (TRG) as per the Mandard's system. Seventy-five percent of the patients with a significant metabolic response, i.e., a ΔSUV% of 60% or more, also had a good pathological response to treatment. Thus, by considering a ΔSUV% of 60%, we could predict for a good pathological response (TRG of 1 or 2) to chemoradiotherapy in our patient set with a sensitivity of 95.45% and a specificity of 72.72%.

Upfront Skeletal Muscle Metastases from Non-small Cell Lung Carcinoma: Report of an Extremely Rare Occurrence Detected by 18F-Fluorodeoxyglucose Positron Emission Computed Tomography Scan.

Adenocarcinoma lung with upfront metastases to skeletal muscle is rarely encountered in clinical practice since skeletal muscles are highly resistant to dissemination from solid organs. Moreover, these muscle metastatic lesions generally present with pain and palpable mass to get detected clinically. However, silent skeletal muscle metastases without any symptoms or signs getting detected by functional imaging with whole body 18F-fluorodeoxyglucose positron emission/computed tomography (18FDG-PET/CT) scan have been scarcely described in literature, while we present such an interesting case in a 45-year-old female. She was diagnosed as a case of biopsy-proven metastatic adenocarcinoma lung after evaluation by 18FDG-PET/CT. Despite treatment with palliative chemoradiotherapy, her disease progressed, and she finally succumbed to her illness. This case is discussed to highlight an unusual scenario we encountered, the clinical course of the disease with its management and overall poor prognosis.