Purpose:To compare quantitatively Gross tumor volume (GTV), both primary and nodal areas of head and neck cancers, delineated on [18F]-2fluoro, 2deoxy d-glucose-positron emission tomography/computed tomography ([18F]-FDG-PET-CT) scan to those delineated on Contrast-enhanced CT scan (CECT scan).Methods:A total of 26 consecutive patients with squamous cell cancers of head and neck were included in this study. The primary sites were oropharynx (n = 7), hypopharynx (n = 6), paranasal sinus (n = 6), nasopharynx (n = 4), oral cavity (n = 2), and one with unknown primary and secondary neck node. All patients underwent routine staging work-up. FDG-PET and CECT scans were performed with dedicated PET-CT scanner in single session as a part of the radiotherapy treatment planning for Intensity modulated radiotherapy/Image-guided radiotherapy.Results:All patients had abnormal increased uptake in PET-CT scans. PET-CT resulted in changes of CT-based staging in 8 of 26 patients (up-staged in 7 and down-staged in 1). The mean primary and nodal GTV volumes on PET-CT and CT were significantly different (primary: PET-GTV: 48.43 ± 53.21 cc vs. CT 54.78 ± 64.47 cc, P < 0.001; nodes: PET-GTV: 12.72 ± 15.46 cc vs. 11.04 ± 14.87 cc, P < 0.001). The mismatch between two target volumes was statistically significant (P = 0.03 for GTV primary, P = 0.04 for GTV node).Conclusion:Accuracy of delineation of GTV can be improved along with functional imaging using [18F]-FDG. These metabolically active volumes are significantly smaller than CT-based volumes and could be missed during conventional CT-based target delineations of GTVs.
61 year old female presented with chief complaints of headache for 30 days, fever for 10 days, altered behavior for 10 days and convulsion for 2 days. She was diagnosed and treated as a case of carcinoma of left breast 5 years ago. MRI brain showed a lobulated lesion in the left frontal lobe. She came to our hospital for whole brain radiation as a diagnosed case of carcinoma of breast with brain metastasis. Review of MRI brain scan, revealed metastasis or query infective pathology. MR spectroscopy of the lesion revealed choline: creatinine and choline: NAA (N-Acetylaspartate) ratios of ∼1.6 and 1.5 respectively with the presence of lactate within the lesion suggestive of infective pathology. She underwent left fronto temporal craniotomy and evacuation of abscess and subdural empyema. Gram stain showed gram positive cocci. After 1 month of evacuation and treatment she was fine. This case suggested a note of caution in every case of a rapidly evolving space-occupying lesion independent of the patient's previous history.
Aim: The aim of this study was to determine diagnostic and prognostic roles of the neutrophil to lymphocyte ratio (NLR) in breast cancer patients, in view of disease-specific survival and the intrinsic subtype. Methods: We carried out a retrospective study of a sequence of 300 breast cancer registered between 2008 and 2012 at R.G.C.I, New Delhi, India. Results: The median age was 48years (range 18-88). The TNM stage distribution was stage I -3 %, stage II -20%, stage III -57%, and stage IV -20%. ER/PR and her2neu positivity was 50% and 20%, respectively. Triple-negative breast cancer (TNBC) constituted 30%. Patients with higher NLR (NLR ≥ 2.5) showed significantly lower disease-specific survival rate than those with lower NLR (NLR < 2.5). Higher NLR along with her2neu positive receptor status and positive nodal status were independently correlated with poor prognosis, with hazard ratio 2.08 (95% confidence interval [CI], 1.62-4 .28), 1.93 (95% CI, 1.08-3.99, and 3.23 (95% CI, 1.34-5.83), respectively. Triple-negative subtype was the only intrinsic subtype in which higher NLR patients showed significantly poor prognosis (87.7% vs. 96.7%, p = 0.009). Conclusions: Patients with an elevated pretreatment NLR showed poorer disease-specific survival than patients without elevated NLR, most evident in the triple-negative subtype. It has been suggested some immune check points are also play a part in the biology of triple-negative breast cancer. Disclosure: All authors have declared no conflicts of interest.
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