Publications by authors named "Nilendu Purandare"

229 Publications

Small cell carcinoma of the oesophagus: experience of an Indian Tertiary Cancer Centre.

Ecancermedicalscience 2022 19;16:1393. Epub 2022 May 19.

Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India.

Introduction: Small cell carcinoma of the oesophagus (SCCE) is a rare and aggressive tumour with no established standard treatment.

Methods: This is a retrospective study of adult patients with histologically proven SCCE registered between February 2011 and March 2020 at Tata Memorial Hospital in Mumbai.

Results: There were 56 patients, with 29 (51.8%) having limited-stage disease (LD) and 27 (48.2%) having extensive-stage disease (ED). The median age was 58 (interquartile range = 51-65) years; 57.1% were men; and 40% were smokers. Among LD-SCCE patients, 23 underwent local therapy, i.e., radiation (19, 65.5%) and surgery (4, 13.8%), and 27 received chemotherapy in neoadjuvant (23, 79.3%), concurrent (18, 62.1%) and adjuvant (4, 13.8%) settings. Totally, 19 ED-SCCE patients (70.4%) received chemotherapy. Prophylactic cranial irradiation (PCI) was delivered to 11 (37.9%) and 7 (25.9%) patients with LD-SCCE and ED-SCCE, respectively. Significant grade 3 or more chemotoxicities in patients with LD-SCCE and ED-SCCE included febrile neutropenia in 33.3% and 23.5%, anaemia in 9.5% and 17.6%, and dyselectrolytemia in 14.3% and 11.8%, respectively. The median overall survival (OS) in LD-SCCE and ED-SCCE was 22.9 (95% CI = 1.8-44.1) months and 11.8 (95% CI = 7.3-16.4) months, respectively. Age <60 years ( = 0.004) and tumour epicentre in the lower third oesophagus ( = 0.002) were independent good prognostic factors for OS in LD-SCCE and ED-SCCE patients, respectively. The incidence of brain metastasis was low, at both presentation (1/27, 3.7%) and relapse (5/56, 8.9%).

Conclusion: Although the survival of LD-SCCE is better than ED-SCCE, it is still under 2 years. Brain metastases are uncommon and the role of PCI is uncertain.
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http://dx.doi.org/10.3332/ecancer.2022.1393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9300396PMC
May 2022

Congenital Melanocytic Nevi Syndrome With Leptomeningeal Melanoma.

Clin Nucl Med 2022 Jul 19. Epub 2022 Jul 19.

From the Department of Nuclear Medicine and Molecular Imaging.

Abstract: The incidence of congenital melanocytic nevi (CMNs) is 1% to 6% for small- to intermediate-size nevi to 1 in 500,000 for giant size nevi. Large and satellite CMNs are known to be associated with neurocutaneous melanosis and central nervous system malformations such as Dandy-Walker malformation, defects of the vertebra-skull, and intraspinal lipomas. We hereby present a case of CMN syndrome in an 18-year-old girl with leptomeningeal melanoma, evaluated with MRI, adequately staged, and screened with FDG PET.
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http://dx.doi.org/10.1097/RLU.0000000000004354DOI Listing
July 2022

Comparison of 68Ga-FAPI PET and 18F-FDG PET Findings in a Patient With Bilateral Breast Cancer of 2 Different Histopathologies.

Clin Nucl Med 2022 Jun 10. Epub 2022 Jun 10.

Departments of Nuclear Medicine and Molecular Imaging.

Abstract: We present the findings of 18F-FDG PET and 68Ga-fibroblast activation protein PET scans done in a case of bilateral breast carcinoma with 2 different histopathology, left breast tubulolobular carcinoma and right breast invasive breast carcinoma of no special type.
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http://dx.doi.org/10.1097/RLU.0000000000004308DOI Listing
June 2022

Radiation Therapy Dose Escalation in Unresectable Ewing Sarcoma: Final Results of a Phase 3 Randomized Controlled Trial.

Int J Radiat Oncol Biol Phys 2022 Aug 11;113(5):996-1002. Epub 2022 May 11.

Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.

Purpose: Our aim was to assess the effect of radiation therapy (RT) dose escalation on outcomes in surgically unresectable Ewing sarcoma (ES)/primitive neuroectodermal tumor (PNET).

Methods And Materials: Patients with nonmetastatic unresectable ES/PNET (excluding intracranial/chest wall) receiving vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide chemotherapy, planned for definitive RT, were accrued in this single-institution, open-label, phase 3 randomized controlled trial. Randomization was between standard dose RT (SDRT; 55.8 Gy/31 fractions/5 days a week) versus escalated dose RT (EDRT; 70.2 Gy/39 fractions/5 days a week) with a primary objective of improving local control (LC) by 17% (65%-82%). Secondary outcomes included disease-free survival (DFS), overall survival (OS), and functional outcomes by Musculoskeletal Tumor Society score.

Results: Between April 2005 and December 2015, 95 patients (SDRT 47 and EDRT 48) with a median age of 17 years (interquartile range, 13-23 years) were accrued. The majority of patients were male (59%). Pelvis was the most common site of primary disease (n = 60; 63%). The median largest tumor dimension (9.7 cm) and the median maximum standardized uptake value (8.2) on pretreatment fluorodeoxyglucose positron emission tomography-computed tomography were similar. At a median follow-up of 67 months, the 5-year LC, DFS, and OS for the entire cohort was 62.4%, 41.3%, and 51.9%, respectively. The 5-year LC was significantly better in EDRT compared with SDRT (76.4% vs 49.4%; P = .02). The differences in DFS and OS at 5 years (for EDRT vs SDRT) did not achieve statistical significance (DFS 46.7% vs 31.8%; P = .22 and OS 58.8% vs 45.4%; P = .08). There was a higher incidence of Radiation Therapy Oncology Group grade >2 skin toxic effects (acute) in the EDRT arm (10.4% vs 2.1%; P = .08) with excellent functional outcomes (median Musculoskeletal Tumor Society score = 29) in both arms.

Conclusions: EDRT results in improved LC with good functional outcomes without a significant increase in toxic effects. Radiation dose escalation should be considered for surgically unresectable nonmetastatic ES/PNET.
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http://dx.doi.org/10.1016/j.ijrobp.2022.04.024DOI Listing
August 2022

FDG PET/CT in Metastatic Spindle Cell Sarcoma of Penile Origin: A Rare Malignancy.

Clin Nucl Med 2022 Jun 4;47(6):e470-e471. Epub 2022 Apr 4.

From the Departments of Nuclear Medicine and Molecular Imaging.

Abstract: Spindle cell sarcoma is a connective tissue tumor usually involving bone or muscle. Penis is an unusual and very rare site for the primary involvement of the tumor, especially mesenchymal tumor. We here present a case of a 27-year-old man diagnosed with spindle cell sarcoma of penile origin in which FDG PET/CT was done as part of workup.
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http://dx.doi.org/10.1097/RLU.0000000000004178DOI Listing
June 2022

Benign Metastasizing Leiomyoma and Findings on Fluorodeoxyglucose Positron Emission Tomography/Contrast-Enhanced Computed Tomography.

Indian J Nucl Med 2022 Jan-Mar;37(1):68-70. Epub 2022 Mar 25.

Department of Nuclear Medicine and Molecular Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India.

Benign metastasizing leiomyoma is a rare condition where benign smooth muscle tumors having a histological appearance similar to uterine leiomyoma are present at distant sites. This entity is commonly associated with a past history of hysterectomy done for uterine fibroids. The knowledge of the presence of significant fluorodeoxyglucose uptake in leiomyoma helped in the diagnosis of this condition in a 47-year-old patient who being evaluated for multiple unusual sites of metastases; this was further confirmed on histopathology.
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http://dx.doi.org/10.4103/ijnm.ijnm_118_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9037878PMC
March 2022

Audit of Demographics, Treatment Patterns and Outcomes of Differentiated Thyroid Cancers Treated with Tyrosine Kinase Inhibitors.

Indian J Surg Oncol 2022 Mar 29;13(1):81-86. Epub 2021 Oct 29.

Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.

The real-world patterns of TKI use in differentiated thyroid cancer (DTC) are largely governed by the accessibility and financial feasibility of the patient with more sorafenib use compared to lenvatinib. There are limited data available on the toxicity profile, safety and tolerance of sorafenib and lenvatinib in DTC. Hence, we audited our practice on DTC. This is a retrospective single-centre analysis of patients with DTC who were referred to the Department of Medical Oncology for systemic therapy. Baseline demographics (age, sex, ECOG PS, comorbidities, substance use), tumour details (site of metastasis), previous treatment details, clinical features at metastasis (symptoms), the pattern of treatment, adverse events and outcomes including progression and death were extracted. There were 67 patients with DTC referred for systemic therapy; the median age was 56 (33-81) with a male preponderance (55.6%). The most common reason to start TKI therapy was radioactive iodine (RAI) cumulative dose > 600 milliCurie, followed by low iodine uptake in the RAI low-dose scan done at progression. The most common TKI used in the first line was sorafenib in 56 (83.6%) patients followed by lenvatinib in 9 (13.4%) patients. Papillary thyroid carcinoma was the most common histology (51, 76.1%), and the rest were follicular carcinoma (16, 23.9%). With a median follow-up of 36 months, the median PFS was 13.2 months (95% CI 10.4-16.0). The median OS was 18.8 months (95% CI 10.0-27.6). Among variables tested, no factors had a significant impact on the PFS or OS. The most common adverse events were hand-foot syndrome (54, 80.5%), diarrhoea (23, 33.3%) and transaminitis (24, 34.4%). The pattern of care of patients with RAI-refractory DTC is TKI therapy, especially sorafenib and lenvatinib in the real-world settings with comparable efficacy and safety profile compared to international literature.
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http://dx.doi.org/10.1007/s13193-021-01445-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8986946PMC
March 2022

An Audit of Systemic Therapy in Medullary Carcinoma Thyroid.

Indian J Surg Oncol 2022 Mar 15;13(1):61-67. Epub 2021 Aug 15.

Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012 India.

There is a paucity of evidence of the impact of sorafenib on MCT and it is the preferred therapy used in India. We decided to do an audit of all patients of MCT who were referred to us for systemic therapy. The objective of this exercise was to identify the treatment pattern, outcomes, and adverse events with therapy in MCT. Baseline demographics (age, gender, ECOG PS, comorbidities, habits), tumor details (site of metastasis), previous treatment details, clinical features at metastasis (symptomatic or asymptomatic), the pattern of treatment, adverse events (CTCAE version 4.02), date of progression, date of death and status, and follow-up were extracted from the rare tumor database and electronic medical records. Out of 75 patients referred for therapy for MCT, 47 (62.7%) patients were considered for immediate tyrosine kinase inhibitors as they had symptomatic status and 28 (37.3%) patients were kept on observation due to the asymptomatic nature of the disease. Out of the 28 patients, 15 (53.6%, n = 28) patients were subsequently started on TKI while in 13 (46.4%, n = 28) patients observation was continued. In the overall cohort, the median PFS was 18.9 months (95% CI 11.9-29.9) and OS was 26.6 months (95% CI 14.4-39.0). Among variables tested, only female gender had an impact on PFS (hazard ratio = 0.364 95% CI 0.148-0.895; P = 0.028) and the absence of lung metastasis had a positive impact on OS (hazard ratio = 0.443 95% CI 0.207-0.95; P = 0.037). Most commonly used TKI was sorafenib (n = 61) and sunitinib in 1 patient. The most common adverse events with TKI were palmo-plantar dysesthesia (50, 80.6%) and oral mucositis (25, 40.2%). The strategy of treating symptomatic MCT and observing in asymptomatic MCT is associated with reasonable PFS and OS. Sorafenib is the most commonly used TKI in our setup and provides similar outcomes as globally.
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http://dx.doi.org/10.1007/s13193-021-01381-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8986934PMC
March 2022

18 F-FDG PET/CT Appearance of Radiation-Induced Delayed Transverse Myelitis.

Clin Nucl Med 2022 Sep 22;47(9):e589-e590. Epub 2022 Apr 22.

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, India.

Abstract: Delayed-onset radiation-induced myelitis is a rare but serious complication of radiation exposure to the spinal cord. In this report, we describe the 18 F-FDG PET/CT findings of radiation-induced myelitis in a patient with carcinoma of buccal mucosa treated with external beam radiotherapy.
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http://dx.doi.org/10.1097/RLU.0000000000004232DOI Listing
September 2022

Unusual Presentation of Helicobacter pylori Infection as PSMA-Avid Gastric Mass.

Clin Nucl Med 2022 Sep 6;47(9):e607-e608. Epub 2022 Apr 6.

From the Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.

Abstract: 68 Ga-PSMA PET/CT is one of the most common imaging uses for prostate cancer imaging. Although initially thought to be specific for prostate cancer, there are many evidences that are coming of its concentration in many other neoplastic and nonneoplastic pathologies. Helicobacter pylori is the most common bacteria causing gastric inflammation and usually presents with gastroduodenal ulcer. Here we present one unusual case of benign gastric mass formation caused by H. pylori infection with PSMA concentration.
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http://dx.doi.org/10.1097/RLU.0000000000004215DOI Listing
September 2022

Systemic inflammatory biomarkers in primary central nervous system lymphoma versus high-grade glioma: exploratory, comparative and correlative analysis.

CNS Oncol 2022 06 4;11(2):CNS83. Epub 2022 Apr 4.

Department of Radiation Oncology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, 400012, India.

To assess systemic inflammatory biomarkers in non invasive differential diagnosis of primary central nervous system lymphoma (PCNSL) from high-grade glioma (HGG). Patients with similar morphology (PCNSL or HGG) on conventional neuro-imaging were included. Systemic inflammatory indices were calculated from pretreatment complete blood counts and liver function tests and compared against histopathology as reference standard. Mean values of absolute lymphocyte count and prognostic nutritional index were significantly different between PCNSL (n = 42) versus HGG (n = 16). Area under receiver operating characteristics curve for absolute lymphocyte count and prognostic nutritional index in the diagnosis of PCNSL was 0.70 and 0.72 respectively suggesting fair and acceptable diagnostic accuracy. Systemic inflammatory biomarkers complement established clinico-radiological features and aid in the differential diagnosis of PCNSL from HGG.
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http://dx.doi.org/10.2217/cns-2022-0004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9134933PMC
June 2022

Radiomics: a quantitative imaging biomarker in precision oncology.

Nucl Med Commun 2022 May;43(5):483-493

Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, The Netherlands.

Cancer treatment is heading towards precision medicine driven by genetic and biochemical markers. Various genetic and biochemical markers are utilized to render personalized treatment in cancer. In the last decade, noninvasive imaging biomarkers have also been developed to assist personalized decision support systems in oncology. The imaging biomarkers i.e., radiomics is being researched to develop specific digital phenotype of tumor in cancer. Radiomics is a process to extract high throughput data from medical images by using advanced mathematical and statistical algorithms. The radiomics process involves various steps i.e., image generation, segmentation of region of interest (e.g. a tumor), image preprocessing, radiomic feature extraction, feature analysis and selection and finally prediction model development. Radiomics process explores the heterogeneity, irregularity and size parameters of the tumor to calculate thousands of advanced features. Our study investigates the role of radiomics in precision oncology. Radiomics research has witnessed a rapid growth in the last decade with several studies published that show the potential of radiomics in diagnosis and treatment outcome prediction in oncology. Several radiomics based prediction models have been developed and reported in the literature to predict various prediction endpoints i.e., overall survival, progression-free survival and recurrence in various cancer i.e., brain tumor, head and neck cancer, lung cancer and several other cancer types. Radiomics based digital phenotypes have shown promising results in diagnosis and treatment outcome prediction in oncology. In the coming years, radiomics is going to play a significant role in precision oncology.
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http://dx.doi.org/10.1097/MNM.0000000000001543DOI Listing
May 2022

Granulomatous Lung Nodule Mimicking as Metastasis on F18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in a Case of Adrenocortical Carcinoma.

Indian J Nucl Med 2021 Oct-Dec;36(4):453-454. Epub 2021 Dec 15.

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.

A variety of fungal pulmonary infections can produce radiologic findings that mimic malignancy. Distinguishing these infectious lesions from malignancy remains challenging for physicians. We describe one such case where fungal lung nodule mimicked metastasis on fluorodeoxyglucose positron emission tomography/computed tomography scan.
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http://dx.doi.org/10.4103/ijnm.ijnm_48_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8771079PMC
December 2021

Recurrent Gastric Cancer Metastasizing to the Bone Marrow Detected on F-Fluorodeoxyglucose Positron Emission Tomography/Contrast-Enhanced Computed Tomography Scan.

Indian J Nucl Med 2021 Oct-Dec;36(4):445-446. Epub 2021 Dec 15.

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.

Gastric cancer is one of the important causes of cancer-related mortality worldwide, with significantly low median survival in metastatic gastric cancer. Thus, when planning treatment for gastric cancer, it becomes important to determine whether or not there is metastasis. Bone marrow is a rare region for metastasis in cases of gastric carcinoma, as suggested by the literature. We are herewith presenting the case of a 56-year-old patient of recurrent gastric carcinoma who showed a rare site of metastasis involving marrow on fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan.
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http://dx.doi.org/10.4103/ijnm.ijnm_64_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8771076PMC
December 2021

18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Findings of Osteoblastoma Of Rib - A Rare Benign Tumor with Unusual Site and Uncommon Age.

Indian J Nucl Med 2021 Oct-Dec;36(4):443-444. Epub 2021 Dec 15.

Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India.

Osteoblastoma accounts for approximately 1% of all primary bone tumors. We report F18-fluorodeoxyglucose positron emission tomography/computed tomography (F18-FDG PET/CT) findings of an osteoblastoma in the rib of a 20-month-old girl child, who had fever with pain in the right shoulder for 4 months. This lesion was initially judged as a malignant bone tumor but a biopsy revealed it to be an osteoblastoma. The age of patient and predominant site of disease involvement contributes to uniqueness of our case. In our case, F18-FDG PET/CT has facilitated biopsy planning and ruled out other sites of disease involvement.
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http://dx.doi.org/10.4103/ijnm.ijnm_68_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8771061PMC
December 2021

Rare Presentation of Radiation-induced Sarcoma Detected on F-18 FDG Positron Emission Tomography/Computed Tomography in a Treated Case of Giant Cell Tumor.

Indian J Nucl Med 2021 Oct-Dec;36(4):429-431. Epub 2021 Dec 15.

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India.

Giant cell tumors (GCTs) are benign bone lesions which are treated with curettage and bone grafting. Infrequently, GCTs show local site recurrences which are then treated with either surgical excision or radiation therapy. Radiation-induced sarcoma is rarely seen as a late complication of radiation therapy which needs to be differentiated from recurrent GCT. We report one such rare case of radiation-induced sarcoma detected on Flourine-18 fluorodeoxyglucose (18F FDG) positron emission tomography/computed tomography in a 40-year-old male who was treated with radiation therapy for recurrent GCT 9 years ago.
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http://dx.doi.org/10.4103/ijnm.ijnm_61_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8771068PMC
December 2021

Incidentally Detected COVID-19 Lung Changes during Oncologic Fluorodeoxyglucose Positron Emission Tomography-Computerized Tomography Studies: Experience from Tertiary Care Cancer Hospital.

Indian J Nucl Med 2021 Oct-Dec;36(4):357-361. Epub 2021 Dec 15.

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.

Objective: The objective is to evaluate incidental detection of COVID-19 lung involvement in asymptomatic individuals who undergo fluorodeoxyglucose (FDG) positron emission tomography-computerized tomography (PET/CT) scans for oncologic indications.

Patients And Methods: The study was conducted in a tertiary care oncology hospital and included patients who were asymptomatic for COVID-19 infection and underwent FDG PET/CT scans for standard oncologic indications between April 15, 2020, and September 30, 2020. Patients who showed CO-RADS category 4/5 changes (high level of suspicion) on the CT chest component of the PET/CT study were considered for analysis. CT severity score, presence of FDG uptake, and maximum standardized uptake value of FDG avid lung involvement were noted and correlated with reverse transcriptase-polymerase chain reaction (RT-PCR) test.

Results: 1982 PET/CT scans were performed, 78 (3.9%) patients showed lung changes with high degree of suspicion of COVID-19 pneumonia (CO-RADS 4/5). Hematolymphoid and head-neck cancer were the most common tumor types (23%), and restaging/response evaluation was the most common PET/CT indication. Of the patients who underwent RT-PCR testing, 70% showed a positive result. The mean CT severity score was 6 (standard deviation 5.9) with no significant difference seen between the RT-PCR positive and negative groups. FDG avidity in lung lesions was noted in 41 out 57 (72%) patients. A significant correlation was seen between the RT-PCR positivity and FDG uptake in lung lesions.

Conclusion: A small but significant proportion of patients undergoing routine oncologic PET/CT scans showed incidental COVID-19 lung involvement. Lung involvement in these asymptomatic patients showed a low CT severity score in all patients and FDG avidity in majority. Timely detection of such incidental cases can initiate further confirmatory RT-PCR testing and isolation measures that not only influence patient's cancer treatment protocols but also have a larger community impact of limiting the spread of infection.
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http://dx.doi.org/10.4103/ijnm.ijnm_94_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8771077PMC
December 2021

Sunitinib-Induced Myositis Detected on 18F-FDG PET/CT.

Clin Nucl Med 2022 Mar;47(3):e311-e312

From the Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.

Abstract: Sunitinib is one of the most commonly used multikinase inhibitors for metastatic renal cell carcinoma. Myositis is one of the rarest known adverse effects of sunitinib. Presenting herewith one such case with its relevant imaging findings on FDG PET/CT and ultrasound.
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http://dx.doi.org/10.1097/RLU.0000000000004035DOI Listing
March 2022

Prognostic value of lung shunt fraction in hepatocellular carcinoma and unresectable liver dominant metastatic colorectal cancer undergoing transarterial radioembolisation.

Nucl Med Commun 2022 Jan;43(1):24-31

Department of Nuclear Medicine and Molecular Imaging.

Aim: To assess the overall survival and determine whether pre-TARE shunt fraction, tumor volume and tumor marker impact the outcome.

Methods: This is a retrospective study of 75 patients who were referred for 90Y-glass microsphere radioembolisation by a joint clinic decision between 1 January 2010 and 31 December 2014. All patients underwent pre-TARE CECT and 99mTc-MAA lung shunt fraction (LSF) imaging.

Results: Overall survival was 19 months for hepatocellular carcinoma (HCC) and 24 months for metastatic colorectal carcinoma. For hepatocellular carcinoma-LSF higher than 6.51 % was predictive of significantly decreased survival (P value 0.00). A progressive disease in survival was observed as LSF increased from less than 6.51 % to more than 20%. Tumor volume and tumor marker did show correlation with patient outcomes. For metastatic colorectal carcinoma-LSF and tumor marker did not show significant correlation with survival and tumor volume showed significant correlation with survival with P value of 0.049.
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http://dx.doi.org/10.1097/MNM.0000000000001492DOI Listing
January 2022

Diagnostic performance of F-fluorodeoxyglucose positron emission tomography/computed tomography in anorectal melanoma.

World J Nucl Med 2021 Jul-Sep;20(3):215-221. Epub 2021 Aug 20.

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India.

To evaluate the diagnostic role of F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in initial staging and restaging of anorectal melanoma. This was a single-institution, retrospective observational study; patients for initial staging and with clinical or radiological suspicion of disease recurrence referred for PET/CT between January 2006 and December 2015 were included in the study. Diagnostic performance of PET/CT was evaluated for baseline staging and disease recurrence. A total of 61 patients who were referred for initial staging were included. PET/CT correctly detected primary lesion in 57 (93.44%) cases, regional nodes in 46 (75.4%) cases, nonregional nodes in 22 (36%) cases, and distant metastases in 25 (41%) cases. The sensitivity (SN); specificity (SP); positive predictive value (PPV); negative predictive value (NPV); and accuracy for primary lesion, regional nodes, nonregional nodes, and distant metastases were 96.6%, 100%, 100%, 50%, and 96.7%; 97.9%, 100%, 100%, 93.3%, and 98.4%; 100%, 100%, 100%, 100%, and 100%; and 100%, 100%, 100%, 100%, and 100%, respectively. A total of 24 patients were included for suspected recurrence/restaging. All the patients were treated previously by surgery, radiotherapy, or chemotherapy. PET/CT detected disease recurrence in 20 (83.3%) patients. Ten patients had recurrence at the primary site, 8 of whom also had distant metastases and 2 had only locoregional metastatic nodes. In the remaining 10 patients, there was no primary site recurrence; however, 2 patients had locoregional nodal and distant metastases and 8 patients had only distant metastases. PET/CT was false negative in 1 patient, which missed liver metastasis. SN, SP, PPV, and NPV of PET/CT was found to be 95%, 100%, 100%, and 75%, respectively, with accuracy of 96%. PET/CT demonstrates overall high diagnostic accuracy in the initial staging and detection of recurrent disease in cases of anorectal melanoma.
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http://dx.doi.org/10.4103/wjnm.WJNM_116_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8488889PMC
August 2021

Spectrum of Flurodeoxyglucose Positron Emission Tomography/Computerized Tomography Findings in Tumors and Tumor-Like Conditions of the Musculoskeletal System.

Indian J Nucl Med 2021 Jul-Sep;36(3):327-339. Epub 2021 Sep 23.

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India.

Bone and soft-tissue tumors display a wide range of metabolic activity on flurodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) imaging due to their varying histopathological features. Several benign tumors show high FDG uptake similar to that seen in malignant lesions and their metabolic characteristics can overlap. Certain benign tumors can potentially undergo malignant transformation and FDG PET/CT can play an important role in detecting malignant change. The intensity of metabolic activity on FDG PET/CT correlates with histological grade of malignant tumors and also acts as a valuable prognostic factor. FDG PET/CT plays an important role in the staging work up of bone and soft-tissue malignancies. It has been found to be superior to conventional imaging techniques primarily for detecting distant metastatic disease. Because of its ability to detect metabolic changes, FDG PET/CT is a very useful in assessing response to treatment. Metabolic response seen on FDG PET is a powerful surrogate marker of histopathological response to chemotherapy. The purpose of this article is to study the variable patterns of FDG uptake in tumors of the musculoskeletal system, describe the clinical utility of FDG PET/CT in predicting malignant change in benign tumors and discuss its role in staging, response assessment, and prognostication of malignant lesions.
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http://dx.doi.org/10.4103/ijnm.ijnm_242_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8481850PMC
September 2021

F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Postsurgical and Postprocedural Setting in Thorax and Abdominopelvic Malignancies: A Pictorial Essay (Part II).

Indian J Nucl Med 2021 Jul-Sep;36(3):319-326. Epub 2021 Sep 23.

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, HBNI (Homi Bhabha National Institute), Parel, Mumbai, India.

This pictorial essay depicts normal appearances, complications and residual or recurrent disease on fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) studies in the postsurgical and postprocedural setting, other than head and neck malignancy. Reading and reporting FDG PET/CT in this scenario is daunting due to the multiple confounding false positives seen during this period. This article which is the second part in this series will familiarize the readers with the normal appearance and pitfalls seen in FDG PET/CT studies in thoracic and abdominopelvic malignancies during the postoperative and postprocedural period so as to avoid misinterpretations.
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http://dx.doi.org/10.4103/ijnm.ijnm_223_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8481839PMC
September 2021

All that Glitters on PSMA is Not a Lesion: An Unusual Artifact on PSMA PET/CT.

Indian J Nucl Med 2021 Jul-Sep;36(3):310-311. Epub 2021 Sep 23.

Professor, Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India.

Nonspecific uptake of prostate-specific membrane antigen (PSMA) on PSMA positron-emission tomography/computed tomography (CT) is normally encountered in benign conditions, which is detected on morphological changes on CT component. However, having a site of uptake without any CT finding is a rare occurrence. We herewith report one such rare case of a 66-year-old male with metastatic prostatic adenocarcinoma, who demonstrated an incidental finding of intense focal PSMA uptake in the lung parenchyma.
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http://dx.doi.org/10.4103/ijnm.ijnm_3_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8481840PMC
September 2021

Dural Metastasis in Spinal Canal Diagnosed on F-18 Fluorodeoxyglucose Positron Emission Tomography Contrast-Enhanced Computed Tomography Scan in Treated Case of Osteogenic Sarcoma of the Left Femur.

Indian J Nucl Med 2021 Jul-Sep;36(3):304-306. Epub 2021 Sep 23.

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, E. Borges Road. Parel, Mumbai, Maharashtra, India.

We describe a rare case of osteogenic sarcoma of the right femur; who 2 years after the treatment of primary site developed dural metastasis. Surveillance imaging for unusual pattern of metastasis may lead to earlier detection and treatment decision-making, which may improve survival and quality of life.
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http://dx.doi.org/10.4103/ijnm.ijnm_237_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8481849PMC
September 2021

FDG PETCT for assessing marrow involvement at staging pediatric nonhematological round cell malignancies.

Nucl Med Commun 2022 Jan;43(1):56-63

Department of Nuclear medicine and Molecular Imaging, Tata Memorial Hospital, Parel.

Background And Hypothesis: Bone and lung are the common sites of metastasis in pediatric round cell tumors and its presence indicates poor outcomes. Staging workup for these malignancies thus includes bone marrow biopsy (BMB) along with evaluation of thorax, and tissue analysis for N MYCN status in neuroblastoma. BMB is an invasive procedure requiring general anesthesia with known disadvantages.With an aim of avoiding an invasive BMB a study was taken up to evaluate efficacy of FDG PET CT in detecting marrow involvement in neuroblastoma and rhabdomyosarcoma at staging.

Materials And Method: Prospective observational study evaluated 83 newly diagnosed treatment naïve patients of neuroblastoma (n = 43) and rhabdomyosarcoma (n = 42) who underwent conventional imaging of PETCT with CECT of local region along with a CT thorax and BMB (both iliac crest) done within 1 week. Findings of FDG PETCT were compared with bone marrow histology and accuracy parameters were calculated.

Result: The overall sensitivity, specificity, accuracy, positive-predictive value (PPV), negative-predictive value (NPV) of FDG PETCT for detection of marrow disease was 100%, 86.1%, 89.4%. 68.9% and 100%, respectively. Subset analysis showed sensitivity, specificity, PPV and NPV of 100%, 66%, 71.4% and 100%, respectively, for neuroblastoma, with rhabdomyosarcoma patients having few events NPV of 100% accuracy of 97.6%.

Conclusion: FDG PETCT with sensitivity and NPV of 100% can be considered as a first stop imaging and biopsy can be avoided in patients with a negative scan.
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http://dx.doi.org/10.1097/MNM.0000000000001491DOI Listing
January 2022

Outcomes of osteosarcoma, chondrosarcoma and chordoma treated with image guided-intensity modulated radiation therapy.

Radiother Oncol 2021 11 28;164:216-222. Epub 2021 Sep 28.

Department of Nuclear Medicine & Molecular Imaging, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.

Background & Purpose: To evaluate the efficacy and toxicity of dose-escalated image guided-intensity modulated radiation therapy (IG-IMRT) in osteosarcoma (OGS), chondrosarcoma (CS) and chordoma (CH) of head and neck (H&N) and pelvis.

Methods And Materials: In this prospective non-randomized study, 65 patients of H&N or pelvic OGS (24), CS (7) and CH (34) mandating definitive or post-operative radiotherapy from May 2013 to December 2018 were included. Radiotherapy doses in definitive setting were 72.0 Gy for CH and 70.2 Gy for OGS and CS; while in post-operative setting it was 66.6 Gy and 64.8 Gy respectively (at 1.8 Gy per fraction).

Results: Planned doses of radiotherapy could be completed in 61 (93.8%) patients; with grade III or higher acute and late toxicities of 3% and 0% respectively. With a median follow-up of 52 (range 6-92) months, the five-year actuarial local control (LC) rates were 66% in OGS, 38.1% in CS and 75.9% in CH; while cause-specific survival (CSS) rates were 54.7%, 64.3% and 92.2% respectively. There was no statistically significant difference in outcomes for patients receiving definitive and post-operative radiotherapy. Locally controlled disease at first follow-up after radiotherapy was associated with improved CSS and OS in CS (p = 0.014) and CH (p < 0.001). Radiotherapy resulted in significant and sustained improvement in Musculoskeletal tumour society (MSTS) score and reduction in pain score. Salvage re-irradiation was feasible in local progression after radiotherapy, with good outcomes and tolerability.

Conclusion: Dose-escalated IG-IMRT results in good LC & functional improvement with minimal toxicity in OGS, CS and CH.
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http://dx.doi.org/10.1016/j.radonc.2021.09.018DOI Listing
November 2021

Bone marrow biopsy in PCNSL: Relevant or redundant?

Neuro Oncol 2021 12;23(12):2117-2118

Department of Medical Oncology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai,India.

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http://dx.doi.org/10.1093/neuonc/noab185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8643457PMC
December 2021

Ga-DOTATATE PET/CT imaging in endogenous hyperinsulinemic hypoglycemia: A tertiary endocrine centre experience.

Clin Endocrinol (Oxf) 2022 02 8;96(2):190-199. Epub 2021 Sep 8.

Department of Endocrinology, Seth GS Medical College & KEM Hospital, Mumbai, India.

Objective: Literature regarding utility of Ga-DOTATATE PET/CT in insulinoma localization across various subgroups [benign/malignant/multiple endocrine neoplasia-1 (MEN-1) syndrome associated] remains scarce. In this study, the performance of Ga-DOTATATE PET/CT was compared with contrast-enhanced computed tomography (CECT) and Ga-NODAGA-Exendin-4 PET/CT (whenever available) in an endogenous hyperinsulinemic hypoglycemia (EHH) cohort.

Design: Retrospective audit.

Patients: EHH patients [N = 36, lesions (n) = 49, final diagnosis: benign sporadic insulinoma (BSI) (N = 20), malignant insulinoma (N = 4, n = 14), MEN-1 syndrome associated insulinoma (N = 9, n = 15), Munchausen syndrome (N = 2) and drug-induced hypoglycemia (N = 1)] having both preoperative imaging modalities (CECT and Ga-DOTATATE PET/CT).

Measurements: Per-lesion sensitivity (Sn) and positive predictive value (PPV) for histopathological diagnosis of insulinoma.

Results: Sn and PPV of Ga-DOTATATE PET/CT were 67.3% and 89.2%; 55% and 100%; 85.7% and 100%; and 66.7% and 77% for overall EHH, BSI, malignant, and MEN-1 syndrome associated insulinoma cohorts respectively. Despite having comparatively lower sensitivity in BSI cohort, Ga-DOTATATE PET/CT localized a pancreatic tail lesion missed by other modalities. Ga-DOTATATE PET/CT had comparatively higher sensitivity in malignant insulinoma than BSI cohort. Ga-DOTATATE PET/CT also paved the way for successful response to Lu-based peptide receptor radionuclide therapy (PRRT). In MEN-1 cases, lower PPV as compared with BSI was due to uptake in non-insulinoma pancreatic neuroendocrine tumours (Pan-NET).

Conclusions: Ga-DOTATATE PET/CT has supplemental role in selected cases of BSI with negative and/or discordant results with CECT and Ga-NODAGA-Exendin-4 PET/CT. In malignant insulinoma, Ga-DOTATATE-PET/CT has an additional theranostic potential. Interference due to uptake in non-insulinoma Pan-NET in MEN-1 syndrome may hinder insulinoma localization with Ga-DOTATATE-PET/CT.
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http://dx.doi.org/10.1111/cen.14586DOI Listing
February 2022

Brain FET PET tumor-to-white mater ratio to differentiate recurrence from post-treatment changes in high-grade gliomas.

J Neuroimaging 2021 Nov 13;31(6):1211-1218. Epub 2021 Aug 13.

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.

Background And Purpose: Highergrade glial neoplasms undergo standard treatment with surgery, radiotherapy, and alkylating agents. There is often a clinical/neuroimaging dilemma in the post-treatment setting to differentiate disease recurrence from treatment-related changes. FET (fluoro-ethyl-tyrosine) PET has emerged as a molecular imaging modality for cases where MR imaging is inconclusive. This study aims to develop a cutoff on FET PET for differentiating true recurrence from post-treatment changes.

Methods: We retrospectively analyzed72 patientswith post-treatment grade 3 or 4 brain gliomas. Five to six mCi of F-FET was injected and static imaging of the brain was performed at 20 min. A tumor-to-white matter (T/Wm) ratio was used as semiquantitative parameter. A T/Wm cutoff of 2.5 was used for image interpretation. Imaging findings were confirmed by either histopathologic diagnosis in a multidisciplinary joint clinic or based on follow-up of clinical and neuroimaging findings.

Results: Forty-one of 72 patients (57%) showed recurrent disease on FET PET. Thirty-five of them were confirmed to have tumor recurrence; six patients showed post-treatment changes. Thirty-one of 72 patients (43%) showed post-treatment changes on FET PET; 27 were confirmed as post-treatment change and four patients had tumor recurrence on subsequent MR imaging. An optimum T/Wm cutoff of 2.65 was derived based on receiver operating characteristic analysis with a sensitivity of 80% and specificity of 87.5%.

Conclusion: Static FET PET can be used as problem-solving imaging modality with a T/Wm cutoff of 2.65 to differentiate late recurrence from post-treatment changes in grade 3 or 4 brain gliomas with equivocal MR features.
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http://dx.doi.org/10.1111/jon.12914DOI Listing
November 2021

Pelvic Venous Thromboembolism Leading to Pulmonary Embolism in a Case of Chondroblastic Osteosarcoma Detected on FDG PET/CT.

Indian J Nucl Med 2021 Apr-Jun;36(2):231-232. Epub 2021 Jun 21.

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.

Chondroblastic osteosarcoma is an uncommon subtype of osteosarcoma, constituting about 25% of all osteosarcoma cases. It has shown high propensity for developing tumor thrombi and thromboembolism, with poor overall survival rate. Differentiation between tumor thrombus and bland thrombus is an important factor in making treatment decisions. 18 F fluorodeoxyglucose positron emission tomography/computed tomography plays a very important role in detecting and differentiating bland thrombus from tumor thrombus.
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http://dx.doi.org/10.4103/ijnm.ijnm_239_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8320837PMC
June 2021
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