case_images: PMC6459944_01
case_images: Representative histologic image of patient's Merkel cell carcinoma with hematoxylin and eosin staining.
case_images: fonc-09-00223-g0001.jpg
case_images: PMC6459944_01_fonc-09-00223-g0001.jpg
case_images: F1
case_images: A 70-year-old male was diagnosed with Merkel Cell carcinoma of the right thigh (Figure 1).
case_images: Adjuvant radiation therapy plan of right thigh and groin showing axial and coronal representation.
case_images: fonc-09-00223-g0002.jpg
case_images: PMC6459944_01_fonc-09-00223-g0002.jpg
case_images: F2
case_images: Due to close surgical margins and inguinal nodal involvement, the patient received adjuvant intensity modulated radiation therapy (IMRT) to the right thigh and right pelvic and inguinal nodal region to a dose of 50 Gy delivered in 25 fractions (Figure 2), as well as consolidative carboplatin and etoposide post-operatively.
case_images: PET-imaging demonstrating metastatic dissemination of Merkel cell carcinoma. (A) whole body positronic imaging showing bilateral pelvic and retroperitoneal SUV avidity consistent with metastatic disease. (B) representative fused PET CT-scan axial imaging showing SUV avid retroperitoneal adenopathy.
case_images: fonc-09-00223-g0003.jpg
case_images: PMC6459944_01_fonc-09-00223-g0003.jpg
case_images: F3
case_images: Shortly after locoregional recurrence in the right pelvic nodal region, the patient developed metastatic disease involving bilateral pelvic nodes and the retroperitoneum on PET-scan (Figure 3).
case_images: Isolated left pelvic nodal progression on pembrolizumab. PET-scan showing SUV avid progression involving the left inguinal and left external iliac regions.
case_images: fonc-09-00223-g0004.jpg
case_images: PMC6459944_01_fonc-09-00223-g0004.jpg
case_images: F4
case_images: After 10 months of pembrolizumab (15 cycles), the patient had an isolated left inguinal and external iliac nodal progression (Figure 4).
case_images: Intensity modulated radiation therapy (IMRT) plan for left pelvic nodal progression to a prescription dose of 45 Gy delivered in 25 fractions with concurrent pembrolizumab.
case_images: fonc-09-00223-g0005.jpg
case_images: PMC6459944_01_fonc-09-00223-g0005.jpg
case_images: F5
case_images: For this reason, the patient was treated to the involved left inguinal and left external iliac nodes with IMRT to a dose of 45 Gy delivered in 25 fractions with concurrent pembrolizumab (Figure 5), without any acute radiation side effects.