case_images: PMC10665082_01
case_images: Diagnostic imaging of NPC at primary site. CT scan demonstrating a large mass at the right nasopharynx upon diagnosis (A). MRI of nasopharynx demonstrating complete response following chemoradiation and adjuvant chemotherapy (B).
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case_images: Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a large right nasopharyngeal-enhancing soft tissue mass obstructing the nasopharyngeal airway and extending into the right posterior nasal cavity, pterygopalatine fossa, nasopalatine fossa and inferior sphenoid sinus ( Figure 1A ). Post-treatment MRI scans suggested complete response ( Figure 1B ).
case_images: Diagnostic imaging of NPC metastasis. PET scan demonstrating bony lesions in the right femur (A) and multiple iliac bony lesions and metastatic adenopathy in the abdomen, retroperitoneum, and chest (B) prior to gemcitabine/cisplatin (G/C) chemotherapy. CT scan after 4 cycles of G/C chemotherapy demonstrating resolution of metastatic adenopathy (C). PET scan after 8 cycles of G/C chemotherapy demonstrating cancer progression in the ilium, retroperitoneum, and pelvis (D). Latest CT scan to date (22 months post-pembrolizumab) demonstrating stable healed bony metastasis (E).
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case_images: Treatment was initiated with analgesics, packed red cell transfusion, palliative radiation 2000 Gy in 5 fractions to the femur, zoledronic acid 4 mg IV, and gemcitabine/cisplatin chemotherapy on a 21 day schedule. There was rapid improvement in the patient's pain and a CT of the abdomen and pelvis following cycle 4 chemotherapy demonstrated complete resolution of the retroperitoneal and pelvic metastatic adenopathy ( Figure 2C ). PET/CT after cycle 8 demonstrated cancer progression with new intrathoracic, retroperitoneal, and pelvic nodal lesions and left iliac bony lesion ( Figure 2D ). Subsequent CT results to date show only stable healed bony metastasis ( Figure 2E ).
case_images: Timeline of disease progression and treatment.
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case_images: The patient's treatment timeline and EBV titers are summarized in  Figure 3 ;  Table 1 , respectively.