case_images: PMC5922490_01
case_images: This image demonstrates the metabolic changes observed on the 18F-FDG PET/CT at baseline (prior to initiating MS with TMZ in September 2015), restaging studies performed after 5 cycles, in May 2016, and 15 cycles, in March 2017, of the chemotherapy regimen consisting of MS with TMZ and high-dose lanreotide. In September 2015, maximum standardized uptake value (SUVmax) normalized to lean body mass (SULmax) of the most active lesion (marked in orange) was 23.12. In May 2016, a PMR was noted (SULmax) of the target lesion = 12.49, which is 45.9% reduction). In March and September 2017, there was stabilization of the PMR and no new lesions were detected on either of the studies. 18F-FDG PET/CT: 18F-fluorodeoxyglucose positron emission tomography/computed tomography; PMR: partial metabolic response; TMZ: temozolomide.
case_images: 10.1177_1179554918763367-fig1.jpg
case_images: PMC5922490_01_10.1177_1179554918763367-fig1.jpg
case_images: fig1-1179554918763367
case_images: Restaging 18F-FDG PET CTs performed in May 2016, after 5 cycles, and in March 2017, after 15 cycles, demonstrated a PMR and a stabilized PMR, respectively (Figure 1). On his latest 18FDG-PET/CT of September 2017 after 22 cycles, the patient continued to demonstrate prolonged stabilized PMR and currently he continues under 28th course of treatment (Figure 1).
case_images: PMC5922490_02
case_images: This image demonstrates the metabolic changes observed on the 18F-FDG PET CT 1 month after initiating TMZ in September 2015, restaging studies performed after 4 cycles, in January 2016, after 13 cycles, in October 2016, and after 17 cycles, in March 2017, of the chemotherapy regimen consisting of MS TMZ, denosumab, and high-dose lanreotide. In October 2015, maximum standardized uptake values (SUVmax) of the most active lesions located at the right iliac crest and the left third rib (marked in red) were 16.0 and 13.6, respectively. In January 2016, a PMR was noted of the right iliac crest lesion and of the left third rib lesion (SUVmax of 9.2 and of 7.9), showing a 42.5% and 41.9% of SUVmax reduction, respectively. In October 2016, there was a dissociated metabolic response. While the SUVmax of the right iliac lesion increased to 21.62, the SUVmax of the left third rib lesion decreased by 19.8% to 6.33. No new lesions were noted in either restaging studies. New lesions and increased metabolic activity were noted in the 18F-FDG PET CT performed in March 2017, indicating PMD. 18F-FDG PET/CT indicates 18F-fluorodeoxyglucose positron emission tomography/computed tomography; PMD, progressive metabolic disease; PMR, partial metabolic response; TMZ, temozolomide.
case_images: 10.1177_1179554918763367-fig2.jpg
case_images: PMC5922490_02_10.1177_1179554918763367-fig2.jpg
case_images: fig2-1179554918763367
case_images: The patient did not develop any adverse effects apart from grade 2 lymphopenia, which was managed with prophylactic antibiotics. 18F-FDG PET CT in October 2016 demonstrated a dissociated metabolic response and no new lesions were detected (Figure 2). Patient completed 17 cycles of this chemotherapy regimen in March 2017. 18F-FDG PET CT in March 2017 revealed PMD and this treatment regimen was discontinued (Figure 2).