case_images: PMC9834690_01
case_images: Computed tomography findings of the right supraclavicular lymph node (#1R) and mediastinal lymph node (#4R) metastases (a) before initiation of radiation therapy, (b) 3 months after radiation therapy, and (c) 9 months after radiation therapy
case_images: TCA-14-206-g002.jpg
case_images: PMC9834690_01_TCA-14-206-g002.jpg
case_images: tca14751-fig-0001
case_images: However, these lymph node metastases regrew, and a new right supraclavicular lymph node metastasis (#1R) developed 11 months after the initiation of first-line treatment (Figure 1a). However, computed tomography (CT) performed 3 months after radiation showed that the lesions within the radiation field had apparently progressed (Figure 1b). System) using the tissue obtained from mediastinal lymph node (#2R) metastasis before the initiation of radiotherapy revealed a KEAP1 Y525C mutation, estimated as a loss-of-function mutation, wild-type NRF2, and a TP53 R306* (c. 916C>T) mutation, a truncating mutation. She received subsequent chemotherapy (docetaxel as second-line therapy and S-1 as third-line), but the lesions inside and outside the radiation field (multiple lung metastases and pleural dissemination) rapidly progressed (Figure 1C), and a thrombus in the superior vena cava was observed.
case_images: Radiation treatment plan. Dose distribution of a volumetric modulated arc therapy plan in an axial (a), sagittal (b), and coronary (c) scan images
case_images: TCA-14-206-g003.jpg
case_images: PMC9834690_01_TCA-14-206-g003.jpg
case_images: tca14751-fig-0002
case_images: Since these were localized disease, she suspended the systemic therapy and initiated thoracic radiation therapy for localized lesions (volumetric modulated arc therapy: 60 Gray/30 Fractions [Figure 2]).