case_images: PMC11236383_01
case_images: September 2021, PET-CT axial view, L3.
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case_images: F1
case_images: The patient exhibited an oligometastatic lesion in the body of L3 with some uptake in the left transverse process (Fig. 1).
case_images: Radiation planning, isodose line 95% from 21 Gy PTV. PTV, planning target volume.
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case_images: F2
case_images: Following a physical examination and imaging evaluation, a treatment plan was proposed for SBRT to L3, with a dose regimen of 21 Gy in 3 fractions for the CTV and 30 Gy integrated boost to GTV (Fig. 2, 3).
case_images: Radiation planning, isodose line 95% from 30 Gy PTV. PTV, planning target volume.
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case_images: F3
case_images: Following a physical examination and imaging evaluation, a treatment plan was proposed for SBRT to L3, with a dose regimen of 21 Gy in 3 fractions for the CTV and 30 Gy integrated boost to GTV (Fig. 2, 3).
case_images: December 2021, PET-CT axial view, L3 showing progressive disease in left transverse pedicle and left lamina.
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case_images: F4
case_images: A PET-CT scan conducted in December 2021 revealed progression at the left transverse process and body of vertebra, with a decreased uptake exactly at the GTV of the radiation plan (Fig. 4).
case_images: December 2021, PET-CT coronal view, L2-L4 progression.
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case_images: F5
case_images: April 2022, the patient continued to experience backache with no clinical improvement. A PET-CT scan conducted at that time revealed response in the isodose line of 95% for 30 Gy planning target volume with progression in the low-dose area of L3 and demonstrated disease progression in L2 and L4 (Fig. 5).
case_images: May 2022, re-radiation treatment planning. Red color 40 Gy, blue -30 Gy treatment planning volumes.
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case_images: F6
case_images: In May 2022, he received radiation totaling 30 Gy in 10 fractions, with an integrated boost up to 40 Gy encompassing all areas with high uptake observed in the PET-CT (Fig. 6).
case_images: November 2022, PET-CT coronal view, response in L2-L4.
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case_images: F7
case_images: The first radiological signs of the L3 vertebral fracture were observed (Fig. 7).