case_images: PMC4546739_01
case_images: Computed tomography scan of the thorax showing left-sided local relapse in the pleura and thoracic wall after lobectomy. Status before palliative radiotherapy.
case_images: CRIONM2015-964687.001.jpg
case_images: PMC4546739_01_CRIONM2015-964687.001.jpg
case_images: fig1
case_images: In July 2013, 3D conformal palliative radiotherapy was administered to the region of pleural/thoracic wall recurrence (13 fractions of 3 Gy), Figure 1.
case_images: (a) Computed tomography scan of the thorax showing left-sided axillary nodal metastasis and mediastinal lymph node metastases. Status before palliative radiotherapy. (b) Computed tomography scan of the thorax showing right-sided pulmonary metastases (example of the patient's bilateral metastases). During radiotherapy, this region received a cumulative dose of <1 Gy.
case_images: CRIONM2015-964687.002.jpg
case_images: PMC4546739_01_CRIONM2015-964687.002.jpg
case_images: fig2
case_images: In November 2013, systemic progression was detected, with new bilateral pulmonary metastases and mediastinal and left-sided axillary lymph node metastases, Figures 2(a) and 2(b).
case_images: Skin lesions at the time of simulation before palliative radiotherapy to the mediastinum and left axilla. Bullous pemphigoid mainly involving trunk and arms.
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case_images: fig3
case_images: During radiotherapy, the bullous pemphigoid was exacerbated and secondary infection occurred (status at simulation shown in Figure 3).
case_images: Time course of neutrophil leukocyte and lymphocyte counts during follow-up. The green line corresponds to the date of the computed tomography scan showing the nontargeted effect. At this time, the patient had recovered from presumably radiation-related lymphopenia. Abnormally high lymphocyte counts were never detected. In contrast, several episodes of leukocytosis occurred.
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case_images: PMC4546739_01_CRIONM2015-964687.004.jpg
case_images: fig4
case_images: Serum C-reactive protein was elevated to 50 mg/L and leukocyte count was slightly elevated to 11.1 x 109/L (Figure 4).
case_images: Computed tomography scan of the thorax showing right-sided pulmonary metastases approximately 3 weeks after radiotherapy to other targets. Marked reduction in size.
case_images: CRIONM2015-964687.005.jpg
case_images: PMC4546739_01_CRIONM2015-964687.005.jpg
case_images: fig5
case_images: Computed tomography (CT) showed partial response of the irradiated and nonirradiated lesions (Figure 5, January 2014).
case_images: Computed tomography scan of the thorax showing progression of the right-sided pulmonary metastases approximately 3 months after radiotherapy to other targets. Temporary nontargeted effect.
case_images: CRIONM2015-964687.006.jpg
case_images: PMC4546739_01_CRIONM2015-964687.006.jpg
case_images: fig6
case_images: In April 2014, CT showed progression of all pulmonary metastases (Figure 6).