case_images: PMC11366605_01
case_images: Patient's imaging and diagnose before anti-tumor treatment. (A-D)
  18F-FDG-PET/CT suggested a solid tumor (91 mm x 51 mm X 78 mm) in the right breast with multiple metastases. (E) Enhanced MRI of the head indicates intracranial metastasis. (F) Chest CT shows multiple lung metastases. (G) Right breast biopsy indicates invasive carcinoma, ER (-), PR (+, approximately 20%), Her-2 (3+), Ki-67 35%-40%. Cancer cells are observed in the pathological biopsy of the lymph node above the right clavicle. Immunohistochemical staining shows ER (-), PR (+, approximately 10%), Her-2 (3+), Ki-67 35%-40%. Cancer cells are found in the pathological biopsy of the right axillary lymph node, ER (-), PR (-), Her-2 (3+), Ki-67 approximately 35%-40%.
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case_images: F1
case_images: A magnetic resonance imaging (MRI) scan indicated multiple intracranial occupancies, which, in conjunction with the patient's medical history, suggested brain metastasis (Figure 1).
case_images: Complete treatment process of the patient since diagnosis. Brain MRIs of the patient were displayed. 1) Enhanced MRI of the head upon patient's admission in December 2020 displays multiple intracranial metastatic tumors. 2) The enhanced MRI of the head from August 2021 shows that compared to the baseline scan, the size and number of intracranial metastatic foci have increased (prior to radiation therapy). 3) Follow-up enhanced MRI of the head after radiation therapy in September 2021 demonstrates a reduction in the number and size of the intracranial metastatic tumors. 4) Before the Anlotinib treatment, the enhanced MRI of the head in August 2022 shows that the size and number of multiple brain parenchyma metastatic tumors have increased compared to previous scans. 5) The follow-up enhanced MRI of the head in November 2022 shows a significant reduction in the number and size of metastatic tumor lesions compared to previous scans.
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case_images: F2
case_images: The patient commenced first-line systemic chemotherapy in December 2020, following the albumin-bound paclitaxel, trastuzumab, and pertuzumab regimen (12 cycles each, Figure 2). An MRI review in June 2021 showed an increase in size and number of the patient's intracranial metastases, with the therapeutic response evaluated as progressive disease (PD) (Figure 2). A head MRI review in September 2021 indicated a reduction in the number and size of the patient's intracranial metastases (Figure 2). In the next follow-up, the patient experienced dizziness, and a head MRI review in August 2022 showed an increase in the size and number of the patient's intracranial metastases, with the therapeutic response evaluated as PD (Figure 2).
case_images: Illustration of the patient's radiation treatment planning and dose distribution. The red and purple isodose color-wash indicate doses of 60 Gy (GTV) and 40 Gy (whole-brain), respectively.
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case_images: F3
case_images: In June 2021, the patient began radiotherapy for the intracranial metastases, with a gross tumor volume (GTV) of 6000 cGy/20F (faction) and whole-brain irradiation of 4000 cGy/20F (Figure 3).
case_images: Brain MRIs of the patient before and after the Anlotinib treatment. (A) Before the Anlotinib treatment, the enhanced MRI of the head in August 2022 shows that the size and number of multiple brain parenchyma metastatic tumors have increased compared to previous scans. (B) The follow-up enhanced MRI of the head in November 2022 shows a significant reduction in the number and size of metastatic tumor lesions compared to previous scans.
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case_images: F4
case_images: An MRI review in November showed a decrease in tumor size, indicating successful tumor control (Figure 4B).