case_images: PMC8273575_01
case_images: A T1cN3M1b NSCLC patient. (A) PET revealed that one occupying lesion is in left lung. There is one right supraclavicular lymph node enlargement and multiple mediastinal lymphadenopathies. Moreover, there were multiple bone metastases, including the fourth cervical vertebra, the left first rib, and the left pubis. (B) According to the immunohistochemical analysis, a diagnosis of poorly differentiated adenocarcinoma was made.
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case_images: Moreover, there were multiple bone metastases, including metastases in the fourth cervical vertebra, left first rib, and left pubis ( Figure 1A ). Based on the result of immunohistochemical analysis, a diagnosis of poorly differentiated adenocarcinoma was made ( Figure 1B ).
case_images: Tumor recurrence after treatment of crizotinib. (A) PET revealed multiple bone metastases in the right ilium and the right ischium. Moreover, there were multiple metastatic focuses in the brain. (B) The contrasted MR showed that the patient had BM. (C) The dose distribution of radiotherapy in BM. (D) The dose distribution of radiotherapy in the lesion of the right iliac bone.
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case_images: PET revealed multiple bone metastases in the right ilium and right ischium ( Figure 2A ). Moreover, there were multiple metastatic foci in the brain ( Figure 2A ). Contrast-enhanced magnetic resonance imaging (MRI) disclosed nine BMs ( Figure 2B ). The dose of WBRT was 39.6 Gy delivered in 22 fractions, and that of SIB was 55 Gy delivered in 22 fractions ( Figure 2C ). The patient also received radiotherapy of the right iliac bone lesion (60 Gy in 24 courses,  Figure 2D ).
case_images: The number of BM increased after radiotherapy. (A) The MR showed that the number of brain metastasis increased to about 50. (B) MR showed that the number of BM increased to about 80.
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case_images: MRI after completing 10 fractions of cranial radiotherapy. MRI indicated that the number of BMs had increased to approximately 50 ( Figure 3A ). After finishing WBRT, the patient became comatose, and MRI revealed approximately 80 BMs, including some in the brain stem ( Figure 3B ).
case_images: The number of BM decreased after treatment of alectinib. (A) MR showed that the number of brain metastasis decreased to about 60. (B) The number of brain metastasis further decreased to about 20.
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case_images: MRI revealed a reduction in the number of BMs to approximately 60 and a decrease in the total metastatic tumor volume ( Figure 4A ). MRI illustrated that most of the hematoma was absorbed and the number of BMs had further decreased to approximately 20 ( Figure 4B ).