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case_images: PET-CT/CT scans of the primary lung tumor and hip bone lesion. Chest CT scans of the primary lung tumor prior to first-line treatment (A), after first-line treatment (B), and after second-line treatment (C); Pelvis CT scans of the hip bone lesion prior to first-line treatment (D and G), after first-line treatment (E), and after second-line treatment (F); PET-CT scans of the primary lung tumor in Apr 2018 (H) and Jan 2020 (J); PET-CT scans of the metastatic lesion to left hip joint in Apr 2018 (I) and Jan 2020 (K). Red arrows indicated the primary lung tumors and blue arrows indicated the hip bone lesions.
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case_images: Chest computed tomography (CT) noted a mass in the left lower pulmonary lobe (6.0 cm, Figure 1A). Pelvic CT revealed a soft tissue mass with bone destruction, which suggested a neoplastic lesion in the left-hip joint (Figure 1D and G). The enlargement of the primary lung lesion (Figure 1B) and stabilization of the left hip joint lesion was noted in Jan 2018 (Figure 1E). Positron emission tomography (PET)-CT scans in Apr 2018 revealed increased metabolic activity in both the primary lung tumor (Figure 1H) and metastatic lesion to the left-hip joint (Figure 1I). Despite the initial partial response, the disease progressed six months later, when CT scans showed an enlarged primary lung tumor (Figure 1C) while the hip joint metastasis remained stable (Figure 1F). TAC1-ALK (Tintergenic: A20) fusion with an AF of 15.51%. Crizotinib was continued after the surgery. As of the follow-up in Jan 2020, there was no sign of recurrent disease in the lung (Figure 1J), and the bone metastasis remained stable (Figure 1K). The patient was in high-performance status (ECOG PS of 1).
case_images: Diagram presentation of multimodal treatment described in this report. The patient underwent three lines of therapies that consisted of radiotherapy, ALK inhibitor crizotinib, and surgery, with molecular monitoring. Notably, salvage thoracic surgery was performed after progression on second-line treatment based on crizotinib and was followed by a remarkable PFS of 31 months at last follow-up.
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case_images: Feb 2017 revealed that either ALK fusions or other previously identified genomic aberrations were detected, and circulating tumor DNA (ctDNA) clearance was observed in all subsequent tests (Figure 2). Follow-up CT scans in Oct 2017 showed a reduction in the primary lung lesion (2.0 cm) consistent with a response evaluation of partial response. She had therefore achieved an overall survival of 51 months, including a noteworthy 31-month PFS after salvage thoracic surgery (Figure 2).