case_images: PMC11827419_01
case_images: Carcinoma changes:  tumor,  pleural effusion. (A) Before the treatment (2023-01-09), (B) On the day of the first intravenous infusion of Paberizumab, PET/CT scan (2023-01-19), (C) After the first cycle of antitumor therapy (2023-02-09): carboplatin + ABP + Pembrolizumab, (D) Third cycle of carboplatin + ABP + Pembrolizumab (2023-03-27), (E) Fourteen months later (2024-03-26).
case_images: fonc-14-1463772-g001.jpg
case_images: PMC11827419_01_fonc-14-1463772-g001.jpg
case_images: f1
case_images: Chest compute tomography (CT) scans showed a huge mass (13.9 cmx9.2 cm) in the anterior superior mediastinum (Figures 1A, 2A), accompanied by elevated left diaphragm, bilateral pleural effusion, pericardial effusion, and enlarged mediastinal lymph nodes ( Figure 1A ). Figure 1B ). Furthermore, vascular ultrasound and During the treatment process, as the tumor shrank and the pleural effusion decreased (Figures 1C, D) the patient's dyspnea gradually resolved, and his physical strength improved while his weight slowly increased, PS has gradually recovered ( Figure 3 ). In both the February 2024 enhanced CT reconstruction and the March 2024 CT scan, it showed that the largest cross-sectional dimension of the tumor was 6.3 cm x 3.0 cm, and there was no recurrence of pleural effusion ( Figures 1E , 2B).
case_images: (A). Enhanced CT angiography of the three-dimensional reconstruction reveals that the upper margin of the tumor extends beyond the aortic arch, while the lower margin reaches the inferior border of the heart, compressing the aortic arch, thoracic aorta, left pulmonary artery, and heart (2023-01-10). (B). After a year of treatment, the tumor showed significant shrinkage (2024-02-23).
case_images: fonc-14-1463772-g002.jpg
case_images: PMC11827419_01_fonc-14-1463772-g002.jpg
case_images: f2
case_images: Chest compute tomography (CT) scans showed a huge mass (13.9 cmx9.2 cm) in the anterior superior mediastinum (Figures 1A, 2A), accompanied by elevated left diaphragm, bilateral pleural effusion, pericardial effusion, and enlarged mediastinal lymph nodes ( Figure 1A ). In both the February 2024 enhanced CT reconstruction and the March 2024 CT scan, it showed that the largest cross-sectional dimension of the tumor was 6.3 cm x 3.0 cm, and there was no recurrence of pleural effusion ( Figures 1E , 2B).
case_images: Time and method of drug use, as well as tumor changes. C: Cycle; D: Day; CAB: Carboplatin (mg); ABP: Albumin-bound paclitaxel (mg); PBL: Pembrolizumab (mg); RIPI: Right intrapleural injection; LIPI: Left intrapleural injection; IV: Intravenous drip; RT: Radiation therapy; LMH: Low molecular weight heparin; PS: Performance Status; CT: Compute tomography; PET/CT: Positron emission tomography/Compute tomography; CAB(C1-D1): Carboplatin (administered on the first day of the first cycle).
case_images: fonc-14-1463772-g003.jpg
case_images: PMC11827419_01_fonc-14-1463772-g003.jpg
case_images: f3
case_images: In the fifth and sixth cycles, 300 mg of carboplatin was administered intravenously on the same day as ABP, and an additional 100 mg was injected into the LPC during the sixth cycle ( Figure 3 ). During the treatment process, as the tumor shrank and the pleural effusion decreased (Figures 1C, D) the patient's dyspnea gradually resolved, and his physical strength improved while his weight slowly increased, PS has gradually recovered ( Figure 3 ). Based on changes in the patient's hemoptysis and bloody pleural effusion, the dose of low-molecular-weight heparin was increased from 2,500 U once daily to 5,000 U every 12 hours and then gradually reduced until the end of radiotherapy ( Figure 3 ). Therefore, pembrolizumab maintenance therapy was resumed ( Figure 3 ).