case_images: PMC11004365_01
case_images: Thoracic CT-scan images axial sections (A) Pulmonary lesion in the posterioir right upper lobe (48mm); (B) Partila regression of the pulmonary lesion (22 mm); 18F-FDG PET scan images axial sections (C) Hypermetabolic bone lesion of the right iliac spine; (D) Partial metabolic response of the bone lesion.
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case_images: The patient presented concomitant extra-cerebral relapse with a nodule in the posterior segment of the right upper lobe (48 mm) ( Figure 1A ) and an osteolytic lesion of the right sacral. After two cycles, the revaluation showed regression of the right upper nodule to 22 mm versus the initial 48 mm ( Figure 1B ), but due to digestive (grade 2 anorexia, grade 2 mucositis) and hematological toxicity (grade 4 thrombocytopenia), chemotherapy was stopped, and pembrolizumab monotherapy was continued. Six cycles later, 18F-FDG PET scan showed metabolic mediastinal, supraclavicular and hilar lymph nodes and bone progression in the right iliac spine ( Figure 1C ). Paclitaxel (80 mg/m2) and Bevacizumab (10 mg/kg) as second-line treatment allowed a partial bone response and a complete lymph node response during eleven months ( Figure 1D ).
case_images: PMC11004365_02
case_images: Thoraric CT-scan images axial section (A) Left hilar tumoral lesion. (B) Appearance of a left plural effusion and progression lower right paratracheal area lymph nodw (4R).
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case_images: Patient B: A 60-year-old male patient with a medical history of supraglottic laryngectomy due to squamous cell carcinoma, chronic obstructive lung disease, ongoing smoking and chronic alcoholism was diagnosed with pulmonary and brain metastatic lung adenocarcinoma (cT4N3M1c according to 8th TNM edition) ( Figure 2A ). Weekly carboplatin (AUC2) and paclitaxel (80 mg/m2) chemotherapy due to respiratory and general fragility was proposed during two cycles without efficacy ( Figure 2B ).
case_images: PMC11004365_03
case_images: 18F-FDG PET scan images axial sections (A) Right upper lobe pulmonary primary lesion (26x19 mm) with right hilar necrotic adenophaty (B) Partial metabolic regression of the primary lung lesion (10 mm versus 26 mm and the right hilar lymph node (C) Persistent partial metabolic response of the pulmonary lesion and hilar lymph node.
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case_images: f3
case_images: An 18F-FDG PET scan revealed a right pulmonary upper lobe primary lesion measuring 26 x 19 mm associated with right hilar necrotic adenopathy (cT3N1M1c according to 8th TNM edition) ( Figure 3A ). After two cycles of systemic treatment, partial response was observed in the primary lung lesion (10 mm versus 26 mm), lymph nodes and right frontal lesions ( Figure 3B ). Partial response was confirmed after four additional cycles ( Figure 3C ).