PMC7174649_01
Representative computed tomography images of the patient. (A) baseline (before administration of apatinib) showing a left pulmonary lesion; (B) 3 weeks later revealing a substantial shrinkage, (C) 2 months after chemotherapy demonstrating an excellent tumor response; and (D) 4 months after chemotherapy illustrating stable disease.
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F1
Chest computed tomography (CT) revealed a 3.6 x 2.8 cm left lung mass (Figure 1A) with bilateral hilar, mediastinal, and supraclavicular lymphadenopathy. Chest CT performed at the same time and showed shrinkage of the lung primary with a PR (Figure 1B). At 2 and 4 months after chemotherapy, the thoracic disease remained stable (Figure 1) and there was a clinical complete response (CR) for the BMs (Figures 2E-H).
Representative magnetic resonance imaging images of the brain metastatic lesions at different time points. Prior to the treatment showing lesions in the left occipital lobe, right temporo-occipital lobe junction and a large region of edema according to enhanced T1-weighted MRI (A) and T2-weighted FLAIR MRI (B). On the first day after finishing the whole course of brain radiotherapy, showing shrinkage of tumors in enhanced T1-weighted MRI (C) and T2-weighted MRI (D), along with marked alleviation of cerebral edema. Enhanced T1-weighted MRI (E,G,I),T2-weighted MRI (F) and T2-weighted FLAIR MRI (H,J) performed at 1, 3, 12 months after brain radiotherapy showed the brain tumors were well controlled. RT, radiotherapy.
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F2
Brain magnetic resonance imaging (MRI) demonstrated multiple BMs with high peritumoral brain edema (PBE) (Figures 2A,B). On the first day after finishing the whole course of brain radiotherapy, the patient's neurologic symptoms entirely ceased and a partial response (PR) for the BMs with near-complete resolution of PBE was achieved (Figures 2C,D). At 2 and 4 months after chemotherapy, the thoracic disease remained stable (Figure 1) and there was a clinical complete response (CR) for the BMs (Figures 2E-H). At 12 months after brain radiotherapy, the primary lesion remained well controlled, with a tumor size of 2.5 x 1.7 cm; no BM lesions could be seen at that time. (Figures 2I,J).
Immunohistochemical staining of VEGFR-1, VEGFR-2, PDGFR, and c-kit. VEGFR-1(A), VEGFR-2 (B), and PDGFR (C) were strongly positive, while c-kit (D) was negative.
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F3
The results showed that VEGFR-1, VEGFR-2, and PDGFR were strongly positive, while c-kit was negative (Figure 3).