PMC3350025_01
Pretreatment planar PET/CT image.
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fig1
Activity in the patellar region of the initial PET/CT scan was thought to be related to the surgical intervention (Figure 1). We elected to treat the entire length of the tibia as the involved field, due to the diffuse nature of the disease on the pretreatment imaging (Figure 1) and the apparent involvement of the marrow space.
Tomotherapy planning study images demonstrating dose distribution and relative sparing of posterior compartment.
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fig2
He was treated via Tomotherapy to the entire tibia with 200 cGy fractions to a total of 4400 cGy (Figure 2) and was able to complete his radiation therapy without any treatment breaks.
Postchemotherapy and radiotherapy planar PET/CT image.
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fig3
A posttreatment PET/CT scan showed no residual activity (Figure 3).
Posttreatment planar PET/CT image demonstrating recurrence of PET-avidity at site of original disease.
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fig4
A subsequent PET/CT scan, nine months after completion of radiation therapy, showed increasing metabolic activity at the previous site of disease (Figure 4).
Postrebiopsy planar PET/CT image demonstrating no evidence of contiguous spread nor systemic recurrence.
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fig5
Repeat PET/CT scans, labs, and physical exams, most recently nearly two years after completion of combined modality therapy (CMT), have continued to show only the one area of elevated 18F FDG activity near his original site of disease with no evidence of distant failure (Figure 5).