PMC4546739_01
Computed tomography scan of the thorax showing left-sided local relapse in the pleura and thoracic wall after lobectomy. Status before palliative radiotherapy.
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fig1
In July 2013, 3D conformal palliative radiotherapy was administered to the region of pleural/thoracic wall recurrence (13 fractions of 3 Gy), Figure 1.
(a) Computed tomography scan of the thorax showing left-sided axillary nodal metastasis and mediastinal lymph node metastases. Status before palliative radiotherapy. (b) Computed tomography scan of the thorax showing right-sided pulmonary metastases (example of the patient's bilateral metastases). During radiotherapy, this region received a cumulative dose of <1 Gy.
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fig2
In November 2013, systemic progression was detected, with new bilateral pulmonary metastases and mediastinal and left-sided axillary lymph node metastases, Figures 2(a) and 2(b).
Skin lesions at the time of simulation before palliative radiotherapy to the mediastinum and left axilla. Bullous pemphigoid mainly involving trunk and arms.
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fig3
During radiotherapy, the bullous pemphigoid was exacerbated and secondary infection occurred (status at simulation shown in Figure 3).
Time course of neutrophil leukocyte and lymphocyte counts during follow-up. The green line corresponds to the date of the computed tomography scan showing the nontargeted effect. At this time, the patient had recovered from presumably radiation-related lymphopenia. Abnormally high lymphocyte counts were never detected. In contrast, several episodes of leukocytosis occurred.
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fig4
Serum C-reactive protein was elevated to 50 mg/L and leukocyte count was slightly elevated to 11.1 x 109/L (Figure 4).
Computed tomography scan of the thorax showing right-sided pulmonary metastases approximately 3 weeks after radiotherapy to other targets. Marked reduction in size.
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fig5
Computed tomography (CT) showed partial response of the irradiated and nonirradiated lesions (Figure 5, January 2014).
Computed tomography scan of the thorax showing progression of the right-sided pulmonary metastases approximately 3 months after radiotherapy to other targets. Temporary nontargeted effect.
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fig6
In April 2014, CT showed progression of all pulmonary metastases (Figure 6).