PMC10160372_01
Immunohistochemical staining of histopathology: (A) Hematoxylin eosin staining of primary squamous cell carcinoma; (B) Immunohistochemical staining of P63; (C) Immunohistochemical staining of CK5/6; (D) Immunohistochemical staining of Ki67. Bar=100 um.
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Figure 1 ). FDG-PET CT identified an intensely avid lobe of left lung (LLL) mass (maximum standardized uptake value 10.6 (Max SUV), 32 mmx30 mm) extending to the cecum, top cranial skin, lumbar vertebra, inguinal groin, and left ventricle ( Figures 2A, B ). The detailed radiotherapy regimens for each site were shown in  Figure 3  and  Table 1 .
Systemic treatment strategies: (A) Whole-body PET-CT: maximum standardized uptake value: lung tumor 10.6, cecum 11.2, lumbar vertebra 15.7, inguinal groin 10.7, left ventricle 9.0, Cranial top skin 18.6; (B) Baseline computed tomography-enhanced CT of the chest; (C) The patient's chest enhancement MRI was reassessed two weeks after chemotherapy; (D) MRI of lumbar spine metastases; (E) Review of chest, abdomen and pelvic enhancement CT; (F) MRI of the head suggests nasal and scalp neoplasm.
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Figure 1 ). FDG-PET CT identified an intensely avid lobe of left lung (LLL) mass (maximum standardized uptake value 10.6 (Max SUV), 32 mmx30 mm) extending to the cecum, top cranial skin, lumbar vertebra, inguinal groin, and left ventricle ( Figures 2A, B ). The nasopharyngeal roof and bilateral walls were symmetrically swollen, with increased metabolism and a tendency to inflammation ( Figure 2A , 2021-02-05). The oncological control was satisfied at this point ( Figure 2C ). The imaging showed stabilized lesions of pulmonary origin, appendix, and inguinal metastases ( Figures 2D, E ). Unfortunately, after cycle 3 of treatment, the patient had progressive enlargement of the metastases at the top of the skull and new metastases in the nasal cavity ( Figure 2F ).
Radiotherapy plan: (A) Radiotherapy plan for the lumbar spine: Gross tumor volume (GTV L4-5) 35Gy/10F, Clinical target volume (CTV) 30Gy/10F; (B, C) Radiotherapy plan for inguinal metastatic lymph nodes: Gross tumor volume (GTVp) 52Gy/23F; (D-G) Radiotherapy plan for primary lung lesions: Gross tumor volume (GTVp) 47.6Gy/19F, Lymph node target volume (GTVn) 41.8Gy/19F.
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The detailed radiotherapy regimens for each site were shown in  Figure 3  and  Table 1 .