PMC4752370_01
Staging CT scan.. Coronal CT scan showing multiple abdominal agglomerated masses with cystic components revealing evidence of peritoneal carcinomatosis.
cureus-0008-000000000455-i01.jpg
PMC4752370_01_cureus-0008-000000000455-i01.jpg
FIG1
Positron Emission Tomography (PET) staging identified multiple areas of increased metabolic activity in the abdomen and pelvis (maximum SUV 11.6) along with bilateral pleural effusions (Figures 1-2). Pleurocentesis was negative for malignant cells.
Staging PET-CT scan.. PET-scan before the first cycle of chemotherapy showing multiple areas of increased metabolic activity in the abdomen and pelvis (maximum SUV 11.6) along with bilateral pleural effusions.
cureus-0008-000000000455-i02.jpg
PMC4752370_01_cureus-0008-000000000455-i02.jpg
FIG2
Positron Emission Tomography (PET) staging identified multiple areas of increased metabolic activity in the abdomen and pelvis (maximum SUV 11.6) along with bilateral pleural effusions (Figures 1-2). Pleurocentesis was negative for malignant cells.
Re-staging PET-CT scan . PET-scan after six cycles of chemotherapy showing excellent response with only two residual masses: one in the right flank with an SUV of 2.3, and a second in the pelvis with an SUV of < 2.
cureus-0008-000000000455-i03.jpg
PMC4752370_01_cureus-0008-000000000455-i03.jpg
FIG3
There were only two residual masses: one in the right flank that measured 4.5 cm in greatest dimension with an SUV of 2.3, and a second in the pelvis that measured 10.7 cm in greatest dimension with an SUV of < 2 (Figures 3-4).
Coronal CT scan prior and after chemotherapy.. Comparison between staging CT scan and after the 6th cycle of chemotherapy, revealing significant regression with two residual lesions: one in the right flank measuring 4.5 cm in greatest dimension and one in the pelvis measuring 10.7 cm in greatest dimension.
cureus-0008-000000000455-i04.jpg
PMC4752370_01_cureus-0008-000000000455-i04.jpg
FIG4
There were only two residual masses: one in the right flank that measured 4.5 cm in greatest dimension with an SUV of 2.3, and a second in the pelvis that measured 10.7 cm in greatest dimension with an SUV of < 2 (Figures 3-4).
Total dose distribution.. Left: Color wash coverage to the peritoneal cavity with homogeneous distribution on a dose of 24 Gy (light green) and a boost of 36.3 Gy delivered to the residual lesions (red).  Right: acceptable dose distribution in both kidneys.
cureus-0008-000000000455-i05.jpg
PMC4752370_01_cureus-0008-000000000455-i05.jpg
FIG5
A total abdominopelvic RT dose of 24 Gy with a boost of 12.3 Gy to the two residual masses was prescribed, for a total dose of 36.3 Gy to the masses (Figure 5).
Superior and Inferior abdominal Cone-Beam CT during radiation treatment.
cureus-0008-000000000455-i06.jpg
PMC4752370_01_cureus-0008-000000000455-i06.jpg
FIG6
TrueBeam linear accelerator (Varian Medical Systems) (Figure 6). Target coverage was verified daily with CBCT.