PMC7906006_01
T1-weighted head and neck magnetic resonance image (MRI) with fat saturation revealed a 2.6 centimeter enhancing soft tissue lesion occupying the right carotid space and the right parapharyngeal space at the level of carotid bifurcation with right internal and external carotid artery encasement (Open arrow).
fonc-10-599403-g001.jpg
PMC7906006_01_fonc-10-599403-g001.jpg
f1
Magnetic resonance image (MRI) of the head and neck revealed a 2.6-centimeter soft tissue mass occupying the right carotid space and the right parapharyngeal space at the level of carotid bifurcation ( Figure 1 ).
Irradiation 50Gray (Gy) in 25 fractions (Fx) was delivered to carotid body tumor and right neck regional lymphatics (level Ib to level III) (Left) followed by boost radiotherapy 20Gy in 10Fx to carotid body tumor (Right). The red and blue lines represented the clinical target volume and plan target volume respectively. The orange line and light blue lines represented the isodose line of the 100% and 50% prescribe dose in two phases of radiotherapy, respectively.
fonc-10-599403-g002.jpg
PMC7906006_01_fonc-10-599403-g002.jpg
f2
CCRT was then initiated one month after biopsy. Conventional fractionated RT to right carotid body tumor and right neck level Ib, II, III (50 Gray [Gy] in 25 fractions [Fx]) followed by right carotid tumor boost (20 Gy in 10 Fx) was delivered via 6MV photons ( Figure 2 ).
Treatment course of this case was represented in a timeline. Weekly dose of carboplatin (area under curve 2) was administrated every week for 6 cycles, and conventional fractionated radiotherapy to carotid body and regional lymphatics was delivered concurrently with chemotherapy.
fonc-10-599403-g003.jpg
PMC7906006_01_fonc-10-599403-g003.jpg
f3
Acute side effects of grade 2 skin reaction, grade 2 oral mucositis, and grade 1 cervical esophagitis were observed during treatment course and were medically controlled without treatment interruption ( Figure 3 ).
Post-treatment T1-weighted head and neck MRI showed decreased size of the right carotid body tumor with slightly anterior displacement of the right parapharyngeal fat (Arrow head).
fonc-10-599403-g004.jpg
PMC7906006_01_fonc-10-599403-g004.jpg
f4
Post-treatment MRI study revealed decreased main tumor size three months after CCRT ( Figure 4 ).
Outgrowth cellular organoids were observed and cells were stained positive for vimentin and negative for CD45 or EpCAM. Cellular sensitivity to cytotoxics was measured with relative ATP abundance comparing to cells treated with mock solvent.
fonc-10-599403-g005.jpg
PMC7906006_01_fonc-10-599403-g005.jpg
f5
Figure 5 ). Furthermore, cellular sensitivity to cytotoxics was measured with relative ATP abundance comparing to cells treated with mock solvent.
Proliferation suppression of circulating sarcoma cells, more than 80% of growth inhibition, was observed for doxorubicin, eribulin, gemcitabine, olaratumab/doxorubicin combination, and pazopanib.
fonc-10-599403-g006.jpg
PMC7906006_01_fonc-10-599403-g006.jpg
f6
More than 80% proliferation suppression was observed for doxorubicin, eribulin, gemcitabine, olaratumab/doxorubicin combination, and pazopanib at the equivalent concentration of Cmax corresponding to a standard treatment dose ( Figure 6 ).