PMC10174457_01
Timeline of disease development and treatment courses.
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Example of the dose distribution on MRI from the SBRT course, composed of five 10-Gy fractions delivered over consecutive days. The transverse, sagittal, and coronal views demonstrate the isodose levels from 50 Gy (prescription) to 25 Gy.
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SBRT, delivering 50 Gy in five fractions to the segment 5 liver tumor. SBRT was performed on a hybrid magnetic resonance/linear accelerator (MR/Linac) platform using MR-guided online adaptive radiotherapy (MRgOART) ( Figure 2  ). 
PET CT comparison of the disseminated disease before (top row) and after (bottom row) the SBRT course combined with ImT (nivolumab/relatlimab). The primary tumor treated with SBRT (compare to 
Figure 2
) as well as some of the metastases are annotated on the pre-treatment imaging.
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ImT-induced hepatitis, and systemic therapy was discontinued out of concern for another severe ImT-related adverse event (irAE). Interval PET/CT 3 months after SBRT showed a CMR with no suspicious hypermetabolic activity within the surgical cavity and complete resolution of all FDG-avid lesions in the liver (including unirradiated ones) and axial spine where hypermetabolism had previously been identified ( Figure 3 ).