PMC3702549_01
Malignant thrombosis of the superior vena cava before treatment: (A) whole-body positron emission tomography/computed tomography scan; (B) magnetic resonance image.
ott-6-749Fig1.jpg
PMC3702549_01_ott-6-749Fig1.jpg
f1-ott-6-749
The whole-body positron emission tomography/computed tomography (PET/CT) scan revealed a mass (1.5 x 1.0 cm) in the upper lobe of the right lung, with a maximal standard uptake value (SUVmax) of 4.2; enlarged lymph nodes in levels 1, 2R, and 4R; and a huge 7.4 cm long mass with a SUVmax of 8.9 (Figure 1A) inside the SVC, which was confirmed by magnetic resonance imaging (Figure 1B).
Dose distribution in the primary intensity-modulated radiation therapy. The red, olive, and grey lines represent dose distributions of 66, 30, and 20 Gy, respectively. The red, blue, and green areas represent malignant thrombosis in the superior vena cava, metastatic lymph nodes, and the planning target volume, respectively.. Notes: "I" indicates Inferior, "L" Left and "A" Anterior, which represents the directions of view of the patient.
ott-6-749Fig2.jpg
PMC3702549_01_ott-6-749Fig2.jpg
f2-ott-6-749
The gross tumor volume was contoured according to the PET/CT images, which included a primary lesion in the right upper lung, metastatic mediastinal lymph nodes, and malignant thrombosis of the SVC (Figure 2).
T1-weighted images showing residual malignant thrombosis of the superior vena cava at 40 Gy.
ott-6-749Fig3.jpg
PMC3702549_01_ott-6-749Fig3.jpg
f3-ott-6-749
During weekly physical examinations of the patient, the distention of the jugular and chest veins was found to have resolved completely following radiotherapy delivered at 22 Gy, while significant tumor remission was observed after radiation treatment at 40 Gy (Figure 3).
Positron emission tomography/computed tomography images showing the superior vena cava during follow-up at 1 month (A), 3 months (B), and 45 months (C).
ott-6-749Fig4.jpg
PMC3702549_01_ott-6-749Fig4.jpg
f4-ott-6-749
All the STMs were controlled and the lymph nodes that had been enlarged before treatment were found to have shrunk significantly without abnormal SUV elevation by the last follow-up (Figure 4).