PMC6381877_01
Chest X-ray and chest CT images before initial EGFR-TKI treatment. (a) Chest X-ray image showed a right hilar mass followed by lymphangitic carcinomatosis in the right lower lung field. (b) Chest CT image showed a large lung mass, extending to posterior chest wall and vertebral body, in the right lower lung as well as multiple lymphadenopathy and right pleural effusion.
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F1
In the imaging test of full body, chest X-ray and chest CT revealed a large lung mass, extending to posterior chest wall and vertebral body, surrounded by lymphangitic carcinomatosis in the right lower lung as well as multiple lymphadenopathy and right pleural effusion (Fig. 1a, b).
Chest X-ray and chest CT images after 28 days of gefitinib therapy. (a) Chest X-ray image showed the increased right hilar mass and the worsened lymphangitic carcinomatosis. (b) Chest CT image showed interval progression of the lung mass and the lymphadenopathy.
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F2
However, by 28 days after the start of gefitinib therapy, his symptoms further deteriorated along with the increased tumor size, resulting in PS 3 (Fig. 2a, b).
Chest X-ray and chest CT images after 21 days of combination therapy with bevacizumab and erlotinib. (a) Chest X-ray image showed the decreased right hilar mass and the improved lymphangitic carcinomatosis. (b) Chest CT image showed interval response of the lung mass and the lymphadenopathy. Especially, cavitation of the lung mass as bevacizumab-specific response was observed.
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F3
By 21 days after the start of this combination therapy, his symptoms gradually improved along with the decreased tumor size, resulting in better PS with no severe toxicities (Fig. 3a, b).