PMC4748788_01
a Clinical findings before surgery. Erythematous lesion on the patient's genital and hemorrhagic tumor on the right labia major. b Local recurrence around the postoperative scar (black arrowhead). c Skin metastasis before docetaxel therapy (white arrowhead). d CT revealed multiple lung metastases.
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F1
When she was referred to us 7 months later, the erythematous lesion had enlarged with the appearance of a small hemorrhagic tumor on her right labia major (fig. 1a). Nine months after surgery, a local recurrence was found around the postoperative scar (fig. 1b). A CT showed some metastatic lesions, including the lymph nodes of the para-aorta, inferior vena cava and pelvis, and the lower abdominal skin (fig. 1c). When 6 courses of the low-dose FP regimen were finished 16 months after surgery, she was finally found to have lung, liver and intraperitoneal metastases, causing paralytic ileus, in addition to the formerly found metastatic lesions (fig. 1d).
Response to docetaxel therapy. a The patient demonstrated partial response, since the volume of the metastases was reduced by 50% on CT (white arrows). b Changes in serum CEA levels and ADL index. The serum CEA level and ADL index improved after 2 courses of MDT. However, the serum CEA level immediately increased after changing to a weekly regimen. OPE = Operation; DTX = docetaxel.
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F2
After 2 courses, the volume of the metastases was reduced by 50% on CT (fig. 2a), and her serum CEA level immediately decreased to 125.0 IU/l from 243.8 IU/l, with a remarkable improvement in ileus as well as in the score of the activities of daily life (ADL) index (Barthel and vitality index), leading to the diagnosis of partial response (fig. 2b). Soon after changing to the weekly regimen, her serum CEA level and the size of the metastases increased (fig. 2).