PMC4755421_01
FDG PET/CT images with upper row showing PET scan sequences and lower row showing respective CT cross-sections.. Notes: (A) Initial PET/CT depicting a locally advanced disease upon diagnosis. (B) Complete remission following definitive concurrent chemoradiation. (C) Appearance of right kidney lesion that turned out to be metastatic squamous cell carcinoma on nephrectomy. (D) Appearance of FDG-avid left renal lesion. (E) Complete metabolic response in the left kidney after the initiation of cetuximab. (F) Relapse in the left kidney after treatment holiday. (G) Complete remission again observed after the reinitiation of cetuximab therapy.. Abbreviations: FDG, fluorodeoxyglucose; PET/CT, positron emission tomography and computerized tomography.
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Initial 18-fluorodeoxyglucose (FDG) positron emission tomography and computerized tomography (PET/CT) scan revealed an extensive, intensely FDG-avid, right base of tongue lesion and metastatic right upper neck lymphadenopathy with no distant metastasis (Figure 1A). She experienced a complete metabolic response on restaging PET/CT at 6 months (Figure 1B). A follow-up PET/CT obtained ~19 months from the initial PET/CT was consistent with the persistent response in the head and neck region but showed an intense right renal lesion and another less intense lesion on the left kidney (Figure 1C). Repeat PET/CT scan performed at 22 months revealed a slight progression of the left renal lesion without any evidence of FDG-avid metastatic disease elsewhere (Figure 1D). She was therefore initiated on palliative cetuximab and achieved complete remission as evidenced by restaging PET/CT 2 months later (Figure 1E). Interval PET/CT performed at 36 months showed recurrence in the left kidney (Figure 1F). Cetuximab was resumed again and she had the resolution of the prior noted left kidney lesion within 3 months after the resumption of the therapy (Figure 1G).