PMC9939648_01
Brain magnetic resonance imaging images at different time points. (A) Brain metastases were newly diagnosed after second-line treatment. (B) One month after brain radiation therapy. (C) New brain metastasis after taking anlotinib 10 cycles. The PRES developed gradually after taking anlotinib for (D) 1 cycle, (E) 3 cycles, (F) 4 cycles, (G) 6 cycles, (H) 8 cycles, and (I) 10 cycles.
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F1
March 2020, her brain magnetic resonance imaging (MRI) showed the left basal ganglia metastasis (Figure 1A). Meanwhile, the abdominal CT scan discovered left adrenal metastasis. Then she received whole-brain radiation therapy (WBRT) of a total dose of 37.5 Gy (in 15 fractions), which had achieved radiographic complete regression (Figure 1B) and left adrenal gland radiation of a total dose of 46.0 Gy (in 23 fractions) from 9 Her brain MRI showed mild demyelination of white matter after one cycle with anlotinib and the extension of the demyelinating lesions increased slowly (Figures 1D-I), but she had no neurological symptoms. Her contrast-enhanced MRI showed the demyelination of white matter in T2-weighted fluid attenuated inversion recovery (FLAIR) images and the pons had enhancement lesions, which was considered metastasis (Figure 1C).
Chest CT scans of the patient. (A) The scan was performed after second-line treatment. (B) The scan was performed after third-line treatment. (C) The scan was performed after taking anlotinib for one cycle. (D)The scan showed tumor cavity formation after taking anlotinib for six cycles. (E) The scan showed tumor cavity was larger after taking anlotinib for eight cycles. (F) The tumor cavity didn't change significantly after taking anlotinib for 10 cycles.
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The contrast-enhanced CT (10 June 2020) showed a 46 mm x 39 mm mass in the left lower lobe, which was larger than before (Figures 2A,B). After one cycle of anlotinib, we performed the first evaluation by CT and brain MRI, which showed a stable disease (SD) (Figure 2C). Chest CT showed tumor cavity formation and tumor assessment was SD (Figures 2D, E, F).