PMC7247610_01
Timeline of different treatments and disease status.
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The treatment timeline is shown in Figure 1.
PET-CT and CT images of the patient. (A) The patient transferred to our hospital, (B) after chemotherapy of other regimens, (C) after two cycles of combination treatment of nab-paclitaxel and carboplatin and pembrolizumab, (D) after 6 cycles of combination treatment of nab-paclitaxel and carboplatin and pembrolizumab, (E) explosive growth of the tumor.
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CT and PET-CT was performed in our hospital. Computed tomography (CT) scan (Figure 2A) of the chest and abdomen revealed an irregular cervical mass measuring 4.16*4.15cm, with invasion of the vagina, and infiltration of the bilateral parametrium up to the pelvis. The positron emission tomography-computed tomography (PET/CT) (Figure 2A) showed cervical cancer with invasion in lower uterus and vaginal invasion. The CT (2018-11) (Figure 2B) showed that the treatment outcome was not satisfactory. The CT scan (Figure 2C) depicted resolved lesions in almost all initial tumor including cervix, the invasion of the vagina, left adnexa, the left supraclavicular lymph nodes, and liver. PET/CT (Figure 2D) obtained before the last session (2019-3-15) demonstrated almost complete resolution of all lesions. CT scan showed (Figure 2E) reduced lesion in cervix, the vagina and bilateral adnexa, but with an extensive growth in the liver, supraclavicular lymph nodes, retroperitoneal lymph nodes, and many new lesions were noted in thoracic and peritoneal lymph nodes.
Changes in tumor index values. The ordinate is displayed on a logarithmic scale. (A) The patient started combination treatment of chemotherapy and immunotherapy. (B) The patient was transferred to radiotherapy combined with immunotherapy. (C) Radiotherapy was interrupted and the patient started single use of pembrolizumab.
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Tumor biomarker CA-125 and CEA were high, while SCC was normal (Figure 3). However, after two sessions of the EP chemotherapy, the tumor biomarkers showed increased expression of CEA, CA-125, CA19-9 (Figure 3). Two cycles after the treatment, the biomarker CA-125 became more than four times lower than before, CEA decreased to almost three times lower than before, and other biomarkers returned to normal value (Figure 3). The values of the biomarkers gradually decreased, and at the end of the four cycles, only CEA was slightly high (Figure 3).
Representative picture of immunohistochemical staining. The picture revealed positive CK7 staining which showed brown color (magnification, x400).
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The histopathological report indicated poorly differentiated adenocarcinoma (Figure 4).
Image of the cervix at the end of therapy.
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No obvious lesions were observed in the cervix (Figure 5).