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Continued.
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A nasopharyngeal MRI after 2 cycles showed PR, while PET-CT showed that the CR was achieved (Figure 1) after another 2 cycles.
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Comparison of PET-CT images before (July 2019) and after (November 2019) the PCET treatment in patient 1. (A) The value of standardized uptake value (SUV) of the mass (it can be seen in the blue coil) in the right nasal cavity was 5.0 in July 2019. In the upper part of the figure, we can see that the mass of the right nasal cavity was gone, and the SUV value of nasal mucosa reduced to 3.0 after 4 cycles of treatment. (B) The SUV value of the nasopharynx (it can be seen in the blue coil) was 25.2 in July 2019 before the PCET treatment. In the upper part of the figure, we can see that the nasopharyngeal metabolic value decreased significantly (SUV= 5.0) in November 2019. The inflammation of the nasal cavity and sinuses had also improved obviously in November 2019.
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In June 2019, a routine MRI scan indicated the abnormal signals on the left nasopharyngeal sidewall and the left behind the tongue (Figure 2A), which were new lesions. His symptoms were gone after the first cycle carried out, and the MRI scan after 2 cycles showed that the abnormal signal on the left nasopharyngeal wall and the left rear of the tongue (Figure 2B) was significantly reduced compared with that in June 2019.
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The MRI findings of case 2. (A) The swelling (it can be seen in the blue coil) in the left nasopharyngeal wall and rear of the tongue before receiving the PCET regimen. (B) The neoplasm (it can be seen in the blue coil) shrank obviously after 2 cycles completed.
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AE1/AE3 (-), Ki-67 (40%+), and EBER (+). An enhanced CT scan showed that lymphadenopathy of the left neck remained (Figure 3A). The PET-CT scan displayed no hypermetabolic foci in the primary lymphadenopathy of the left neck (Figure 3B).