PMC6290870_01
The neck CT scan showed multiple metastatic cervical lymph nodes located in the right III, IV, V, and VI regions, with no clear boundary with the right common carotid artery at the second local regional relapse (A and B). After induction chemotherapy and definitive reirradiation with synchronized weekly chemotherapy, the patient experienced complete remission (C).. Abbreviation: CT, computed tomography.
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A subsequent computed tomography (CT) scan indicated multiple enlarged lymph nodes located in the right region of the neck at levels III-VI, without a clear boundary with the right common carotid artery (Figure 1A and B). After a cycle of induction chemotherapy (docetaxel+nedaplatin), reirradiation with 70 Gy/35 f to the metastatic lymph nodes and 50 Gy/25 f to the high-risk neck region concurrently with three weekly cycles of nedaplatin contributed to the complete remission (CR) response (Figure 1C).
The process of tumor change and ulcer formation during the application of apatinib, after the third local regional recurrence.. Notes: In January 2018, the patient experienced a third recurrence in the right region of the neck (A). The tumor progressed aggressively during a 2-month period before the initiation of apatinib (B). The tumor shrank significantly after 7 days of 250 mg apatinib daily (C). The 20-day use of apatinib contributed to complete remission, but deep ulcers formed owing to tumor regression (D). After a 2-week suspension of apatinib, the tumor regrew (E). The tumor disappeared after a 3-week reapplication of apatinib, but large ulcers with local infection occurred (F).
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In January 2018, the patient experienced a third regional relapse in the right region of the neck again (Figure 2A). The tumor grew rapidly, extending to the anterior cervical region, and was cauliflower-like or nodular with surface bleeding and exudation (Figure 2B). After only 7 days of use, the tumor shrank dramatically (Figure 2C). However, deep local ulcers formed due to the rapid tumor shrinkage (Figure 2D), and apatinib was suspended. Two weeks later, the tumor had grown aggressively (Figure 2E). However, giant infected ulcers emerged (Figure 2F).
The CT scan conducted on May 17, 2018, revealed obvious tissue defects in the right lower neck and anterior cervical region, with no clear boundaries with the right carotid artery and vein.. Abbreviation: CT, computed tomography.
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The CT scans revealed huge tissue defects, with invasion and exposure of the right carotid vein and artery (Figure 3).