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FIGURE LEGEND
Fig. 1 Serial abdominal CT scans shows dynamic change from the base line
to the radiation. a1 the base line of the metastatic mediastinal lymph
nodes a2 a3 the base line of the primary tumor at the left lung. b1
after two cycles of chemotherapy with TC(taxol and carboplatin), the
metastatic mediastinal lymph nodes shrink but a new metastatic lymph
node occur. b2 b3 the primary tumor partly shrink. c1 after
radiotherapy, the all the metastatic lymph nodes obviously shrink. c2 c3
the primary tumor totally shrink.
Fig.
2 Histopathological examination shows poorly differentiated squamous
cell mixture TTF1(+) and SYN(+) cells which small neuroendocrine cell
carcinoma could not been excepted. A, (× 200); B (× 100);
Fig. 3 Serial abdominal CT scans shows dynamic change of the follow-up
treatment and the last period. a1 a2 after 4 cycles of immunotherapy
with durvalumab, the mediastinal lymph nodes did not recur. a3 the
primary tumor at the left lung recur and a new mass occur at the right
low lung. b2 after two cycles of chemotherapy with EP(etoposide and
cis-platinum) and anti-angiogenesis agent anlotinib, the mediastinal
lymph nodes have no change compared before. b1 b3 the primary tumor
progressed fastly. c1 c2 at the last period, the pleural effusion and
the pericardial effusion appeared.
Fig. 4 Overview of the whole treatment process.
Supplement figs1 the target volume of this case was preventability lymph
node area radiation.
Supplement figs2 the CT scan images of the male from the base line to
the last period.
Supplement figs3 the CT scan images of the female from the base line to
the last period show the disaster nut lung cancer progressed so fast
that there is no chance to treat.