Chemoradiotherapy for Inoperable Carotid Body Leiomyosarcoma: A Case Report and Review of Literature

Figures

• 

  Figure 1. T1-weighted head and neck magnetic resonance image (MRI) with fat saturation revealed a 2.6 centimeter enhancing soft tissue lesion occupying the right carotid space and the right parapharyngeal space at the level of carotid bifurcation with right internal and external carotid artery encasement (Open arrow).

• 

  Figure 2. Irradiation 50Gray (Gy) in 25 fractions (Fx) was delivered to carotid body tumor and right neck regional lymphatics (level Ib to level III) (Left) followed by boost radiotherapy 20Gy in 10Fx to carotid body tumor (Right). The red and blue lines represented the clinical target volume and plan target volume respectively. The orange line and light blue lines represented the isodose line of the 100% and 50% prescribe dose in two phases of radiotherapy, respectively.

• 

  Figure 3. Treatment course of this case was represented in a timeline. Weekly dose of carboplatin (area under curve 2) was administrated every week for 6 cycles, and conventional fractionated radiotherapy to carotid body and regional lymphatics was delivered concurrently with chemotherapy.

• 

  Figure 4. Post-treatment T1-weighted head and neck MRI showed decreased size of the right carotid body tumor with slightly anterior displacement of the right parapharyngeal fat (Arrow head).

• 

  Figure 5. Outgrowth cellular organoids were observed and cells were stained positive for vimentin and negative for CD45 or EpCAM. Cellular sensitivity to cytotoxics was measured with relative ATP abundance comparing to cells treated with mock solvent.

• 

  Figure 6. Proliferation suppression of circulating sarcoma cells, more than 80% of growth inhibition, was observed for doxorubicin, eribulin, gemcitabine, olaratumab/doxorubicin combination, and pazopanib.