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. 2020 Apr 16;5(2):e000635. doi: 10.1136/esmoopen-2019-000635

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© Author (s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ on behalf of the European Society for Medical Oncology.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, any changes made are indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Active sites of disease treated with SBRT and 223-Ra with reduced radiotracer uptake on post-treatment SPECT. (A) Sixteen-year-old with TNTC lung metastases (patient L in tables 1 and 2) exhibited two active sites of bone-forming disease on ^99mTc-MDP bone scan with SPECT: left lower lobe lung and left femur. The lung lesion (A) and the femoral lesion (B) were treated simultaneously with SBRT and six cycles of 223-radium. No radiotracer uptake was observed on the post-treatment SPECT in either lesion. This patient achieved disease stability and excellent quality of life (attended school) while on therapy with 223-radium with denosumab, oral cyclophosphamide and SBRT. PTV, planning target volume; SBRT, stereotactic body radiation therapy; SPECT, single-photon emission computed tomography.