28403086 Visualization

In 2013 Date , a 50 Age - year Age - old Age man Sex patient visited Clinical_event hospital Nonbiological_location complaining of local Detailed_description bone Biological_structure pain Sign_symptom in the left Biological_structure leg Biological_structure .
On August Date 14, Date 2013 Date , the patient underwent a left Biological_structure distal Biological_structure femoral Biological_structure tumor Sign_symptom en Detailed_description bloc Detailed_description resection Therapeutic_procedure and reconstruction Therapeutic_procedure with a modular Detailed_description femoral Detailed_description prosthetic Detailed_description system Detailed_description .
Pathology Diagnostic_procedure diagnosis Diagnostic_procedure confirmed osteoblastic Detailed_description osteosarcoma Disease_disorder (Fig.2).
One Dosage cycle Dosage of neoadjuvant Detailed_description chemotherapy Medication and 4 Dosage cycles Dosage of adjuvant Detailed_description chemotherapy Medication with MAP Medication regimen Medication ( high Dosage - dose Dosage methotrexate Medication , cisplatin Medication , and doxorubicin Medication ) were administered.
In January Date 2015 Date , a mass Sign_symptom was found on the left Biological_structure upper Biological_structure crus Biological_structure area Biological_structure .
Tumor recurrence Sign_symptom was confirmed by biopsy Diagnostic_procedure on January Date 23, Date 2015 Date .
However, only an upper Biological_structure femur Biological_structure amputation Therapeutic_procedure was carried out, as the patient refused hip Biological_structure joint Therapeutic_procedure replacement Therapeutic_procedure .
After wound Therapeutic_procedure healing Therapeutic_procedure , the patient went Clinical_event back Clinical_event to Clinical_event his Clinical_event normal Clinical_event life Clinical_event in the help of artificial Therapeutic_procedure limb Therapeutic_procedure , but refused to receive further chemotherapy Medication due to concerns regarding the chemotherapy toxicities such as nausea, vomiting, leucopenia, deadlimb, and headache.
About half Date a Date year Date after Date the amputation, the patient got occasional Detailed_description cough Sign_symptom and chest Biological_structure tightness Sign_symptom .
Then a thin Detailed_description chest Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) was performed on July Date 15, Date 2015 Date .
The CT results revealed multiple Detailed_description pulmonary Biological_structure nodules Sign_symptom (Table ​1), considering the possibility of metastases Sign_symptom .
The patient still rejected further chemotherapy Medication .
Immunophenotype Diagnostic_procedure was suggestive of CD31+ Detailed_description and CD34+ Detailed_description tumor Sign_symptom cells (Fig.3).
Furthermore, most cells Coreference showed strong Lab_value positive Lab_value staining Diagnostic_procedure for Diagnostic_procedure VEGFR-2 (Fig.3).
Apatinib Medication was administered at a dose of 500 Dosage   mg Dosage daily Dosage .
Half Date a Date month Date later Date , the symptoms Sign_symptom disappeared, but a progressive Detailed_description wound Sign_symptom necrosis Sign_symptom appeared.
A debridement Therapeutic_procedure surgery Therapeutic_procedure was finally conducted and an enlarged Sign_symptom lymph Biological_structure node Biological_structure near Biological_structure iliac Biological_structure vessels Biological_structure was resected Therapeutic_procedure on February Date 24, Date 2016 Date (Fig.(Fig.4).4).
The result of pathological Diagnostic_procedure examination Diagnostic_procedure revealed an inflammatory Detailed_description hyperplasia Sign_symptom lymph Biological_structure node Biological_structure .
Apatinib Medication administration was stopped during the 3 Duration weeks Duration of wound Therapeutic_procedure healing Therapeutic_procedure period.
The thin Detailed_description chest Biological_structure CT Diagnostic_procedure was performed 7 Date and Date 11 Date months Date following apatinib administration.
At the 7 Date - month Date follow Clinical_event - up Clinical_event time point, 2 Lab_value out Lab_value of Lab_value 5 Lab_value measurable Lab_value and 9 Lab_value out Lab_value of Lab_value 17 Lab_value non Lab_value - measurable Lab_value lesions Sign_symptom disappeared, but 1 Lab_value new Lab_value measurable Lab_value nodule Sign_symptom and 6 Lab_value new Lab_value non Lab_value - measurable Lab_value lesions Sign_symptom were observed (Table ​1, Fig.5), which considered PD Lab_value according to the Response Diagnostic_procedure Evaluation Diagnostic_procedure Criteria Diagnostic_procedure in Diagnostic_procedure Solid Diagnostic_procedure Tumors Diagnostic_procedure ( RECIST Diagnostic_procedure ) 1.1 Detailed_description standard.
However, at the 11 Date - month Date follow Clinical_event - up Clinical_event time point, a total of 9 Lab_value lesions Sign_symptom disappeared, including 1 Lab_value measurable Lab_value nodule Lab_value and 2 Lab_value non Lab_value - measurable Lab_value lesions Lab_value presented before apatinib treatment as well as 6 Lab_value non Lab_value - measureable Lab_value lesions Lab_value presented 7 months after apatinib treatment.
No new lesion was raised.
After target lesion Detailed_description measurement Diagnostic_procedure according to the RECIST Diagnostic_procedure 1.1 Diagnostic_procedure standard Diagnostic_procedure , it was narrowly considered PR Lab_value .
The toxicities the patient experienced included mild Severity hand Disease_disorder - foot Disease_disorder syndrome Disease_disorder and slight Severity high Sign_symptom blood Sign_symptom pressure Sign_symptom .
Both were well Lab_value controlled Lab_value after Lab_value appropriate Lab_value treatment Lab_value .
No severe Severity toxicities Sign_symptom and other treatment Detailed_description - related Detailed_description adverse Sign_symptom events Sign_symptom were observed.
The patient continued to use apatinib Medication as maintenance therapy without major toxic Sign_symptom effects Sign_symptom , and went Clinical_event back Clinical_event to Clinical_event normal Clinical_event life Clinical_event , even driving Activity an automatic Detailed_description car Detailed_description .