Patient Summary

• Left composite resection + marginal mandibulectomy + left sentinel node biopsy with reconstruction (January 2025)
• Radiation therapy (April 2025)
• A prior PET-CT (January 2026) showed a new lesion along the right mandibular ramus and a spiculated lung opacity - confirmed right cheek lesion SCC on biopsy
• Has been on chemotherapy since then

Region-by-Region Findings

Brain

• Normal. No abnormal metabolic activity or lesions.

Head & Neck (Left Side - Operative Site)

• Good news on the left: The surgical flap reconstruction looks stable. No abnormal FDG uptake or enhancing lesions at the operative bed - no signs of local recurrence on the treated side.
• Left neck nodes: No significantly enlarged or FDG-avid nodes (no active nodal disease on the left).

Head & Neck (Right Side - Active Disease)

• There is a persistent soft tissue lesion along the right mandibular ramus, infiltrating the upper right masseter muscle.
• Size reduced: From 3.6 x 2.6 x 3.1 cm → now 3.2 x 2.3 x 2.6 cm
• SUVmax reduced: From 8.2 → now 7.1 (SUVmax reflects metabolic activity; lower = less active)
• The lesion still erodes the right zygomatic bone cranially, but no significant destruction of the mandibular ramus itself.
• It has effaced fat planes near the right parotid gland and infiltrates the subcutaneous space, but the overlying skin appears uninvolved.
• Small right neck level IB, II, and tiny level III nodes show low-grade FDG uptake - considered likely reactive (not malignant) and are stable.

Thorax (Lungs)

• A persistent spiculated opacity (irregular lung mass) in the right lung perihilar region, abutting the right pulmonary artery (middle/lower lobe branches).
• Size reduced: From 2.8 x 2.4 x 2.5 cm → now 2.3 x 1.6 x 2.5 cm
• SUVmax: 6.14 (previously 6.4) - marginally reduced metabolic activity
• Causing compression of right middle lobe bronchi with some distal collapse (atelectasis).
• No pleural effusion. No other lung lesions. No enlarged mediastinal or axillary nodes.

Abdomen & Pelvis

• Liver, spleen, gallbladder, pancreas, adrenals, left kidney: All normal.
• Tiny calcium deposit in the right kidney (incidental, likely benign).
• Prostate is mildly enlarged but shows no suspicious FDG uptake.
• No abnormal nodes in the abdomen or pelvis.

Musculoskeletal / Bones

• No FDG-avid lytic or sclerotic bone metastases anywhere in the body.

Overall Conclusion (Radiologist's Remarks)

"Overall scan findings are suggestive of partial response to treatment."

1. The right mandibular/masseter lesion has shrunk slightly and become slightly less metabolically active, but it is still present and still active (SUVmax 7.1 is significantly elevated).
2. The right lung lesion has also partially reduced in size but remains active.
3. The left-side surgical site is clean - no recurrence there.
4. No new metastatic sites have appeared anywhere in the body.

What "Partial Response" Means Clinically

• Complete response = no detectable disease
• Partial response = measurable reduction in tumor size/activity (typically >30% reduction in size), but disease is still present
• Stable disease = no significant change
• Progressive disease = tumor growth or new lesions