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A 67-year-old man with locally advanced non-small cell lung cancer entered a phase I trial combining a novel phosphoinositide 3-kinase inhibitor (BKM120) with palliative radiotherapy.1 The trial uses 18F-misonidazole (FMISO) positron emission tomography (PET)-CT imaging to assess any changes in tumour hypoxia. FMISO is a tracer currently only used in the research setting.
A pretreatment FMISO PET-CT scan identified an occult, asymptomatic scapular metastasis (figure 1) undetectable on routine CT imaging (figure 2A). This was subsequently confirmed …