RT Book, Section
A1 Abrahm, Janet L.
A1 Banffy, Michael B.
A1 Harris, Mitchel B.
A2 McPhee, Stephen J.
A2 Winker, Margaret A.
A2 Rabow, Michael W.
A2 Pantilat, Steven Z.
A2 Markowitz, Amy J.
SR Print(0)
ID 6603657
T1 Spinal Cord Compression in Patients With Advanced Metastatic Cancer: "All I Care About Is Walking and Living My Life"
T2 Care at the Close of Life: Evidence and Experience
YR 2011
FD 2011
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071637954
LK jamaevidence.mhmedical.com/content.aspx?aid=6603657
RD 2024/04/20
AB Ms  H  is  a  56-year-old  interventional  radiology  technician  living  alone  in  a  2-story  house.  In  1986,  she  developed  breast  cancer,  initially  treated  by  left  mastectomy  followed  by  chemotherapy  and  chest  wall  radiotherapy.  In  1990,  she  developed  bony  metastases.  Bisphosphonates  were  initiated  and  a  left  rib  resection  performed;  after  a  salpingo-oophorectomy,  she  had  regression  of  a  left  hip  metastasis.  In  2000,  a  T7  vertebral  metastasis  was  treated  with  44  Gy  to  the  T6  to  T8  vertebral  area.  In  2004,  a  recurrent  lesion  required  T7  vertebral  corpectomy  with  structural  rib  autograft  and  a  T4  to  T10  instrumented  fusion.  Capecitabine  was  begun  and  continued  through  November  2006,  when  she  developed  thoracic  pain  and  progressive  difficulty  walking.  The  T7  vertebral  tumor  now  involved  the  T6  to  T7  ventral  epidural  space  with  significant  cord  impingement.  The  posterior  spinal  fixation  had  loosened,  and  she  had  progressive  deformity  of  her  spine.  Ms  H's  original  surgeon,  Dr  L,  recommended  surgery  by  Dr  O  followed  by  stereotactic  radiosurgery  (1500  centigrays  in  5  fractions  during  5  days)  at  a  university  hospital  400  miles  from  her  home.  Ms  H  agreed.