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 2024/10/12 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.