Care at the Close of Life: Evidence and Experience
Stephen J. McPhee, Margaret A. Winker, Michael W. Rabow, Steven Z. Pantilat, Amy J. Markowitz
Part B Symptom Management
Chapter 10. Spinal Cord Compression in Patients With Advanced Metastatic Cancer: “All I Care About Is Walking and Living My Life”
Janet L. Abrahm, MD, Michael B. Banffy, MD, Mitchel B. Harris, MD
Sections:
The Patient's Story, Perspectives, Conclusion, Methods to Update This Chapter, Resources, References, Chapter Glossary Terms
Topics Discussed:
spinal cord compression
Excerpt:
"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...."
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