Stories of patients

Valentina Igorevna born in 1953
(personal information was changed)
Under treatment at the Onco.Rehab clinic from 2018 to the present
Treating doctor Vladimir V. .
1) IV stage central BL of left lung T4NxM1 with lung and bone metastasis; 2) right breast tumor

1) Condition after 3 courses of the second line of polychemotherapy (4 courses of EP, pemetrexed in monoregime 3 courses). Progression. Condition after 6 courses of immune therapy (with atezolizumab) from 11.2019 till 03.2020. Condition after 3 courses of chemotargeted therapy (docetaxel + nintedanib).

2) Condition after radical mastectomy in 1990. Condition during therapy with bisphosphonates (zoledronic acid). Condition during the follow-up course of therapy: (nintedanib) + Photodynamic therapy + Bioelectrotherapy of lungs. Second clinic group. ICD-10 C34.1

Histology: No. 2449 dated 23.2.19 – moderately differentiated lung adenocarcinoma, glandular version of structure.

Immunohistochemistry dated 24.02.2020 – TTF-1: reaction in tumour cells is not found. GATA-3: diffuse, different degree of severity nuclear reaction in most tumour cells.

Allred receptor status: estrogen receptors (clone EP1): 5 (PS)+3(ls)=8(TS). Progesterone receptors (clone 1E2):5(PS)+2(IS)=7(TS). Value of ASCO/CAR’13 Her2-status: Her2-status: 0 – immunophenotype of the tumour most of all corresponds to the immunophenotype of breast cancer.

Immunohistochemistry dated 03.10.2019 – ALK tumour – negative, ROS1 – negative. The patient had 4 courses of polychemotherapy according to the scheme (EP) – during CT of chest organs dated 15.06.2019.

Conclusion: CT-image of a large formation at the root of the left lung (central cr) with invading of organs in mediastinum, focal formation in S7 to the right. Multiple small focal changes in both lungs. Quantitative lymphadenopathy. Heterogeneity of body structure of Th6 vertebra, rear part of the sixth rib. Liquid in the pericardial cavity. The patient was consulted in SBHOMR “Moscow Regional Oncology Hospital” in Balashikha. Three courses of the second line of polychemotherapy (pemetrexed 1000 mg 1 time for 3 weeks) + therapy with bisphosphonates (zoledronic acid 4 mg 1 time for 28 days) at the place of residence is recommended.

The patient underwent courses in Onco.Rehab without peculiarities.

Control screening – progression. CT of chest organs with i/v contrast dated 13.11.2019.

Conclusion: CT-image of the central C-r left lung with partial atelectasis S3, invasion of the mediastinum, the left pulmonary artery, the pericardium, traces of liquid in the pericardial cavity involving the interlobular pleura. Multiple focal shadows in the lung parenchyma and at the pleura, small increase of one of foci in S3 to the right, possibility of mts. Osreoblastic changes in the body Th6 vertebra and in the sixth and eighth ribs to the right, the breast being removed, possibility of mts. Visualization of lymph nodes of the mediastinum and the retroperitoneal space – without dynamics. Concrement in the gallbladder. Formation of the right adrenal gland – possibility of adenoma. Additional lobule of the spleen. The patient was consulted in SBHOMR “Moscow Regional Oncology Hospital” in Balashikha, immunotherapy (atezolizumab, 6 courses) were recommended, undergone from 11.2019 till 03.3030. Negative dynamics – CT of chest contrast with i/v contrast dated 24.03.2020.

Conclusion: CT signs of formation of the upper part of the left lung, surrounded by plastic atelectasis and infiltrative changes (possibility of small-cell c-r). Diffuse hematogenic nodular dissemination in all segments of the right and S ½, 3, 4, 5, 6, 8 left lungs. Mediastinal and bilateral bronchopulmonary lymphadenopathy. Left axillary lymphadenopathy. Atherosclerosis of the descending thoracic aorta and coronary heart vessels, enlargement of the pulmonary artery. Cardiomegaly. Changes are in the body of Th6 vertebra and in 6, 8, 7 ribs to the right (possibility of osteoblastic mts). Comparing with the screening dated 13.11.2019 – negative dynamics in the form of growth of the formation size, quantity of metastasis in lungs, enlargement of left axillary nodes. CT of abdominal organs with i/v contrast dated 24.03.2020.

Conclusion: CT – signs of pyeloсaliecoureteroectasia from two sides (possibility of chronic pyelonephritis). Atherosclerosis of the abdominal aorta. Thickening of Gerota’s fascia to the left. Retroperitoneal hepatic lymphadenopathy. Choledochoectasia. Mesenteric panniculitis. Osteoblastic metastasis in L5 and S1 vertebrae. Additional lobule of the spleen. Hepato- and splenomegaly. Calculous cholecystitis. Formation of the left adrenal gland. Comparing with the screening dated 21.03.2018 – negative dynamics in the form of growth of the quantity of enlarged lymph nodes: hepato- and splenomegaly. Chemotargeted therapy (docetaxel 75 mg/m2 i/v 1 time for 21 days + nintedanib (vargatef) 200 mg x 2 times a day per os 2-21 days No.3). The patient does not get medications within AMS and RMS.

Come into Onco.Rehab clinic
Stages of treatment:

Medical commission took place. There was taken a decision to choose multi-course photodynamic therapy + the treatment described above. The patient came to the therapy: docetaxel + vargatef 200 mg x 2 times a day according to new recommendations of SBHOMR “Moscow Regional Oncology Hospital” in Balashikha. There was taken a decision to choose polychemotherapy docetaxel 75 mg/m2 – 150 mg i/v 1 time for 21 days + vargatef 200 mg daily, in case of visible toxicity reduction of the dosage up to 50%. The patient had 3 courses of the therapy docetaxel+vargatef mentioned above. CT of chest organs with i/v contrast dated 10.07.20.

Conclusion: Central cr of the upper part of the left lung, atelectasis of S3 segment of the left lung. Disseminated focal changes in the parenchyma of both lungs. Lymphadenopathy bifurcational lymphnode. Osteosclerotic mts in the body of Th6 vertebra and in 6, 8 ribs to the right; dated 24.03.2020 – positive dynamics in the form of decrease of foci intensity in lungs, sizes of thoracic lymph nodes. CT of abdominal organs with i/v contrast dated 10.07.2020.

Conclusion: Diffuse changes of liver, fatty hepatosis. Gallstones. Chronic calculous cholecystitis. Bilateral pyeloectasia. Lymphadenopatia of retroperitoneal lymph nodes, the lymph node of porta hepatis (dated 24.03.2020 – some decrease of sizes of retroperitoneal lymph nodes). Nodular thickening of the left medial adrenal pedicle (without dynamics). Additional lobule of the spleen. Osteosclerotic mts in the bodies of I5, S1 and S2 vertebrae and right iliac bone without visible dynamics. SBHOMR “Moscow Regional Oncology Hospital” in Balashikha recommended to continue chemotargeted therapy up to 3 courses with the scheme (docetaxel 75 mg/m2 i/v 1 time for 21 days + nintedanib 200 mg x 2 times a day 2-21 days).

Medical commission took place in Onco.Rehab clinic.

There was taken a decision to follow the therapy with 50%-reduction because of remarkable toxicity + LPS. Reduction of vargatef by 50% and docetaxel by 25% was caused by their toxic effect. Therapy passed satisfactory. CT of abdominal organs with i/v contrast dated 05.01.2020.

Conclusion: Diffuse changes of liver, fatty hepatosis. Gallstones. Chronic calculous cholecystitis. Bilateral moderate pyeloectasia. Additional formation of rear segment of the left kidney, more information for angioma, dated 10.07.2020 – without dynamics. Lymphadenopatia of retroperitoneal, mesenteric lymph nodes, the lymph node of porta hepatis (dated 10.07.2020 – some decrease of sizes of the lymph node of porta hepatis). Nodular thickening of the left medial adrenal pedicle (without dynamics). Additional lobule of the spleen. Osteosclerotic mts in the bodies of I5, S1 vertebrae and right iliac bone without visible dynamics. CT of abdominal organs with i/v contrast dated 05.01.2020.

Conclusion: Central cr of the upper part of the left lung, atelectasis of S3 segment of the left lung. Disseminated focal changes in the parenchyma of both lungs. Lymphadenopathy of the bifurcational lymphnode. Osteosclerotic mts in the body of Th6 vertebra and in 6, 8 ribs to the right; dated 10.07.2020 – positive dynamics in the form of decrease of intensity and quantity of subsolid foci in S4 right lung, decrease of the bifurcation lymph node. Other without negative dynamics. The patient had a consultation in SBHOMR “Moscow Regional Oncology Hospital” in Balashikha, recommendation to continue therapy nintedanib 200 mg daily for 3 months. Courses of therapy passed without particularities. Negative dynamics of the process at the control screening. MSCT of chest organs with i/v contrast dated 29.01.2020.

Conclusion: Central cr of the upper part of the left lung, atelectasis of S3 segment of the left lung. Disseminated focal changes in the parenchyma of both lungs. Lymphadenopathy of bifurcational, subcarinal lymphnodes. Hydropericard. Osteosclerotic mts in the body of Th6 vertebra and in 6, 8 ribs to the right; dated 05.20.2020 – negative dynamics in the form of increase of quantity, sizes and densification of disseminated foci in both lungs, some increase of the sizes of bifurcational, subcarinal lymph nodes. MSCT of chest organs with i/v contrast dated 29.01.2020.

Conclusion: Diffuse changes of liver, moderate hepatomegaly. Gallstones. Chronic calculous cholecystitis. Additional formation of rear segment of the left kidney, dated 05.10.2020 – without visible dynamics. Lymphadenopatia of retroperitoneal, mesenteric lymph nodes, the lymph nodes of porta hepatis (dated 05.10.2020 without negative dynamics). Nodular thickening of the left medial adrenal pedicle (without dynamics). Additional lobule of the spleen. Osteosclerotic mts in the body of L5 vertebra, sacrum and iliac bones without visible dynamics at the screening dated 05.10.2020. The patient had a consultation in SBHOMR “Moscow Regional Oncology Hospital” in Balashikha on 01.02.2021, recommendation to continue therapy vargatef for 2 months + zoledronic acid daily for 3 months.

Medical commission took place in Onco.Rehab clinic.

There was taken a decision to follow the therapy described above. Scintigraphy of bones of the skeleton dated 16.02.2021. Radiopharmaceutical: Pirfotechum 99mTc, introduced activity: 700 MBq. Total efficient dose: 3.99 MSv.

Protocole: Screening was performed in 120 minutes after introduction of the radiopharmaceutical. The screening let receive the image of bones of the whole body skeleton in front and rear projections and SPECT. Physiological distribution of the radiopharmaceutical in kidneys and the bladder is remarkable. Distribution of the radiopharmaceutical in bones is inhomogeneous because of the segments of hyperfixation of the medication in the projection: frontal pariental area to the right. Body of the lower jaw, Th6, rear segment of the 6 rib to the right, Th11 to the left. L2-S1,2, the sacroiliac joint from both sides, bodies of the left iliac bone, diaphysis of femurs from both sides, likely, because of the neoplastic process.

Conclusion: Scintigraphic picture can correspond to metastatic damage of bones of the skeleton.

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