Dados do Trabalho

Título

Spetacular response of huge cervical lymph node metastases after Stereotactic ablative radiotherapy (SABR)

Apresentação do caso

In this case report, a male patient, 60 years, was presente to investigate a cervical mass growth, 01/04/2019 a computerized tomography (CT) showed a suspected lynfonodal metastases at the transition right cervical level II and III, with a 67,3cm³.
Paliative chemotherapy was indicated with carboplatin AUC 5 + paclitaxel 175mg/m² each 21 days regim until progression or intolerance. The first cycle was admistraded at 04/02/2019. In a clinical evaluation (day 08/01/2019), before the release of the fourth cicle (day 08/05/2019), was solicited a ratiotherapy evaluation for a massive cervical lymph node that was in clear progression even while in course of chemotherapy.
The lymph node size was mesured by CT at diagnost of 67cm³ (04/01/2019), growing to 227cm³ (22/03/2019), 607cm³ (23/05/2019) and 1408cm³ (14/08/2019).
At evaluation, the patient has presented with a massive cervical lesion (image 1) with clear signals of local tissue infection, active, but small bleeding, lymphedema 3/4+ in right upper limb, local pain necessitating strong opioids. Palliative radiotherapy was indicated with a ablative dose of 24Gy in 3 fractions of 8Gy each, at days 0, 7 and 21, along the lines the treatment delivered by Nguyen article.
Treatment delivered with parallel-opposed field. The first fraction was delivered at the same day (08/14/2019) and the third and last fraction at day 09/04/2019.
After the treatment there was a large regression from 1408cm³ (08/14/2019) to 192cm³ (09/25/2019), almost disappearing, but the remanescent lesion was stable until the last days of the patient, the last CT was acquired 11/14/2019 with a 261cm³ lesion (Image 2).
Before the last fraction the patiente was already refering a substantially improve in dysphagia and great pain relief, morphine prescription was suspended and analgesia was composed of dipyrone whenever necessary. Afther one month the patient was denying dysphagia. Treatmente was well tolerated, the single toxicity was a grade 2 Acute radiation dermatitis.

Discussão

In this case, the linfonodal growth was above avarege described in the literature but is a exemple of the necessity of treatmente in a short peryod of time after the dianostic. Local control was essential to the patient confort and opiode discontinuention.

Comentários Finais

This radiotherapy schedule was ideal for this patiente because consisted of only 3 days coming to the hospital and also convenient by a spaced apart time of 1 and 2 weeks. Pain and the total cervical mass was greatly reduced.

Palavras-chave

SABR; cervical mass; head and neck cancer; palliative; radiotherapy