- Joined
- Jan 18, 2013
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- 152
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53 yo lady with a known familial MEN 2 A, a history of Medullary Thyroid cancer diagnosed in 2010 and of a Pheochromocytoma of the right adrenal for which she underwent an adrenalectomy during the same year, and who developed back pain close to 5 months back, requiring investigations, these were unfortunately not available for my review but according to the available reports revealed widely metastatic bony disease with a lesion at the Level of D6 vertebral body and posterior arch causing partial compression of the cord and definitely of the roots at this level, with a small paravertebral mass lesion. There was also a lesion in the thyroid bed. CEA and Calcitonin were extremely high with a CEA in the 140 range and Calcitonin above 1900.
She underwent a partial debulking and successful decompression via a posterior approach but still has a very large anterior portion of the tumor which may regrow and cause a second compression beyond surgical redo. While she will definitely be started on vandetanib once the medication is made available to her, she will require palliative radiotherapy.
her recent Pet CT showed a recurrence of the dz at thyroid, multiple bony nodal and viceral mets.
What dose do you recommend in this case?
all studies listed doses ranging from 30 to 60 Gy. On average 40Gy was the minimum effective dose. so what do you suggest?
She underwent a partial debulking and successful decompression via a posterior approach but still has a very large anterior portion of the tumor which may regrow and cause a second compression beyond surgical redo. While she will definitely be started on vandetanib once the medication is made available to her, she will require palliative radiotherapy.
her recent Pet CT showed a recurrence of the dz at thyroid, multiple bony nodal and viceral mets.
What dose do you recommend in this case?
all studies listed doses ranging from 30 to 60 Gy. On average 40Gy was the minimum effective dose. so what do you suggest?
