Renal cancer palliative care
According to these aspects, the patient was included in the intermediate risk group, with median survival estimated at CT exam reassessment for thorax, abdomen, and pelvis with contrast substance scans are performed in Augustand then in Januaryboth suggesting stable disease.
It was decided to continue the treatment renal cancer palliative care sunitinib, with the same doses, with good tolerance and no side effects.
In Augustthe patient was admitted to the nephrology hospital section with elevated levels of nitrates.
Following investigations, there was no evidence renal cancer palliative care acute renal insufficiency and it was recommended to continue the sunitinib treatment. The thoracic, abdominal, endometrial cancer pten CT test performed on June 18, revealed multiple numerical and dimensional secondary pulmonary lesions compared to the previous exam, a stationary aspect of adrenal lesions without other secondary lesions.
Conclusion: disease renal cancer palliative care. Bone scintigraphy performed on July 3, revealed a scintigraphic image without oncological interest.
Figure 1. Abdominal CT renal cancer palliative care - November 28, Following the imaging results that highlighted the disease progression, it was decided to stop the sunitinib therapy and initiate the second-line therapy. Figure 2.
Lung CT scan - July 3, The thoracic, abdominal and pelvic CT test performed on December 4, revealed evolutionary numerical and dimensional secondary pulmonary lesions, adjacent adrenal secondary process with evolutionary aspect, mediastinal and upper abdomen pathological lymph nodes.
Terapia Ţintită În Carcinomul Renocelular
Between December and Octoberthe patient was treated with temsirolimus, weekly dose of 25 mg i. Figure 3.
Tratamentul cu bevacizumab plus interferon-alfa a fost aprobat de ctre ageniile de reglementare din Europa decembrie ; se ateapt rezultatul unei recenzii efectuate renal cancer palliative care SUA de ctre Food and Drug Administration. Everolimus a fost aprobat recent martie de ctre FDA a SUA pentru pacienii cu RCC avansat dup apariia progresiei bolii n condiiile tratamentului cu sunitinib sau sorafenib. Conform acestui ghid, o recomandare de categoria 1 se bazeaz pe dovezi de nivel nalt de ex.
Abdominal CT scan - December 4, Thoracic, abdominal and pelvic CT exam performed on June 21, no contrast substance revealed: secondary lung lesions and left adrenal metastasis in mild dimensional progression compared to previous examination, without secondary liver and bone lesions. Conclusion: stable disease.
Practical Nephrology: Mark Harber · | Books Express
Figure 4. Abdominal CT scan - Renal cancer palliative care 27, Bone scintigraphy on The patient continued the treatment with temsirolimus weekly with 25 mg i. Figure 5. Abdominal CT scan - January 02, In terms of side effects after temsirolimus treatment, the patient experienced repeated haematological toxicity, grade thrombocytopenia between March and Julywhich led to discontinuing the treatment and repeated platelet transfusion.
The administration is resumed in Augustafterwards renal cancer palliative care no side effects.
The thoracic-abdominal-pelvic native CT scan performed on October 10th, revealed secondary lung lesions in dimensional regression from previous examination; without new lesions, the secondary lesion of the left renal cancer palliative care gland in mild dimensional regression, but spontaneous hypodense liver lesion developed in left hepatic lobe, suspected for secondary substrate, mediastinal and infradiafragmatic adenopathies in mild dimensional regression.
Conclusion: disease progression due to new hepatic secondary lesion.
Figure 6. In Novemberhepatic chemoembolization with tandem microspheres loaded with doxorubicin mg was performed. Between December and Januarythe patient continued temsirolimus 25 mg i.
In January renal cancer palliative care,a new thoraco-abdominal-pelvic CT scan was performed, which showed local right renal lobe relapse, secondary hepatic evolution dimensional and numerical tumors, stable secondary pulmonary metastases, secondary adrenal glands lesions with dimensional evolution, and an osteolytic lesion vertebral body L2 - possibly secondary.
It was decided to discontinue the treatment with temsirolimus, and to evaluate the following therapeutic options. In Marchthe patient suffered a left femoral fracture by falling from his own height, for which a surgical intervention was performed on March 6th,in another clinical hospital osteosynthesis with trans-trohantero-cervico-cephalic screws.
During hospitalization, the patient had increased serum calcium levels Bone scintigraphy performed on March 20th, revealed secondary vertebral bone metastases T10, T12, L2and bilateral femur metastases. On April 12 - April 14,the patient was once again hospitalized on the nephrology section with low back pain and inferior limb pain, the diagnosis of admission being: chronic dorsolombalgia, high blood pressure grade 3, papillary thyroid cancer hcc high risk group, insulin-requiring type 2 diabetes, right renal cancer palliative care for Gravitz tumor operated with pulmonary, right adrenal and liver metastases, asymptomatic hyperuricaemia, mixed caused hypercalcemia.
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In April 19th,the patient returned to the Institute of Oncology with balanced hemodynamic and respiratory status, and functional impotence in the left limb. Biological status: anemia hemoglobin 8. Regarding continued treatment options, at the time the patient did not fit into any of the inclusion criteria according to the current therapeutic protocols, axitinib being approved in second-line therapy, and everolimus treatment was not allowed because of the low renal cancer palliative care level and clearence to creatinine.
Also, the actual protocols do not accept the rechallenge therapy for sunitinib, and immunotherapy was not available at that time for renal carcinoma.
Terapia Ţintită În Carcinomul Renocelular
On April renal cancer palliative care,supportive treatment was initiated: erythropoietin weekly, intravenous administration, to normalize hemoglobin level, and intensive hydration to decrease creatinine levels. Therefore, the patient started oral administration of everolimus at 10 mg dose per day.
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In June the patient renal cancer palliative care external RT with palliative indication at the level of bone secondary determinations and continued to administer everolimus, with good tolerance.
Discussions What is to be emphasized is that under four targeted therapy lines, the patient showed an overall survival of 45 months after metastatic disease revealed and 49 months after the diagnosis of renal clear cell carcinoma, compared to the average survival period statistically estimated to be In order to have a correct therapeutic attitude, the following steps are essential for patients with clear kidney tumors: histological confirmation of the diagnosis, subsequently verified by immunohistochemical tests, correct staging, patient framing ranges in one of the risk groups, correct evaluation renal cancer palliative care prognostic factors, control of co-morbidities and the possibility of performing nephrectomy 3.
Regarding the treatment of systemic illness at the moment, we had several therapeutic options. According to international guidelines, in the first line of treatment it is preferable either to treat with tyrosine-kinase inhibitors type as sunitinib, pazopanib, axitinib for the low-risk group and intermediate risk groups, or anti-angiogenesis monoclonal antibody bevacizumab in combination with interferon, either with first-line temsirolimus-type mTOR inhibitors for high-risk patients.
In the second line, guidelines recommend after first-line therapy with a TKI the renal cancer palliative care with another TKI, or the everolimus mTOR inhibitor, or the combination of lenvatinib plus everolimus.