2017 Volume 31 Issue 1 Pages 74-79
Stage IV symptomatic cervical metastasis is accompanied by progressing neurologic symptoms and neck pain. Typically, the goal of the treatment of this type of cancer is to improve the quality of life (QOL) of the patient. Indeed, function recovery is achieved by timely surgical treatment and radiosurgery that delivers high doses of radiation with very high accuracy. Here, we describe a case of symptomatic cervical metastasis that was treated by our multidisciplinary approach, which is imperative to restore the activities of daily living (ADL) of patients and improve their QOL.
A 72-year-old man presented with paralysis of the left arm and neck pain that were caused by cervical metastasis of hepatocellular cancer. The patient was treated with an emergency tumor resection that was followed by posterior cervical spinal fusion. Beginning the next day, acute rehabilitation was provided, and the patient was able to perform ADLs. After three postoperative weeks, he returned home from the hospital. Fractionated radiation using Cyberknife was then administered for 4 days as adjuvant stereotactic radiosurgery. Three months after the first round of radiation treatment, cervical metastasis with muscular weakness of the right arm and pain emerged outside the irradiated field. Thus, fractionated radiosurgery was administered for 4 more days. After 13 months, thoracic spinal metastasis was identified, and the pain was treated with standard external-beam radiotherapy. These treatments resolved the symptoms and pain, and the patient has been able to perform ADLs at his home for more than 18 months.
Restoration of daily activity that was decreased by symptomatic cervical metastasis was essential for improving the QOL of the patient. Considering the poor prognosis of the patient due to the disease progression, it was critical to perform prompt diagnosis, ensure appropriate treatment, and reduce the duration of therapy. Therefore, the results of this report suggest the importance of multidisciplinary team-oriented medicine, including emergency surgery, high-dose radiation with extreme accuracy, focused rehabilitation, coordinated home care, and comprehensive postoperative consultation.
