The recurrence of cancer has become a major problem for patients!
Why does early cancer, after surgical removal of the lump, recur, and even "resurrect" many times?
Because cancer cells are often cunning, just as the leaves of wild grasses can be eradicated, but the roots underground must be hidden in some parts of the body through hibernation, and when the time comes, they will take root and sprout and re-offend.
Ms. Lin, who participated in this multidisciplinary consultation, was diagnosed with chordoma in early May 2020 and quickly underwent surgical resection, but at that time, the staging was earlier and no adjuvant treatment was performed. After more than a year, in August 2021, it was found that the left side of the neck was sore and uncomfortable, and the re-examination to the hospital was a recurrence of the cervical 3-4 vertebral tumor. Out of fear of surgery, the patient did not undergo treatment for the time being, and after 2 months, the pain worsened and a second surgical resection was performed.
At present, 4 months after the second operation, the sensory surgery site and left arm are numb, and the postoperative MRI shows a paravertebral recurrence of the left side of the C3 vertebral body.
One right paravertebral recurrence in the surgical area
Left paravertebral recurrence in the secondary surgical area
If it recurs after two surgeries, can I continue the surgery? If surgery is not possible, are there other anti-recurrence treatments? And see what kind of plan the US-China-Jia and international multidisciplinary consultation expert groups will formulate for them.
Consultation notes
International multidisciplinary consultation, for patients to develop a "one person, one plan", its rationalization and personalized diagnosis and treatment can improve patient survival rate, shorten the patient diagnosis and treatment waiting time, while avoiding the cost and burden of multiple consultations and repeated examinations.
At the beginning of the consultation, the participating experts comprehensively and completely understood the patient's medical records, images and other information, listened carefully to the questions and demands raised by the patients and their families, and then, in view of the patient's condition and demands, dozens of medical teams from the Department of Oncology, Radiotherapy, Imaging, Physicists, Technicians, Nursing Staff and other dozens of people from China and abroad opened the multidisciplinary consultation.
Patient medical records
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Initial diagnosis
After 2 surgeries for cervical chordoma, rpT2N0M0
Introduction to the condition
Patient, female, 53 years old
The patient was diagnosed with cervical 3 vertebral body chordoma in May 2020 and underwent surgery in the hospital on May 8, 2020, without adjuvant therapy. In August 2021, due to the soreness and discomfort of the left neck, the recurrence of the tumor of the 3-4 vertebral body of the neck was re-examined, and the patient's personal wishes were not treated surgically. In October 2021, the pain worsened, and the tumor surgery was performed in the outer hospital. Postoperative pathology: (cervical 3-4) chordoma, CKpan+, EMA+, S 100-, Vimentan-, Ki67 3-5%+, Brachyury+, INI-1 poor expression.
At present, the patient has fixed neck support, complaining of numbness and discomfort in the left neck and left arm, normal stool, no fever, and stable weight.
Moments of discussion
Do you continue the third surgery after the recurrence?
Although surgery is the preferred treatment for chordoma, it is difficult to cure chordoma with surgery alone because tumors that originate in the bone are difficult to completely remove.
If it still recurs after the second surgery, it is recommended to communicate with the surgeon about the possibility of re-operation.
Is proton therapy done?
According to foreign clinical data, the five-year survival rate of patients with early tumors after proton therapy has reached more than 80%. For tumors surrounded by important tissues and organs, other treatments (including surgery) are helpless, and proton therapy shows great superiority.
Treatment of the recurrence site with proton therapy is very precise, allowing for efficient and possibly higher doses of radiation irradiation for the target tumor, with less damage to the surrounding tissues, maximizing tumor control while minimizing collateral damage and improving treatment outcomes.
If proton therapy is not used, local photon radiotherapy can be used, and care needs to be taken to maximize the dose on the basis of protecting the spinal cord.
Conclusion of the consultation
After a detailed discussion, the consultation experts gave the following opinions:
Postoperative MRI shows paravertebral recurrence on the left side of C3 vertebral body. Communicate with the surgeon about the possibility of re-operation, and inform the patient of the possibility of proton therapy if there is no chance of surgery. Topical photon radiotherapy requires a dose of protection based on the spinal cord as much as possible.
Chordoma is prone to recurrence, and the consolidation of proton or photon radiotherapy after surgery has opened a door of hope for the cure of chordoma.
Hu Qiaoying
Director of the Department of Radiotherapy, Shanghai MeizhongJiahe Cancer Clinic
Wen Amin
Radiologist at Shanghai Meizhongjia and Cancer Clinic
U.S.-China-Ka and international multidisciplinary consultation expert team
Professor Fu Shen
Leader of the International Multidisciplinary Consultation Team
U.S.-China-Ka and international multidisciplinary consultation
Multidisciplinary consultation (MDT) is a method of discussing and discussing experts from multiple disciplines to develop a personalized diagnosis and treatment plan for patients, especially for the diagnosis and treatment of complex diseases such as tumors. It is the first diagnosis and treatment method advocated and promoted by MD Anderson Cancer Center in the United States, which is effective in improving the treatment effect of patients.
Meizhongjia International Multidisciplinary Consultation brings together the expert resources of Shanghai Meizhongjiahe Cancer Clinic, Guangzhou Taihe Cancer Hospital, Singapore Taihe International Hospital, etc., and is committed to providing professional, rigorous and high-quality personalized diagnosis and treatment programs for cancer patients.