We report the case of a 55-year-old man with a personal history of bulbar ulcus (Helicobacter pylori positive, misdiagnosed in 2005), pulmonary thromboembolism in 2012 and operated on for right inguinal hernia.
Smoker, with an accumulated total of 20 packs/year.
In May 2011, the patient came to the Emergency Department complaining of instability in gait with a right-sided atheromatous urticaria, with dysnomia and vomiting.
A cranial CAT scan showed a lesion in the right cerebellar hemisphere.
After completing the extension study with TAC-abdominal, cranial MRI, bronchoscopy and PET, a brain lesion suggestive of metastasis was diagnosed in the context of a possible localized lung neoplasia.
It was decided to perform diagnostic-therapeutic cerebral metastasectomy.
The pathological result was microcytic lung carcinoma.
The final diagnosis was stage IV T1N0M1b SCLC.
Adjuvant treatment with holocraneal radiotherapy was administered until reaching a total dose of 37.5 Gys that ended in July 2011 after which he received chemotherapy treatment with cisplatin -VP16.
1.
The patient required change to plateau due to emesis and renal failure, receiving a total of 4 cycles of treatment with poor clinical tolerance and finalizing in October 2011.
Subsequently, in December 2011, the patient received chest consolidation radiotherapy, 45 Gys in 15 Gys according to the recommendations established RT 09372, maintaining stability of the disease in the following controls.
In July 2012 he was admitted from the Emergency Department due to loss of strength of the left lower limb of several days of evolution.
MRI showed leptomeningeal metastases with dorsal implant (D2-D3) that caused a compression which began treatment on levels D1-5. Treatment with spinal cord excellent response was initiated with radiotherapy 20 Gy in clinical practice.
A CAT scan showed a new appearance of 2 cm right hiliar lymphadenopathy, which was started on December 6, 2012 with partial response and stabilization after December 6, 2012.
In the follow-up MRI, in June 2013, multiple punctiform uptake images compatible with leptomeningeal dissemination were visualized along the raquis, both at the dorsal and lumbar level, highlighting the implants at the lumbar level.
Twenty Gys were administered in June 5, 2013.
In a follow-up study using CAT scan in November of that year, it was observed that the right hiliar lymphadenopathy had slightly increased in size compared to the previous CT scan, so it was decided to administer radiotherapy for the lesion 40 Gyliar with a final treatment with a final scheme of 15.
Since then, it has been found in reviews, with good general condition, active and independent life for basic activities of daily living.
There are no data on disease progression in the control studies.
There are no pathological leptomeningeal enhancements in the last MRI of the spine and CT has shown a decrease in the right hiliar adenopathy, which is currently subcentimetric.
