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Radiotherapy for a phalanx bone metastasis of a lung adenocarcinoma.

Sumodhee S, Huchot E, Peret G, Marchal C, Paganin F, Magnin V - Case Rep Oncol (2014)

Bottom Line: Severe pain discouraged the patient from using his left hand.An X-ray of the left hand showed a lytic bone lesion.Analgesics were no longer needed and the patient was able to reuse his left hand in his everyday life.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, CHU Sud Réunion, Saint-Pierre, Réunion, France.

ABSTRACT
Phalanx bone metastasis as the initial presenting sign of lung cancer is a rare presentation. Lung cancer is known to metastasize to the bone, but rarely to the fingers. A 61-year-old male smoker presented with pain in the left ring finger. Severe pain discouraged the patient from using his left hand. An X-ray of the left hand showed a lytic bone lesion. The patient was treated with finger radiotherapy. Analgesics were no longer needed and the patient was able to reuse his left hand in his everyday life. Palliative radiotherapy relieved our patient and improved his quality of life.

No MeSH data available.


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Left ring finger lesion after radiation therapy.
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Figure 4: Left ring finger lesion after radiation therapy.

Mentions: We performed an X-ray of the rib cage, which showed a lytic lesion of the eighth rib. An X-ray of the left hand showed a lytic bone lesion with the destruction of the bone cortex in the proximal phalanx and a swelling of the surrounding soft tissue (fig. 2). A CT scan of the chest showed several suspicious opacities, one in the left lung hilum, a stellar image at the apex of the right lung, and a lytic lesion of the anterior arc of the eighth rib (fig. 3). The pneumologist performed a bronchoscopy, but the first biopsies were negative. Then a biopsy of the rib mass identified an infiltration of the parietal pleura and striated muscle tissue by a pulmonary adenocarcinoma, moderately differentiated TTF1+, KRAS mutant, BRAF wild type, EGFR wild type, and with no ALK rearrangement. The bone scintigraphy showed multiple bone metastases on the rib cage, the spine, and the left scapula. The patient's left ring finger was very painful. He was given a nonsteroidal analgesic. The pain was morphine resistant. The patient received radiotherapy for his left ring finger in March 2014 (dose of total 30 Gy/10 fractions, 5 fractions/week, 6-MV X-rays with 5-mm bolus). Over the next month, the left ring finger became much less painful. Analgesics were no longer needed. The patient was able to use his left hand again in everyday life. The edema decreased (fig. 4), and the finger measured 75 mm in circumference. An X-ray of the left hand done 1 month after the end of the radiotherapy showed a decrease of the soft tissue swelling and an early reossification of the proximal phalanx (fig. 5). Chemotherapy with cisplatin, pemetrexed and bevacizumab was started at the end of the radiotherapy.


Radiotherapy for a phalanx bone metastasis of a lung adenocarcinoma.

Sumodhee S, Huchot E, Peret G, Marchal C, Paganin F, Magnin V - Case Rep Oncol (2014)

Left ring finger lesion after radiation therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4256000&req=5

Figure 4: Left ring finger lesion after radiation therapy.
Mentions: We performed an X-ray of the rib cage, which showed a lytic lesion of the eighth rib. An X-ray of the left hand showed a lytic bone lesion with the destruction of the bone cortex in the proximal phalanx and a swelling of the surrounding soft tissue (fig. 2). A CT scan of the chest showed several suspicious opacities, one in the left lung hilum, a stellar image at the apex of the right lung, and a lytic lesion of the anterior arc of the eighth rib (fig. 3). The pneumologist performed a bronchoscopy, but the first biopsies were negative. Then a biopsy of the rib mass identified an infiltration of the parietal pleura and striated muscle tissue by a pulmonary adenocarcinoma, moderately differentiated TTF1+, KRAS mutant, BRAF wild type, EGFR wild type, and with no ALK rearrangement. The bone scintigraphy showed multiple bone metastases on the rib cage, the spine, and the left scapula. The patient's left ring finger was very painful. He was given a nonsteroidal analgesic. The pain was morphine resistant. The patient received radiotherapy for his left ring finger in March 2014 (dose of total 30 Gy/10 fractions, 5 fractions/week, 6-MV X-rays with 5-mm bolus). Over the next month, the left ring finger became much less painful. Analgesics were no longer needed. The patient was able to use his left hand again in everyday life. The edema decreased (fig. 4), and the finger measured 75 mm in circumference. An X-ray of the left hand done 1 month after the end of the radiotherapy showed a decrease of the soft tissue swelling and an early reossification of the proximal phalanx (fig. 5). Chemotherapy with cisplatin, pemetrexed and bevacizumab was started at the end of the radiotherapy.

Bottom Line: Severe pain discouraged the patient from using his left hand.An X-ray of the left hand showed a lytic bone lesion.Analgesics were no longer needed and the patient was able to reuse his left hand in his everyday life.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, CHU Sud Réunion, Saint-Pierre, Réunion, France.

ABSTRACT
Phalanx bone metastasis as the initial presenting sign of lung cancer is a rare presentation. Lung cancer is known to metastasize to the bone, but rarely to the fingers. A 61-year-old male smoker presented with pain in the left ring finger. Severe pain discouraged the patient from using his left hand. An X-ray of the left hand showed a lytic bone lesion. The patient was treated with finger radiotherapy. Analgesics were no longer needed and the patient was able to reuse his left hand in his everyday life. Palliative radiotherapy relieved our patient and improved his quality of life.

No MeSH data available.


Related in: MedlinePlus