1.A Case of Breast Carcinoma with Multiple Bone Metastases Intervened by Palliative Care Preceding Chemotherapy
Hiroaki SHIBAHARA ; Satoshi KOBAYASHI ; Ei SEKOGUCHI ; Yasuyuki FUKAMI ; Akira ITO ; Sakura ONISHI ; Akihiro TOMITA ; Ryo SHIRATSUKI ; Akira KANAMORI ; Kei MIYAMURA ; Yasuhiro KURUMIYA ; Daisaku NISHIMURA
Journal of the Japanese Association of Rural Medicine 2013;62(1):26-30
This case is a 56-year-old woman. With multiple bone metastases, she was referred to the Department of Palliative Care on the same day as core needle biopsy had just been performed in the Department of Surgery. Aggressively increased oxycodone was administered to relieve her significantly severe pains by bone metastases. After relief of the pains, cancer chemotherapy of EC and weekly PTX regimens were performed parallel to palliative care. In this case, chemotherapy could be performed after the pains had been sufficiently relieved with closer cooperation between the palliative care doctor and the attending surgeon. It is important for patient-focused medical care to be delivered by both the attending doctor administering cancer treatment and the palliative care doctor working for relief of the symptoms, while they are striving to foster their tie-up.
2.A Case of Luminal B Breast Cancer in Which Preoperative Chemotherapy Was Used Due to Ineffective Preoperative Hormone Therapy
Yasuhiro KURUMIYA ; Tae NIWA ; Sakura ONISHI ; Shingo OYA ; Keisuke MIZUNO ; Ei SEKOGUCHI ; Gen SUGAWARA ; Masaya INOUE ; Takehiro KATO ; Naohiro AKITA ; Takayuki MINAMI ; Kosuke INADA ; Kenji TAKEUCHI ; Akihiro SEKIMOTO ; Akihito OGATA ; Akiko OSADA
Journal of the Japanese Association of Rural Medicine 2022;71(1):63-68
A 66-year-old, postmenopausal woman was referred to our hospital because of abnormal breast cancer screening results. A tumor was found in the upper outer part of the left breast. Biopsy revealed papillotubular carcinoma, ER (Allred score total score [TS] 3 = proportion score [PS] 2 + intensity score [IS] 1), PgR (Allred score TS 3 = PS 2 + IS 1), HER2 (2+), fluorescent in situ hybridization 1.1 (negative), and Ki-67 labeling index 15%. In diagnostic imaging, the tumor size was 35 mm. The diagnosis was T2N0M0 Stage IIA, luminal B-like breast cancer. First, letrozole 2.5 mg/day was administered as preoperative hormone therapy. After 2 months of treatment with letrozole, the tumor size had increased to 44 mm and preoperative hormone therapy was discontinued. She was started on preoperative chemotherapy (4 courses of epirubicin plus cyclophsphamide followed by 4 courses of triweekly docetaxel). The tumor size decreased, becoming undetectable. After these preoperative treatments, nipple-sparing mastectomy, sentinel lymph node biopsy, and breast reconstruction with a primary latissimus dorsi flap were performed. As of 3 years and 6 months after the operation, there has been no recurrence. At first, preoperative hormone therapy is performed for Luminal B-like breast cancer as in this case, if the response is insufficient, preoperative chemotherapy after hormone therapy may be a therapeutic option.