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Council of physicians consisting of the doctor of Medicine R.S. Ismail-zade, candidate of Medicine I.V.Prolesovskaya, consulting physician M.V.Seredin
Taking into consideration the histological result of the removed mass (alveolar sarcoma), the presence of focuses (mts?) in lungs, it is reasonable to conduct two blocks of chemotherapy (IVA +CEV) with further CT-control of chest organs. In case of the positive response for treatment on the part of focuses in lungs – perform one block of IVE (according to the CWS protocol). If there is no positive response – perform the pleuracotomy at once. After the pleuracotomy decide about the further conduction of the radiotherapy in the zone where the primary tumor location and about the continuation of the chemotherapy.
Conducted treatment: 05.03. – 07.03.15 VCR 1.0 mg; IFO 4950 mg; D-act 1.0 mg. 13.03.15 VCR 1.0 mg. 25.03.15 VCR 1.0 mg
Clinical blood analysis (30.03.15): Hb-130 g/l, Er-4.7х1012/l, L-2.2х109/l: b-0%, e-1%, stab-10%, segmented-63%, l-17%, m-9%, Tr-184х109/l, ESR-63 mm/hour.
03.04.15-04.04.15 VCR 1.0 mg, Carbo 270 mg, Doxorubicin 44 mg; 10.04.15 VCR 1.0 mg; 21.04.15 VCR 1.0 mg.
Clinical blood analysis (20.04.15): Hb-90 g/l, Er-3,32х1012/l, L-19,5х109/l, Tr-173х109/l.
23/04/15 Discharged home in the satisfactory condition.
CWS-guidance (v.1.5 from 01/07/2009)
| IVA m2=0,55 | CEV m2=0,53 | SURGERY | IVE m2=0,53 | |
| Date: | 05.03-25.03.15 | 03.04-21.04.15 | 29.04.15 20.05.15 | 03.06-05.06.15 |
| VP-16 | - | - | 80 mg x 3 (240 mg) | |
| VCR | 1,0 mg x3 | 1,0 mg x3 | 0,8 mg x3 (2,4 mg) | |
| Act-D | 1,0 mg | - | ||
| IFO | 1650 mg x3 (4950 mg) | - | 1596 mg x 3 (4788 mg) | |
| Doxorub | 11 mg x4 (44 mg) | |||
| Carbo-Pt | 270 mg |
Regular hospitalization to OHD№2 25.04.15.
| 29.04.15 Surgery: Pleuracotomy to the right. Atypical resection of parts of the right lung. |
| Surgical report |
| Lateral pleuracotomy in the 5th ICS to the right. During the revision multiple MTS are identified in the right lung that have the look of dark-blue oval parts with surface location and palpatory in the depth of the lung tissue in the amount of 15 pcs. with diameter from 6 to 3 mm, 15 pcs. 3 MTS in the upper lobe one after one in S1, S2, S3; in the middle lobe three in S5, one in S4; in the lower lobe four MTS in S8 upper and lower lateral borders, the rest 4 on the border and in the depth S9-10. Atypical resection of abovementioned parts was performed. Moreover, 8 whitish parts up to 1 mm are identified in the costal surface of the middle and lower lobes – electrocoagulation 7 and 1 on the border of the lower and middle lobe in S3, the largest was atypically resected. Control over hemostasis, foreign bodies and pneumostasis. Stitch of the wound with leaving the PVC drainage. Aseptic dressing. |
Histopathology report d/d 04.05.15: Parts of the lung tissue with metastasis of alveolar sarcoma of the soft tissue. Metastasis without accurate signs of pathomorphosis.
Discharged on 08.05.15
Regular admission to OHD №2 13.05.15.
| 20.05.15 Surgery № 54/297 | |||
| Lateral pleuracotomy. Atypical resection of parts of the left lung. | |||
| Anaesthesia endotracheal anesthesia | |||
| Surgical report: | |||
| Lateral pleuracotomy in the 5th ICS to the left. During the revision multiple metastases are identified in both lobes of the lung, palpatory dense, of dark-blue colour, diameter from 1 to 5 mm. In the upper lobe there are 5 metastases, two in s1+2, one in s3 in the front and two in the area of the interlobar cleft S4-S5 – performed atypical resection of lung tissue with mts. Three white parts 2 mm in diameter in S5 – coagulated, taking into consideration small similarity with MTS. There are 10 solid focuses in the lower lobe, two in S6, two on the border of S8 and S9 along the side surface, one in S6 near the root, two in S7+8 in the interlobar cleft. Three focuses are on the diaphragmatic surface of the lower lobe of S8-S9 – atypical resection of lung tissue with mts was performed. Control over hemostasis and pneumostasis. Stitch of the wound with leaving the PVC drainage. Aseptic dressing. | |||
| Description of the sample (removed organ, part of organ)lung tissue with mts, the biggest is 5 mm in diameter, of dark-blue colour | |||
| Биопсия | |||
22.05.15 Histopathology report № 2947-60: Parts of the tissue of lung’s parenchyma with metastases of alveolar sarcoma of soft tissue. Without accurate signs of pathomorphosis.
03.06 – 05.06.15 Conducted the 3rd block of IVE, see table. Took it satisfactory.
Clinical blood analysis (08.06.15): Hb-103 g/l, Er-3,62х1012/l, L-2,7х109/l, Tr-205х109/l.
Biochemical blood analysis (08.06.15): Na-137; Cl-100; K-4.12; total protein -64.2; urea-1.3, creatinine- 22, total bilirubin -6.3, АЛТ-39.2; АСТ-54.1; CRP-0.2 mg/dL.
Continues tratment.
Best regards to the collegues.
Dr. Seradzin M.
Tel.+375296503101/Fax+375172654222
08.06.15
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