Patient P., 56 years old, diagnosed with: Right breast cancer stage IIb T2N1M0, after complex treatment in 2002. Progression in 2007 – metastasis to the left lung, after atypical resection of the upper lobe of the left lung (2007), oophorectomy (2007), chemotherapy, hormone therapy, and targeted therapy. Progression in 2011 – metastasis to the right lung, after wedge resection of the upper lobe of the right lung (2011). On hormone therapy and targeted therapy. Stabilization. Clinical group IV. Histological diagnosis: infiltrating ductal carcinoma (Er-0%, Pgr-0%).
At the initial visit in December 2002, the patient complained of a palpable mass in the right breast. After further examination, the diagnosis was: Right breast cancer stage II T2N0M0. Gamma therapy was performed on the primary tumor at a total focal dose (TFD) = 22.5 Gy, followed by surgical treatment in the form of a Madden mastectomy on the right. According to the results of the postoperative material examination, the following histological diagnosis (HD) was made: infiltrating ductal carcinoma with metastases to the axillary lymph nodes (Er-0%, Pgr-0%). Adjuvant radiation therapy with a TFD of 40 Gy was performed on the primary tumor and regional metastasis zones. From 01/30 to 03/26/2003, 4 courses of polychemotherapy (PCT) were performed according to the AC*4 regimen (Doxorubicin 60 mg/m2 intravenously on day 1 + cyclophosphamide 600 mg/m2 intravenously on day 1, once every 3 weeks, 4 cycles). Then, patient P. was sent for dynamic follow-up. From April 2003 to April 2007, she regularly visited an oncologist, underwent the necessary examinations; no signs of disease progression were noted.
In May 2007, a focal lesion was found in the upper lobe of the left lung during a follow-up examination. Computed tomography of the chest organs (CT of the chest) dated 05/25/2007: CT picture of a peripheral tumor of S-3 of the upper lobe of the left lung up to 10 mm, more likely a solitary metastasis. On 06/05/2007, surgical removal of the lung mass was performed in the amount of atypical resection of the upper lobe. Histological examination of the postoperative material showed that there was a metastasis of glandular-papillary adenocarcinoma in the lung tissue, possibly from breast tissue (Er-33%, Pgr-30%, HER2/neu (3+). To control the progression of the disease, from 08/14 to 10/24/2007, PCT was performed according to the AT*4 regimen (Doxorubicin 50 mg/m2 intravenously on day 1 + paclitaxel 220 mg/m2 intravenously on day 1, once every 3 weeks, 4 cycles). Hormone therapy was prescribed (Tamoxifen 20 mg orally, daily, for a long time), and surgical castration was also performed (bilateral adnexectomy dated 12/17/2007). In the study of postoperative material and a smear from the abdominal cavity for oncocytology, no tumor cells were found. In May 2010, bone scintigraphy revealed a slight increase in the accumulation of radiopharmaceutical in the right shoulder joint. On the recommendation of specialists from the N.N. Blokhin Russian Cancer Research Center, aromatase inhibitors (Letrozole 2.5 mg orally, daily, for a long time) and bisphosphonates (Zoledronic acid 4.0 IU intravenously once a month) were prescribed. From 09/03/2007 to 10/20/2011, the patient received targeted therapy (Trastuzumab 440 mg intravenously once every 3 weeks). During this period, no signs of continued growth or recurrence of the tumor were detected.
During a medical examination in October 2010, negative dynamics were revealed. CT of the chest dated 11/21/2011: CT signs of mts in the upper lobe of the right lung. By this time, the patient had received 35 courses of targeted therapy. After further examination, a decision was made to perform a wedge resection of the upper lobe of the right lung. On 12/08/2011, the planned surgical treatment was performed at the Voronezh Regional Clinical Hospital No. 1. Histologically, a recurrence of the disease was established in the form of metastatic lesions of the right lung (Er-0%, Pgr-0%).
From 03/16/2012 to the present, she has been receiving targeted therapy (Trastuzumab 440 mg intravenously once every 3 weeks) and hormone therapy (Letrozole 2.5 mg orally, daily, for a long time). At the time of writing (05/20/2024), the patient is stable and is under dynamic observation at the VRSCOC. Multislice spiral computed tomography of the chest organs dated 05/15/2024 (without dynamics for a long time): condition after courses of PCT for a peripheral tumor/mts of the upper lobe of the right lung; focal lesions in the upper lobe on the left; postoperative changes in the right lung; focal pneumofibrosis on the right; pleurofibrosis on the right; fibrotic changes in the lungs on both sides; moderately pronounced mediastinal lymphadenopathy; hyperplasia of the thymus gland; enchondroma of the head of the right humerus.
- MRI of the abdominal cavity with intravenous contrast from 05/17/2024 (no dynamics for a long time): a picture of multiple liver cysts, single liver hemangiomas, multiple spleen hemangiomas.
- MRI of the lumbar spine with intravenous contrast from 05/17/2024: no data for mts were found.
- MRI of the pelvic organs with intravenous contrast from 05/17/2024: no data for volumetric pathology were found.
- MRI of the retroperitoneal space with intravenous contrast from 05/17/2024 (no dynamics for a long time): a picture of simple kidney cysts (type 1 according to Bosniak).
- MRI of the pelvic bone tissue from 05/17/2024: without signs of mts.
The prognosis for the patient in terms of his health and life is intermediate, since as of May 2024 the condition is stable, medically controlled, however, it is not possible to predict the probability and potential localization of disease progression. The key factors influencing the duration and quality of life are the continuation of optimal drug therapy and regular dynamic monitoring of the patient, for timely assessment of his condition and adequate modification of treatment tactics, if necessary.
