Gradual Recovery from Nonambulatory Quadriparesis Caused by Metastatic Epidural Cervical Cord Compression in an Octogenarian Gallbladder Carcinoma Patient Treated with Image-Guided Three-Dimensional Conformal Radiotherapy Alone Using a Field-in-Field Technique.

[carcinoma of the gallbladder]

Radiotherapy for acute metastatic epidural spinal cord compression (MESCC ) involves conventional techniques and dose fractionation schemes , as it needs to be initiated quickly . However , even with rapid intervention , few paraplegic patients regain ambulation . Here , we describe the case of a mid-octogenarian who presented with severe pain and nonambulatory quadriparesis attributable to MESCC at the fifth cervical vertebra , which developed 10 months after the diagnosis of undifferentiated carcinoma of the gallbladder . Image-guided three -dimensional conformal radiotherapy (IG-3 DCRT ) was started with 25 Gy in 5 fractions followed by a boost of 12 Gy in 3 fractions , for which a field-in -field (FIF ) technique was used to optimize the dose distribution . Despite the fact that steroids were not administered , the patient reported significant pain reduction and showed improved motor function 3 and 4 weeks after the IG-3 DCRT , respectively . Over the following 4 months , her neurological function gradually improved , and she was consequently able to eat and change clothes without assistance and to walk slowly for 10 -20 m using a walker . She succumbed to progression of abdominal disease 8 .5 months after the IG-3 DCRT . This case demonstrates that image-guided FIF radiotherapy with a dose-escalated hypofractionated regimen can potentially improve functional outcome and local control .

Diseases
Validation

Diseases presenting "pain" symptom

achondroplasia

acute rheumatic fever

adrenal incidentaloma

adrenomyeloneuropathy

aniridia

aromatase deficiency

carcinoma of the gallbladder

cholangiocarcinoma

coats disease

congenital diaphragmatic hernia

congenital toxoplasmosis

cushing syndrome

cutaneous mastocytosis

cystinuria

dedifferentiated liposarcoma

dentin dysplasia

dracunculiasis

dystrophic epidermolysis bullosa

epidermolysis bullosa simplex

erdheim-chester disease

erythropoietic protoporphyria

esophageal adenocarcinoma

esophageal carcinoma

esophageal squamous cell carcinoma

fabry disease

familial mediterranean fever

focal myositis

hirschsprung disease

hodgkin lymphoma, classical

holt-oram syndrome

junctional epidermolysis bullosa

kabuki syndrome

kindler syndrome

lamellar ichthyosis

liposarcoma

locked-in syndrome

lymphangioleiomyomatosis

malignant atrophic papulosis

neuralgic amyotrophy

oligodontia

oral submucous fibrosis

papillon-lefèvre syndrome

phenylketonuria

pleomorphic liposarcoma

primary hyperoxaluria type 1

proteus syndrome

pyomyositis

scrub typhus

sneddon syndrome

systemic capillary leak syndrome

thoracic outlet syndrome

trochlear dysplasia

typhoid

von hippel-lindau disease

waldenström macroglobulinemia

well-differentiated liposarcoma

wolf-hirschhorn syndrome

This symptom has already been validated