Case presentation:
A 50-year-old woman was diagnosed with breast cancer with bone
metastasis at a medical institution in her home town, Iwaki City,
Fukushima Prefecture, Japan in January 2016. In February 2016, she was
referred to a university hospital in Tokyo, Japan, which is
approximately 200 km apart from Iwaki City. There, she received hormone
therapy with exemestane and goserelin, and treatment for bone metastases
with denosumab. Because of the worsening local control, the patient
received the mastectomy and axilla dissection in June 2019. In April
2020 she had an enhanced computed tomography (CT), and the results
revealed no signs of exacerbation. After that, due to the increasing
number of COVID-19 cases in Japan, she could not visit the university
hospital in Tokyo from Fukushima.
Instead, she began to receive remote video consultations of the
university hospital and were prescribed medications regularly. In this
period, treatment with denosumab and goserelin was interrupted, and she
and the attending doctor had been looking for a medical institution near
her home where she could have regular imaging exams, but six months had
passed without finding one.
In November 2020, she was firstly referred to our hospital. She had some
mild symptoms with Eastern Cooperative Oncology Group Performance Status
of 1 just before visiting our hospital. We detected elevated CA15-3 of
87.2 and CEA of 7.6, and subsequent positron emission tomography
revealed multiple liver metastases that had not been previously detected
by her previous doctor 7 months ago. She soon started chemotherapy at
our hospital with paclitaxel and bevacizumab and restarted denosumab,
and as of October 2021, her liver metastases have kept shrunk,
fortunately.