Case 3
A 6-year-old patient with prostatic alveolar rhabdomyosarcoma presented
with metastatic disease to lymph nodes and long bones, ribs, and
numerous vertebrae. He developed disease progression at multiple
vertebral levels 17 months after initial diagnosis, associated with
significant back pain. Palliative radiation with 2000 cGy in four
fractions was given to his spine from T5 to L4, with pain improvement.
However, his pain returned three months later and was difficult to
manage, requiring continuous fentanyl and ketamine infusions,
clonazepam, acetaminophen, lorazepam and ibuprofen. He had multilevel
vertebroplasty performed in two stages, one week apart. First, T1, T6,
T7, and T9 were treated, followed by T11, L2, L3 and L4. His pain
improved significantly over the next 30 days, and he was able to be
discharged home with palliative care support and passed three months
following his last intervention.