5.3.3 Case Study
Name：Pu××Gender：Female Age：44 years Ethnicity：Han Nationality Marriage：Married
Chief Complaint：1 year after comprehensive treatment of left breast cancer，liver and lung bone metastasis after 1 cycle of chemotherapy
Current medical history：The patient was diagnosed at the“Kunming General Hospital of Chengdu Military Region”due to“discovering the left breast mass for more than one month and continuing to increase for 3 months”on 2017-10-11.Molybdenum palladium showed：the upper outer quadrant ofthe left breast changed，considering the gland Body hyperplasia may not exclude malignant，2017-10-23 due to“discovering left breast mass for more than 1 month，continue to increase in March”for the first time in our hospital，on 2017-10-30 operated“left breast mass biopsy”，combined with the diagnosis of the disease：left invasive ductal carcinoma，cT4N1M0，ⅢB.On the 2017-11-03 used 4 cycles of“EC” regimen chemotherapy（THP：86mg，CTX：1.0g），the last chemotherapy time：2018-01-12；on the 2018-02-06 used 4 cycles of“PTX”regimen chemotherapy（PTX：0.29 g），the last chemotherapy time：2018-04-02.On 2018-04-26，under the general anesthesia，“modified radical mastectomy for left breast cancer”，combined with the diagnosis of the disease：left breast upper quadrant invasive ductal carcinoma pT2N0M0 ⅡA.Postoperative radiotherapy at 2018-08-10：VMAT（left chest wall+left supraclavicular region）DT50Gy/25F.After regular review，2019/2/2 MR：left cerebellum multiple space-occupying lesions，combined with medical history，considered as brain metastases.Considering the patient's tumor progression，multiple brain metastases appear，and it is recommended to continue treatment.However，due to the approaching Spring Festival，patients and their families are required to return to hospital after the holiday，and they are automatically discharged after repeated persuasion.After discharge，the patient felt dizziness，headache，unstable walking，occasional nausea，vomiting，palpitations，and irritating oil.He was treated in our hospital on 2019-03-12.Both CT and MRI indicated that the brain metastasis increased and increased.With the fourth ventricle compressed，the third ventricle mildly expanded，comprehensive evaluation of the disease progress，please recommend“ventricular drainage”after neurosurgery，after the reduction of intracranial hypertension，then whole brain radiotherapy，in 2019-03-19 transferred to neurosurgery，in the 2019-03-22 under general anesthesia“right ventriculo-peritoneal shunt”，postoperative patients with nausea，vomiting，mental，poor diet，consider intracranial tumor progression，at 2019-04-01 transferred to our department，brain palliative radiotherapy on 2019-04-01：general irradiation：whole brain DT30Gy/10F/14d；DT300cGy/F，local tumor bed intensity increase DT10Gy/5F/5d；DT200cGy/F，The patient's nervous system symptoms and signs were significantly relieved；combined with other auxiliary examination results，the patient had liver，lung and bone metastasis，and the overall progress of the disease，used 1 cycle“NP”regimen chemotherapy on 2019-04-26（vinorelbine 40mg dl，8+cisplatin 40 mg dl-3）.This is for further treatment.
Admission examination
lack of left breast，an old surgical scar on the left chest wall，and healed well.The right breast was normal in appearance，and the enlarged lymph nodes were not touched by the bilateral axilla and the clavicle.The lungs of the lungs were clear，no obvious dry and wet voices，no pleural friction sounds；heart rate Qi，no audible noise in the auscultation area of each valve，no pericardial friction sound.Physiological reflexes exist and pathological reflexes are not elicited.The lower limbs are not swollen.(https://www.daowen.com)
Auxiliary examination
2017-11“Chongqing Military Region Kunming General Hospital”，molybdenum palladium：left upper quadrant changes，considering glandular hyperplasia may not exclude malignant，2017-10-30 operated“left breast mass biopsy”，the disease test showed：left breast invasive ductal carcinoma.Our hospital 2018-04-26 operated“left breast cancer modified radical surgery”，2018-05-04 postoperative pathological report diagnosis：“left breast mass and axillary lymph node”invasive cancer，to be diagnosed by immunohistochemistry；There were no cancerous tissues in the specimen nipple，posterior gland，areola skin and subcutaneous tissue，basal，rejuvenated skin，in the upper and lower quadrants；axillary lymph nodes（0/16），and“interstitial lymphatic adipose tissue”（0/1）with no cancer tissue.ER（-），PR（-），HER2（1+），Ki67（50%）.2019/2/2 MR：multiple left space cerebrovascular lesions，combined with medical history，considered brain metastases.
Diagnosis：1.Left breast cancer postoperative radiotherapy and chemotherapy brain metastasis pT2N0M1 Ⅳ stage Ⅲ negative；1.1 brain secondary malignant tumor after radiotherapy and chemotherapy；1.2 lung secondary malignant tumor；1.3 liver secondary malignant tumor；1.4 kidney continued Malignant tumor；1.5 thoracic and lumbar spine secondary malignant tumor.
Treatment：patients who failed after EC-T chemotherapy，rescue chemotherapy regimen failed in the treatment of sputum ring and smock：1.Single drug regimen：capecitabine，vinorelbine，gemcitabine 2.NX regimen：vinorelbine+Capecitabine（2A）3.NP regimen：vinorelbine+cisplatin（2A）4.GP regimen：gemcitabine+cisplatin/carboplatin（2A）.This patient chooses NP regimen，vinorelbine 25 mg/m2 d1，8，cisplatin 75mg/m2，d1-3，21 days one cycle.
（Yunfen Li）