A 48 years old woman presented to us with paralysis of 4 days duration. She also gave a history of upper backache since past 5 months. She had a past history of being treated for right breast cancer with surgery, chemotherapy and hormonal therapy 7 years back. Clinically both her breasts and lymph node regions were normal. Neurologically her power in both lower limbs was reduced to 1/5 and rest everything was normal. We did a MRI spine for her which showed D4 Vertebral metastases with collapse and cord compression. She also underwent whole body PET CT scan which showed that she had multiple bone metastases and her rest body organs were free of cancer.

Patient was jointly evaluated by team of neurosurgeons, radiation and medical oncologists. She was taken up for neurosurgical tumour decompression and spine stabilization in view of recent onset paralysis and metastases being confined only to bones (which carries better prognosis as compared to patient having metastases in lungs or liver). After surgical decompression, her power in lower limbs improved to 2/5.

Surgery also yielded histopathology and biopsy which confirmed it to be metastases from breast cancer with strong hormonal positivity for Estrogen and Progesterone receptors.

Post- surgery she was started on hormonal tablets for breast cancer. Since her breast cancer was confined only to bones and it had strong positivity for hormonal receptors, she did not require any chemotherapy. She was planned for Stereotactic Body Radiation Therapy (SBRT) to affected D4 vertebrae. Her Radiation Therapy was planned using combined information from CT Myelogram and MRI Spine to spare spinal cord and focus high radiation doses only on cancer affected region. This radiation therapy was given over 5 days. She also underwent regular physiotherapy. As a result of this well planned intensive treatment and rehabilitation, she was up on her feet again.

This case exemplifies importance of multi disciplinary treatment, tumour board, newer radiation techniques like SBRT and quality of life of patients.

Dr Vineeta Goel, Associate Director Radiation Oncology at Max Super Speciality Hospital is the best doctor for  SBRT SPINE AND VERTEBRAL METASTASES.