Tatsumura Masaki, Saito Takeshi, Ito Hiroyuki, Miura Kousei, Yamazaki Masashi
Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center / Mito Kyodo General Hospital, Mito, JPN.
Department of Breast Surgery, Tsukuba University Hospital Mito Clinical Education and Training Center / Mito Kyodo General Hospital, Mito, JPN.
Cureus. 2022 Sep 2;14(9):e28699. doi: 10.7759/cureus.28699. eCollection 2022 Sep.
Breast cancers frequently metastasize to bone. Several guidelines recommend denosumab to control metastasis. In the current case, denosumab allowed the calcification of cervicothoracic spinal metastases following bone decalcification by breast cancer. Six years after administration, denosumab was discontinued and the metastatic lesions became decalcified, but recalcification occurred after re-administration of denosumab. There were no reports of serious decalcification after discontinuation of denosumab. The patient was a 71-year-old woman who was unable to walk independently because of a fracture of the seventh cervical vertebra and severe spinal cord compression. After immobilization with a halo vest, posterior fixation was performed. Examination of the pathology of the breast and cervical spine revealed ductal carcinoma of the breast. After docetaxel for four months, tegafur-gimeracil-oteracil potassium (TS-1) was administered and monthly denosumab was initiated. CT showed postoperative recalcification of the cervicothoracic spine, and MRI revealed spinal cord decompression. The first occurrence of medication-related osteonecrosis of the jaw (MRONJ) occurred five years after cervicothoracic spinal surgery and the second occurrence of MRONJ occurred after six years. Denosumab was discontinued and TS-1 was resumed four months after discontinuation. Fourteen months after discontinuation of denosumab, the patient felt muscle weakness in the right upper extremity and numbness in both hands. CT showed cervicothoracic spine decalcification and MRI showed spinal cord compression. As there were no signs of recurrence in the primary lesion around the left breast, TS-1 was continued and denosumab was resumed. Three months after the re-administration of denosumab, CT showed recalcification and recovery of upper extremity muscle strength, and MRI revealed improvement in spinal cord compression.
乳腺癌常转移至骨骼。多项指南推荐地诺单抗用于控制转移。在当前病例中，地诺单抗使乳腺癌导致的骨脱钙后的颈胸段脊柱转移灶发生了钙化。用药六年停药后，转移灶脱钙，但重新使用地诺单抗后又再次钙化。尚无地诺单抗停药后严重脱钙的报道。患者为一名71岁女性，因第七颈椎骨折和严重脊髓受压而无法独立行走。使用头环背心固定后，进行了后路固定术。对乳腺和颈椎的病理检查显示为乳腺导管癌。使用多西他赛四个月后，给予替吉奥胶囊（TS-1）并开始每月注射地诺单抗。CT显示颈胸段脊柱术后再次钙化，MRI显示脊髓减压。用药相关颌骨坏死（MRONJ）首次发生于颈胸段脊柱手术后五年，第二次发生于六年之后。停用了地诺单抗，停药四个月后恢复使用TS-1。停用后14个月，患者感到右上肢肌肉无力，双手麻木。CT显示颈胸段脊柱脱钙，MRI显示脊髓受压。由于左乳房周围原发灶无复发迹象，继续使用TS-1并重新使用地诺单抗。重新使用地诺单抗三个月后，CT显示再次钙化且上肢肌肉力量恢复，MRI显示脊髓受压情况改善。
