Case 1

CASE DESCRIPTION

Umesh Kumar is a young 36-year-old gentleman survived by wife and a 3-year-old daughter. He presented with a diagnosis  of recurrent abdominal DFSP associated  with the sarcomatous transformation of Right iliac fossa Retroperitoneal mass and solitary lung metastasis. He presented to us with symptoms of extreme distress and inability to walk. He was evaluated with imaging showing  recurrent large right pelvic retroperitoneal mass abutting iliac bone, femoral vessels and femoral nerve involvement. He had taken multiple opinions and was declared palliative in view of disease involving femoral vessels associated with high morbidity. He was feeling helpless as he was the only earning member and was tailor by profession.

Consultation and diagnosis

Prompt and accurate diagnosis made in-house

Tumour board

A multi-disciplinary team deliberated on action

Individualized care

Patient’s mental makeup taken into consideration

Psychosocial support given priority

Modular care

A suite of therapies that contribute to holistic healing

WHAT WE DID
We had a multidisciplinary joint clinic meeting and finally decided to offer a single agent 6 cycles of Doxorubicin and reassess. After 2 cycles of chemotherapy, to our surprise, his walking disability was controlled. He started gaining confidence with our treatment and counseling. After 6 cycles we did a response assessment FDG PET CT scan which showed a partial response and amenable to surgery. After discussion & counseling, we planned for surgery and he underwent Retroperitoneal mass excision with periosteum stripping and femoral nerve segmental resection and reconstruction. During postoperative care, he recovered well with aggressive rehabilitation which is an essential part of management.

• Tumor board involved
• Disability controlled
• Underwent planned surgery
• Adjuvant radiotherapy
• Aggressive rehabilitation

FINAL RESULTS

It has been a whole year since he was declared palliative. Such a dedicated and personalised approach towards patient management can change the outcomes by motivation and render a survival advantage.