hematology -medical oncology trainee faculty of medicine ... · diagnosed august 2016, t4n2mo...

ESMO Preceptorship Programme

Metastatic Nasopharyngeal Carcinoma

at Multiple Sites

Dwi Wahyunianto HadisantosoHematology - Medical Oncology Trainee

Faculty of Medicine, Universitas Indonesia

Cipto Mangunkusumo Central Hospital Indonesia

Dharmais National Cancer Center Hospital

Undifferentiated carcinoma – Nasopharynx – 13th of April 2019

ESMO PRECEPTORSHIP PROGRAMME

DISCLOSURE OF INTEREST

� none

ESMO PRECEPTORSHIP PROGRAMME

Case Summary (1)

� Patient female, 27 y.o., came to clinics referred for

nasopharyngeal carcinoma that already spread to

her lungs and bones.

� Diagnosed August 2016, T4N2MO (st. IV A AJCC

VIII) she underwent chemoradiation (cisplatin

weekly 6 cycles, external irradiation daily 35

fractions) but not neoadjuvant nor adjuvant

chemotherapy.

ESMO PRECEPTORSHIP PROGRAMME

Case Summary (2)

� The program finished December 2016 and she

routinely check-up every 3 months.

� April 2018 the doctor found multiple nodules on her

lungs, suspected for metastasis and referred to us

in haematology and medical oncology division for

chemotherapy.

� We did restaging and found that it also had spread

to her bones and liver.

ESMO PRECEPTORSHIP PROGRAMME

Case Summary (3)

� We sent the patient to radiotherapy department for

weight bearing bones irradiation, and then platinum

and 5-FU combination chemotherapy + zoledronic

acid monthly were planned.

ESMO Preceptorship Programme

ESMO PRECEPTORSHIP PROGRAMME

� Pathology:

– Consistent with non-keratinized undifferentiated

carcinoma (gr. III WHO)

ESMO PRECEPTORSHIP PROGRAMME

09/08/2016 Diagnostic

ESMO PRECEPTORSHIP PROGRAMME

10/04/2017 After Chemoradiation

ESMO PRECEPTORSHIP PROGRAMME

02/02/2018 Thorax

ESMO PRECEPTORSHIP PROGRAMME

24/07/2018 CT Abdomen

ESMO PRECEPTORSHIP PROGRAMME

24/08/2018

ESMO PRECEPTORSHIP PROGRAMME

17-09-2018 Bone Scan