Table 1 Timeline showcasing the relevant events from episode of care
From: Primary neuroendocrine tumor of the pineal gland: a case report
Past medical history: Hypertension | |||
|---|---|---|---|
Date | Summary | Diagnostic Testing | Intervention |
January 2018 | Patient presented with five-day history of vomiting, weakness, balance difficulties, and headaches. | CT head: aggressive pineal tumor with hydrocephalus. | Started on IV steroids and transported to tertiary care centre. |
January 2018 | Patient experiencing symptoms of hydrocephalus. | Third ventriculostomy, biopsy of the pineal tumor, and insertion of external ventricular drain and ICP monitor. | |
February 2018 | Patient experienced minimal symptom relief from drain placement. | Surgical subtotal resection of the pineal tumor for symptom relief. | |
March 2018 | Patient continued to experience symptoms from hydrocephalus. | CT head: hydrocephalus. | Ventriculoperitoneal shunt placed. |
March 2018 | Patient assessed by Medical Oncology and Radiation Oncology. The patient was ECOG-4 at that time. Incidental hyperparathyroidism and hypercalcemia discovered after Endocrinology consultation. | PET-CT: no evidence of FDG-avid neoplasia elsewhere in body. Small renal lesion noted. | No systemic intervention or radiotherapy at that time due to patient’s performance status. |
April 2018 | The patient remained in ECOG-4. The patient and family wished to return home. | Discussion held with patient and family. Decision for the patient to return to his community hospital for palliative care. | |
May 2018 | The patient’s condition improved significantly during rehabilitation to ECOG-2. | Patient discharged from community hospital. | |
June 2018 | Patient reassessed by Radiation Oncology. | MRI head and spine: enlargement of pineal tumor. No evidence of drop metastases within spinal column. | |
July 2018 | Radiation regimen of 54 cGy in 30 fractions to primary tumor and resection cavity. 3600 cGy in 20 fractions to craniospinal axis. | ||
July 2018 | Patient reassessed by Medical Oncology. Discussion held with the patient and family members about the role of systemic therapy with palliative intent. | The patient was provided with information about temozolomide and capecitabine. Systemic therapy planned for post-radiation. | |
September 2018 | Radiotherapy completed. The patient started temozolomide alone based on ECOG, but experienced significant toxicity, resulting in hospital admission. | MRI head and spine: residual tumor slightly decreased in size post-radiotherapy. | Further chemotherapy held. |
December 2018 | Patient reassessed by Medical Oncology. | MRI head: slight decrease in size of residual tumor with stable edema and hydrocephalus. | No further systemic therapy at this time. Continued surveillance. Referral to Palliative Care for best supportive care. |
March, April 2019 | Routine follow-ups with Radiation Oncology. | MRI head: stable residual tumor size. | |
June 2019 | Patient noticed posterior neck swelling. | Biopsy: metastatic disease. MRI cervical spine: at least four enhancing lesions. | Biopsy of neck mass performed. |
July 2019 | Patient reassessed by Medical Oncology and Radiation Oncology. Planned for radiotherapy to control metastatic disease with possible platinum-based chemotherapy post-radiation. | ||
August 2019 | Patient became unwell before radiotherapy attempted. | No radiation due to decline in performance status. . | |
September 2019 | The patient’s condition deteriorated and was admitted to hospital for palliative care, where he later died. | ||