共找到 20 条结果
Palliative care is an essential health service for patients with chronic and life-threatening conditions. Although palliative care has been formally recognized in Georgia's legislation and state programs since the mid-2000s, evidence regarding the development, accessibility, and integration of services remains limited. The WHO framework, Assessing the Development of Palliative Care Worldwide: A Set of Actionable Indicators, and its application in the EAPC Atlas of Palliative Care in the European Region 2025 provide an opportunity for a comprehensive assessment of the national palliative care system. This study evaluated the development of palliative care in Georgia using WHO actionable indicators and compared the findings with the EAPC 2025 Atlas to identify system-level gaps and priorities for improvement. This study employed a descriptive health systems assessment and policy analysis of palliative care development in Georgia. The evaluation was guided by the World Health Organization's 2021 framework, Assessing the Development of Palliative Care Worldwide: A Set of Actionable Indicators. Fourteen indicators across six domains were operationalized using national administrative data, policy documents, institutional reports, and published literature from 2021 to 2024. Quantitative and qualitative findings were triangulated and benchmarked against the European Association for Palliative Care (EAPC) Atlas of Palliative Care in the European Region 2025 to assess service availability, accessibility, geographical distribution, coverage, and system capacity. While palliative care is legally recognized and partially embedded in national health policy, implementation remains limited and uneven. Service provision is highly centralized in Tbilisi, with restricted outpatient and home-based services in regions. In 2024, only 16.7% of the estimated national palliative care need was met. Opioid consumption remains in the very low range, reflecting restrictive regulations, limited medicine availability, and insufficient prescriber training. Similarly, the EAPC 2025 Atlas shows low performance across key WHO indicators, particularly in governance, monitoring mechanisms, service integration, research, and education. Despite early legislative advances, Georgia's palliative care system remains fragmented and inadequately integrated into primary health care. Strengthening governance, financing, education, and monitoring in line with WHO and EAPC benchmarks is essential to achieve equitable, sustainable, and comprehensive palliative care coverage.
Early palliative care can improve end-of-life outcomes, but referrals to palliative care specialists can be delayed in the primary care setting. This pilot study assessed the effect of a machine-learning algorithm on time to palliative care in a primary care population. Patients (aged ≥18 years) were eligible if they were empaneled with a primary care provider (PCP) from July 20, 2020, through May 30, 2021. The algorithm evaluated their health records and presented patients who were predicted to have the greatest need for palliative care. Records were then reviewed by palliative care specialists, and patients were randomized in a stepped-wedge fashion to have a referral notification sent to their PCPs if unmet palliative care needs were verified. Time-to-event outcomes were evaluated with Poisson regression models. Of the 127,080 patients evaluated, 934 had their health records presented for review. Some patients were repeatedly presented by the algorithm (total presentations: 1592). In the intervention arm, PCPs were prompted to order a palliative care consultation for 142 patients. The time to 0.1% of the population receiving a palliative care consultation was 60.9 days for the intervention arm versus 71.8 days for the control arm (probability of a shorter time with the intervention, 0.88). A machine-learning algorithm to identify palliative care needs was successfully integrated into a primary care practice. More work is needed to improve the workflow.
Ensuring a smooth transition from hospital cancer care to home palliative care remains a key challenge, while pharmacist involvement in pre-discharge conferences has traditionally been limited in Japan. We investigated whether coordination by the Board Certified Pharmacist in Palliative Pharmacy (BCPPP) could enhance the extent and quality of pharmacist participation. In this retrospective descriptive observational study, we examined pre-discharge conferences for patients with advanced cancer, pharmacist participation rates and level of involvement from hospital and community pharmacies, methods of medical narcotics administration, and the rates of short-term readmission from January 2018 to December 2024. The BCPPP-led coordination initiative was initiated in 2022, which comprises of identification of the patients requiring home palliative care, arranging the pre-discharge conferences, support for opioid pharmacotherapy, coaching ward pharmacists, and ensuring the continuity of pharmacotherapy after discharge. Outcomes were compared between periods before (2018-2021) and after the start of interventions by a certified pharmacist (2022-2024). A total of 110 pre-discharge conferences were conducted. The certified pharmacist in palliative pharmacy coordinated collaboration with medical social workers. Pharmacist participation in pre-discharge conferences significantly increased after the intervention (hospital: 9.3% vs. 80.0% [p < 0.01], community pharmacies: 5.3% vs. 54.3% [p < 0.01]). The proportion of pharmacist recommendations focused on discharge planning increased from 35.7% to 73.3% (p < 0.05). The two- and four-week readmission rates did not differ significantly before and after the intervention (two-week: 13.2% vs. 3.0%; four-week: 17.6% vs. 18.2%). Coordination by a certified pharmacist in palliative pharmacy increased pharmacist participation inside and outside the hospital and promoted more proactive involvement in palliative care during pre-discharge planning. Although short-term readmission rates did not significantly change, strengthened collaboration between hospital and community pharmacies may contribute to improved continuity of palliative care during the transition to home.
Self-report is the gold standard for assessing pain intensity, although the method of acquiring pain reports may influence the ratings obtained. Retrospective reports of pain intensity are often found to be elevated relative to daily diary reports, possibly due to recall bias and the influence of psychosocial factors on memory. In this study, we sought to examine differences between retrospective reporting of average pain intensity in the past week vs averaged daily diary reporting of pain intensity in a sample of adolescents with juvenile fibromyalgia (JFM). We also sought to determine the predictive effects of pain catastrophizing, functional disability, and depressive symptoms on discrepancies between retrospective and daily diary report. As part of a randomized controlled trial, 317 adolescents with JFM (Mage = 15.7, SD = 1.6, 88.4% female) completed daily diary and one-week retrospective pain intensity measures, the Children's Depression Inventory-2, Functional Disability Inventory, and Pain Catastrophizing Scale at baseline, post-treatment, and 3-month follow-up. We examined the predictive effects of psychosocial factors on mean differences between averaged daily and one-week retrospective reports of pain intensity. Retrospective reports of pain intensity were significantly higher than diary reports across time. A longitudinal multiple linear regression model showed that the magnitude of discrepancies between daily diary and retrospective reports was not significantly predicted by functional disability, depressive symptoms, or pain catastrophizing. These findings raise the possibility that other factors such as cognitive biases (eg, threat interpretation, saliency, recency bias) may play a larger role than psychosocial factors in explaining pain reporting discrepancies.
Refractory status epilepticus complicating hepatic encephalopathy poses unique palliative challenges as standard extubation protocols typically reduce or discontinue sedative infusions, risking immediate seizure recurrence and distress. We report a 53-year-old man with end-stage cirrhosis and hepatocellular carcinoma who developed hepatic encephalopathy and refractory status epilepticus precipitated by small bowel obstruction. Despite ammonia-lowering therapy and multiple antiseizure medications, seizures remained refractory. Electroencephalography confirmed status epilepticus despite escalating therapy. Given prohibitive surgical risk and poor prognosis, the multidisciplinary team and patient's family elected to withdraw life-sustaining treatments, requesting he not die with an endotracheal tube in place. He underwent palliative extubation while continuing propofol and midazolam infusions to suppress seizure activity and ensure comfort. He died peacefully without visible seizure activity. Although limited by a single patient, this case provides a practical example of a rarely described palliative strategy: continuing sedative infusions during palliative extubation to prevent agonal seizures in refractory status epilepticus.
We sought to analyze the effect of a palliative care intervention on quality of life (QoL) in patients with fibrotic interstitial lung disease (fILD). This was a prospective observational study including 14 patients with fILD treated with a bundle of care provided by multidisciplinary specialists in pain and palliative care, a psychologist, physical therapists, and a nutritionist, with all patients initiating 10 mg of morphine sulfate. Measurements at baseline, 30 days, and 90 days included cough, dyspnea, pain, tiredness, nausea, depression, anxiety, sleepiness, appetite, and difficulty sleeping. QoL was recorded using the modified St. George's Respiratory Questionnaire (SGRQ-1). Change over time in each endpoint was analyzed. Baseline assessment reflected an impaired QoL (median SGRQ-1, 91 points). All symptom scores improved at 90 days, with a statistically significant and clinically meaningful 20-point decrease in the SGRQ-1 (p = 0.001). Palliative care intervention improves symptom and QoL in fILD.
Palliative sedation is used to relieve refractory suffering in terminally ill patients. Propofol, an intravenous anesthetic, may offer advantages due to its rapid onset and short half-life. To evaluate the role of propofol in palliative sedation, focusing on symptom control, sedation depth, survival time, safety, and ethical implications. Systematic review registered in PROSPERO (CRD42025643575; February 6, 2025). Scopus, MEDLINE, and Web of Science were searched for English-language studies (2005-2024) on propofol use in adult terminally ill patients. Studies comparing propofol with other sedatives or non-sedated controls were included; those involving anesthetic or intensive care settings were excluded. Risk of bias and certainty of evidence were assessed. Results were synthesized narratively. Ten non-randomized studies were included (observational, cross-sectional, cohort, case series, and before-and-after designs), mostly of moderate quality, conducted in Europe (n = 7) involving 4072 patients (28,3% received palliative sedation), mainly with cancer. Symptom control was reported in 73%-100% of cases, target sedation depth was achieved in 52%-100%, although outcome definitions and measurement methods varied. Survival ranged from 19 h to 38 days. Propofol was used alone (n = 4) or with other sedatives (n = 6). Respiratory depression was the main safety concern. Ethical issues included absence of explicit consent and rare reports of life-shortening intent. Propofol may be considered as a rescue option in selected refractory cases managed by experienced teams; however, given the low to very low certainty of available evidence, findings should be interpreted cautiously and supported by institutional protocols and further prospective research.
Access to a palliative approach to care improves the quality of life of individuals with a serious illness and their families. This paper describes the development of a decision-support tool that identifies individuals receiving home care and long-term care services who could potentially benefit from a palliative approach to their care based on information available in interRAI assessments used in those sectors as part of regular practice. A consultative and iterative multi-phase approach was employed to develop the "Serious Illness Collaborative Action Plan" (or Serious Illness CAP), over an 18-month period. Criteria for triggering this CAP were established with 49 individuals across seven advisory groups; criteria were operationalized using items and measures available in interRAI instruments and tested using anonymized population-level data from home care (N = 568,586) and LTC (N = 35,713) sectors in three Canadian provinces were analyzed. The CAP is based on the presence of health instability and potentially modifiable exacerbating issues (i.e., severe/excruciating daily pain, moderate/severe mood problems, severe fatigue, self-reported loneliness or social isolation, and condition/disease that create instability in thinking, self-care, mood, or behaviour patterns). The CAP identifies three distinct groups: those at high priority for a palliative approach, those at moderate priority, and those who don't trigger the CAP. Among home care clients in Ontario, 42% triggered the CAP; 10% (n = 57,025) at a high priority, and 32% (n = 181,531) at a moderate priority. Within LTC homes in Nova Scotia and Saskatchewan, these equaled 12% (overall), 5.2% (n = 1,858 as high priority) and 6.8% (n = 2,411 as moderate priority). The development of this new CAP will help support clinicians in home care and LTC settings to engage in conversations and promote awareness of the benefits of a palliative approach to care for individuals with serious or life-limiting illness and their families.
Extracorporeal membrane oxygenation, although lifesaving, is invasive. Complications affecting all body systems mandate reevaluation of goals of care. When extracorporeal membrane oxygenation is nonbeneficial, planning for de-escalation/decannulation to allow natural death must occur. In a tertiary care facility with 64 beds using extracorporeal membrane oxygenation, practices varied regarding extracorporeal membrane oxygenation initiation, patient/family communication, futility determination, and symptom management during de-escalation. Symptom management during transition to comfort-directed care was suboptimal, increasing patient, family, and team discomfort. The goals of this quality improvement project were to mitigate practice variability and improve patient experience and communication, allowing for comfortable, natural death. Palliative care integration, literature review of best practices, and creation of an interprofessional task force were process improvements during extracorporeal membrane oxygenation de-escalation. New clinical guidelines provided structure, consistency, and evidence-based care processes mitigating practice variability during de-escalation/decannulation. Successful guideline implementation decreased practice variability, lessening patient/family stress and discomfort. After implementation, team member self-reports of secondary trauma and moral distress symptoms during extracorporeal membrane oxygenation de-escalation/decannulation decreased. Team members reported improved end-of-life care delivery with family education and support, patient advocacy, and symptom management. Family members appreciated attention to the patient's and their own well-being during end-of-life care. Structured debriefings helped staff members process feelings toward end-of-life care and identified opportunities for improvement. Guideline application decreased practice variability in extracorporeal membrane oxygenation de-escalation/decannulation, incorporating patient and family preferences. Death became more comfortable and dignified. Decreased practice variability and proactive symptom management improved patient/family experience.
To raise awareness of fertility preservation and counseling in palliative care and explore considerations for practice. This case report describes the rapid decline and death of a 36-year-old man with astrocytoma. Despite early fertility discussions with the palliative care team, sudden clinical deterioration prevented semen collection prior to death. Following death, the spouse requested post-death sperm retrieval. Post-death sperm retrieval and cryopreservation were successfully completed within the viability window. To achieve this, urgent interdisciplinary coordination across palliative care, emergency medicine, reproductive specialists, and hospital legal and executive teams was required. The case highlights the importance of early and ongoing fertility counseling for patients of reproductive age in palliative care. It demonstrates that clear pathways and coordinated systems can enable post-death sperm retrieval when aligned with patient and partner wishes. The development of evidence-based policies, training, and patient resources may reduce barriers and support clinicians to conduct sensitive, informed fertility discussions.
The abscopal effects (AEs), characterized by tumor regression beyond the site of local treatment, represents a promising therapeutic approach for metastatic cancer. Initially employed as a palliative measure for advanced disease, local antitumor therapy has been shown to elicit AEs through the activation of antitumor immunity. This review provides an in-depth exploration of reports on the induction of AEs, their mechanisms, predicators and enhancement strategies. Various local treatment modalities can induce immunogenic cell death in tumor cells, thereby triggering immune-mediated distant antitumor effects. Although abscopal effects is rarely induced by local treatment alone, several approaches have been developed to potentiate it. This review summarizes these enhancement strategies, discusses existing knowledge gaps, and highlights the substantial clinical potential of abscopal effects.
Malignant tumours account for approximately 20%-30% of primary cardiac tumours, and reports remain rare. Cardiac angiosarcoma is a representative type, but prognosis is extremely poor: the median survival is about 4 months in unresectable cases and 14 months after complete resection [Patel SD, Peterson A, Bartczak A, Lee S, Chojnowski S, Gajewski P, et al. Med Sci Monit 2014;20:103-9].Approximately 29% of angiosarcomas present with metastasis at diagnosis, and the presence of pericardial effusion suggests pericardial invasion. Evidence regarding chemotherapy remains limited, and no standardized treatment has been established for metastatic primary cardiac tumours. We report a case of cardiac angiosarcoma in a 74-year-old man. At the time of presentation, masses were detected in the right atrium and the apex of the left ventricle. The right atrial tumour extended widely along the atrial wall and partially formed fistulous tracts, resulting in direct communication of blood flow from the right atrium into the pericardial cavity. Surgical tumour resection with atrial wall reconstruction was performed, and chemotherapy was initiated following histopathological confirmation. Due to their poor prognosis, cardiac tumours are often managed with palliative care. This case highlights two important points: first, cardiac angiosarcoma can cause atrial wall destruction and rupture, leading to direct communication between the atrium and pericardial space; second, even in cases of primary cardiac angiosarcoma with pulmonary metastases, appropriate cardiac surgery combined with chemotherapy may improve patient outcomes.
In this planned analysis of a study on the effects of dorsal root ganglion stimulation (DRGS) on sleep and functional outcomes, we evaluated device-related complications, with a focus on lead fracture. Data were extracted for adult patients treated with DRGS between January 2018 and February 2025 from a clinical registry; patients with ≥1 follow-up were included. Device-related adverse events, including lead fracture and migration, were identified and cross-checked against clinic notes, operative reports, and device interrogation data. Cumulative fracture probability was determined with Kaplan-Meier estimation; multivariable Cox regression was used to identify predictors of fracture. A standardized fascial anchoring technique was implemented in mid-2020 and its influence on events was assessed. A total of 92 patients received 375 leads with a median follow up of 1059 days (interquartile range [IQR]: 529, 1661.5 days). Lead fracture occurred in 37 of 375 leads (9.9%), affecting 21 of 92 patients (22.8%) with an incidence of 3.2% per lead per year. Six patients had multiple fractured leads. Cumulative incidence increased gradually with follow-up, reaching an estimated 15% at 60 months. In multivariable Cox analysis, body mass index (BMI) was the only independent predictor of fracture (HR: 0.943 per kg/m2; 95% CI, 0.893-0.996; p = 0.037); age, sex, lead level, laterality, number of leads, and primary diagnosis were not significant predictors. Crude incidence of fracture was 11.9% in unanchored leads versus 8.6% in anchored leads; however, time-to-event curves were similar, and anchoring was not an independent predictor. Most patients with fractured leads underwent revision (17/21); four experienced a second fracture. Lead migration occurred in four of 375 leads (1.2%) among four patients, mostly before routine anchoring was implemented at our center in June 2020. Five patients (5.4%) underwent explantation. Lead fracture remains a hinderance to long-term durability of DRGS therapy although events were usually manageable with restoration of therapeutic effect. Anchoring did not change fracture risk but coincided with low migration rates. BMI was the only significant predictor of fracture.
A 58-year-old man had multiple cutaneous neurofibromas since childhood; however, these were not evaluated. Two months prior, he developed bloody sputum and cough. Computed tomography revealed multiple masses throughout the body, including bilateral adrenal glands. The right adrenal mass was diagnosed as a pheochromocytoma via biopsy. The urinary metanephrine levels were extremely high. Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy revealed uptake only in the right adrenal gland, liver, and lungs. He developed heart failure 1 month prior and was transferred to our hospital because of the deterioration of his general condition. Based on the 123I-MIBG scintigraphy findings and cutaneous neurofibromas, the patient was clinically diagnosed with metastatic pheochromocytoma associated with neurofibromatosis type 1 (NF1). He received palliative care because aggressive treatment was not feasible owing to his poor condition. The patient died 1 month later. Autopsy revealed metastases from the right adrenal pheochromocytoma to the liver and lungs. Additionally, malignant peripheral nerve sheath tumors were found in the left adrenal gland, lungs, left humeral diaphysis, and perineum, and a gastrointestinal stromal tumor was found adjacent to the small intestine. Patients with NF1 may have multiple types of tumors simultaneously, which should be considered when making a diagnosis.
Facility-level availability of Japanese Society of Medical Oncology (JSMO) specialists may influence care processes, but national cancer genomic medicine data rarely capture patient-level specialist involvement. We conducted a nationwide retrospective analysis of pancreatic cancer cases in the Center for Cancer Genomics and Advanced Therapeutics (C-CAT). The primary exposure was facility-level registry-listed JSMO specialist count (0-1 vs. ≥2 specialists), with ≥2 interpreted as a proxy for minimum plural specialist-team availability. The primary endpoint was time from systemic therapy start to recorded first-line treatment end. The primary cohort included 14,568 patients at 261 facilities. Median recorded first-line treatment-process duration was 5.7 months in the 0-1 specialist group and 6.4 months in the ≥2 specialist group. In the clinical plus facility-adjusted Cox model, ≥2 specialist availability was associated with a lower hazard of recorded first-line treatment end (HR 0.895, 95% CI 0.810-0.988; p = 0.028). Supportive overall survival findings did not indicate a survival advantage, reinforcing the operational nature of the primary endpoint. These findings indicate a facility-level association with an operational treatment-process endpoint, not patient-level specialist involvement, treatment efficacy, survival benefit, facility ranking, or causality. Chemotherapy-specific national database elements are needed to evaluate specialist contribution directly.
A 7.5-year-old spayed female French Bulldog presented for back pain that did not respond to conservative management after the dog had jumped off a couch. Magnetic resonance imaging (MRI) identified an intramedullary mass that was T2 hyperintense, T1 iso- to hypointense, short tau inversion recovery (STIR) hyperintense, strongly rim-enhancing, and centrally suppressed on post-contrast T2-fluid-attenuated inversion recovery (FLAIR) images. Despite a suspected glial cell neoplasm, clinical signs initially improved with palliative treatment. Follow-up MRI 2 years later showed progressive enlargement of the lesion, with newly noted multiseptated regions. Histopathology indicated a high-grade oligodendroglioma.
Advances in hepatocellular carcinoma (HCC) treatment and patient profiling are driving a shift toward personalized, multimodality management. The enhanced efficacy of locoregional therapies (LRTs) and systemic regimens has expanded treatment options across palliative and curative settings. For patients eligible to curative-intent treatment, adjunctive approaches aim to enhance procedural feasibility and optimize patient outcomes. Bridging and downstaging to liver transplantation, while traditionally relying on intra-arterial therapies are now seeing emerging alternatives such as stereotactic body radiotherapy (SBRT) and systemic agents. In the perioperative setting, immune checkpoint inhibitor (ICI)-based regimens have shown robust pathological response rates and have significantly improved major pathological response and event-free survival for intermediate- to high-risk resectable patients in a recent phase III trial. For incurable disease, treatment intensification via multimodal combinations improves anti-tumor efficacy. Adding ICI-antiangiogenic regimens to transarterial chemoembolization has demonstrated improved response rates and progression-free survival in multiple phase III trials. Systemic-LRT combinations are also being explored in advanced HCC, with a recent phase III trial indicating SBRT's efficacy in this setting. Notably, curative conversion approaches are emerging to enable subsequent curative-intent treatment in select patients that were previously considered incurable. While multimodal care offers significant promise, its complexity necessitates a multidisciplinary approach to patient and treatment selection, and toxicity management. With multidisciplinary guidance, multimodality approaches promise to expand the path to cure for an increasing number of HCC patients.
 The study evaluated several approaches for identifying IN and OUT of bedtimes, comparing their reliability, accuracy, and impact on calculating sleep and circadian parameters. In a 12-month observational study, 72 adults with advanced cancer wore wrist and thigh accelerometers for 72 hours and completed sleep diaries and questionnaires on chronotype, sleep quality, and daytime sleepiness. IN and OUT times were determined using patient diaries, wrist accelerometry event markers, and automated accelerometry algorithms. Automated algorithms identified IN and OUT times more consistently than patient-reported methods (93-100% vs. 48-83%), although both under- and over-estimation of timings occurred. Timings from all methods were significantly correlated (p < 0.001). Excellent agreement was observed between patient‑reports (patient diary and watch event marker, ICC 0.829-0.877), and patient-reports and thigh accelerometry (ICC 0.892). Event markers appeared more accurate than sleep diaries, showing closer agreement with associated DOWN and UP times. The choice of method for identifying IN and OUT times influenced the calculated sleep onset latency, percent sleep and dichotomy index values. These findings highlight the importance of accurate bedtime identification for reliable sleep and circadian analyses, particularly when diagnosed thresholds are used. Further research is required to determine the most accurate and clinically practical approach.
Synchronous primary malignancies are rare and represent a significant diagnostic and therapeutic challenge, particularly when both tumors share a targetable molecular alteration. We present a case of synchronous human epidermal growth factor receptor 2 (HER2)-positive breast and gastric cancers treated using a common HER2-directed strategy. A 77-year-old female was admitted with a right breast lesion classified as Breast Imaging Reporting and Data System (BI-RADS) 5. A core needle biopsy was performed, which confirmed a grade 2 invasive ductal carcinoma. The results showed positivity for estrogen receptor and progesterone receptor, a HER2 immunohistochemical score of 2+, and a Ki-67 index of 15%. Chromogenic in situ hybridization (CISH) confirmed HER2 amplification, establishing a luminal B/HER2-positive subtype (cT4b cN0 cM0). The patient was started on a course of tamoxifen treatment. During the course of treatment, there was a progression of dysphagia and rapid weight loss, which prompted further investigation. A CT scan revealed thickening of the gastric cardia. Following the failure of gastroscopies due to esophageal stenosis, exploratory laparoscopy was performed. The histopathological examination revealed that the gastric cardia tumor was grade 1 tubular adenocarcinoma, with HER2 overexpression (immunohistochemistry (IHC) 3+), proficient mismatch repair (pMMR)/microsatellite stability (MSS) status, and no hormone receptor expression. Due to the unresectable nature of the disease, the patient received a combination of palliative mFOLFOX6 (leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin) and trastuzumab, in addition to ongoing endocrine therapy. Following four cycles, imaging showed disease stabilization, with decreased cancer antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) levels, and evidence of local tumor regression. Despite an initial positive response, the patient subsequently experienced disease progression and clinical deterioration after three months. The overall survival rate was 11.25 months. This case demonstrates the importance of comprehensive molecular diagnostics and the potential of HER2-targeted therapy as a unified treatment approach for synchronous HER2-positive malignancies.
A man in his 70s presented with right ocular pain, visual disturbance, forehead swelling and left iliac pain. Diagnostic imaging revealed a large right orbital-frontal mass with skull involvement, a cavitary lesion in the right upper lobe and a left iliac lesion. Histological and molecular analyses confirmed lung adenocarcinoma with a MET exon 14 skipping mutation. Initial management focused on symptom control via palliative radiotherapy to the orbital and iliac lesions which achieved rapid relief. Following molecular confirmation, tepotinib-a selective MET tyrosine kinase inhibitor-was initiated. This resulted in clinical stability and a slight radiographic reduction of the primary lung lesion. This case highlights an atypical clinical manifestation of orbital metastasis in MET-mutated non-small-cell lung cancer. It underscores the clinical necessity of prompt tissue diagnosis and molecular profiling in patients presenting with atypical metastatic sites to facilitate the timely initiation of targeted systemic therapies.