Case 3
A 6-year-old patient with prostatic alveolar rhabdomyosarcoma presented with metastatic disease to lymph nodes and long bones, ribs, and numerous vertebrae. He developed disease progression at multiple vertebral levels 17 months after initial diagnosis, associated with significant back pain. Palliative radiation with 2000 cGy in four fractions was given to his spine from T5 to L4, with pain improvement. However, his pain returned three months later and was difficult to manage, requiring continuous fentanyl and ketamine infusions, clonazepam, acetaminophen, lorazepam and ibuprofen. He had multilevel vertebroplasty performed in two stages, one week apart. First, T1, T6, T7, and T9 were treated, followed by T11, L2, L3 and L4. His pain improved significantly over the next 30 days, and he was able to be discharged home with palliative care support and passed three months following his last intervention.