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JAMA Oncology Clinical Challenge
March 25, 2021

Lower Back Pain in a Patient With Sarcoma

Author Affiliations
  • 1Department of Radiology, University Hospital, LMU Munich, Munich, Germany
  • 2Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
JAMA Oncol. 2021;7(6):933-934. doi:10.1001/jamaoncol.2020.8080

A 39-year-old female patient with alveolar rhabdomyosarcoma and bone metastases presented in April 2020 with lower back pain, which was aggravated while standing and walking. She reported no known trauma, and no motor or sensory deficits were noted during clinical examination. She had no fever.

After the initial sarcoma diagnosis in September 2018, the patient received 8 cycles of doxorubicin hydrochloride and ifosfamide along with regional hyperthermia, followed by good tumor response. The patient had a history of a pathological fracture of L4, which had been treated with radiotherapy and vertebroplasty in November 2019 and remained unchanged on imaging obtained in April 2020. The treatment regimen recently had been switched to gemcitabine hydrochloride and docetaxel in January 2020 following osseous progression during maintenance chemotherapy with trofosfamide, idarubicin hydrochloride, and etoposide.

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