Abstract Ref Number = APCP887
SURGICAL PALLIATIVE CARE IN AN ADOLESCENCE BOY WITH HIGH GRADE MYXOFIBROSARCOMA
Harida Panduwita,Bidasari Lubis,Olga Rasiyanti,Suyatno
University of Sumatera Utara
Background : Myxofibrosarcomas are one of the rare cases of soft tissue sarcomas in children and high grade myxofibrosarcoma have poorer prognosis. Pediatric soft tissue sarcomas constitute 6 – 8% of all cancers in children less than 15 years of age. A study shows that the incidence was 0.81 per 100.000 children per years. Myxofibrosarcoma predominantly located in extremities, is seen rarely in head and neck region. The treatment of choice of myxofibrosarcoma is a complete surgical excision. Chemotherapy play a smaller role in myxofibrosarcoma treatment. Neoadjuvant radiotherapy may have a potential role in the routine management of myxofibrosarcoma, eventhough its effectiveness still need future research. Palliative care for children is the active total care of the child’s body,mind and spirit and also giving support for the family. It involves multidisciplinary team approach to identify the needs of patients and families for successful improvement in their quality of life.
Case Presentation Summary : A 13 years old boy, without any remarkable medical or surgical history, presented a rapidly growing big tumour on the right gingiva. Over three weeks, the lesions had reached about 16 cm in diameters.(Figure 1a,1b). Pain was felt around the tumour. There was no previous skin lesion and site never traumatized or irradiated. Histopathology result show high grade myxofibrosarcoma. The Karnofsky Performance Scale Index was 60%. From the screening table found the total score is 6, so the patient concluded requiring palliative care. The management of the child involved a multidisciplinary team approach. The pediatric hematologist-oncologist, oncologist surgery, pathology anatomy, radiation oncologist, radiologist and nurses were involved in the care. Surgical wide excision and mandibulectomy total was performed under general anesthesia. Histopathological examination of incisional biopsy showed high grade myxofibrosarcoma. Total parenteral nutrition was given to provide all daily nutritional requirements. There is an orocutan defect to be planned for the reconstruction of the defect closure.
Learning Points/Discussion : All the health care providers were actively involved as a team in treating the child with high grade myxofibrosarcoma. In general, the hospital provided all possible care, but the palliative care was very limited. Therefore, the nurse and other health professionals must understand the concept of palliative care to provide a better care.
Keywords: High grade myxofibrosarcoma palliative care adolescence