Weekly hypofractionated radiation therapy in elderly non-resectable cutaneous squamous cell carcinoma of the head and ne
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RADIOTHERAPY
Weekly hypofractionated radiation therapy in elderly non‑resectable cutaneous squamous cell carcinoma of the head and neck region Francesca De Felice1 · Daniela Musio1 · Vincenzo Tombolini1 Received: 20 April 2020 / Accepted: 10 August 2020 © The Author(s) 2020
Abstract Introduction Treatment of inoperable cutaneous squamous cell carcinoma (cSCC) of the head and neck region is still debated. Case report We report an original case of cure of cSCC of the head and neck region with weekly hypofractionated radiation therapy with megavoltage electrons prescribed for locally advanced inoperable disease. Results Weekly hypofractionated radiotherapy assured complete regression and was well-tolerated. Conclusion The real efficacy of this treatment in the therapeutic arsenal remains to be defined. A clinical trial is ongoing to test the use of 8 weekly fractions of 8 Gy hypofractionated RT regimens in non-resectable cSCC cases. Keywords Head neck cancer · Cutaneous squamous cell carcinoma · Oral cavity · Radiotherapy · Hypofractionation · Elderly
Introduction
Case description
Cutaneous squamous cell carcinoma (cSCC) represents the second most frequent form of non-melanoma skin cancer, with a rising incidence in elderly population (year by year more than 7%) [1]. But its estimated cases for 2020 cannot be predicted because incidence data are not collected by most cancer registries worldwide [2]. cSCC predominantly derives from the malignant proliferation of epidermal keratinocytes. While complete surgical resection is the main standard approach, when feasible, at present, the level of evidence of treatment options for non-resectable cSCC cases is low [3]. We report for the first time a complete response in a elderly patient with a non-resectable cSCC of the cheek treated with weekly hypofractionated radiation therapy with megavoltage electrons. The aim is to share our treatment approach and provide some directions for future research in the management of non-resectable cSCC patients.
In October 2019, a 94-year-old woman, with difficulties in mobilizing, cardiovascular comorbidities and cognitive impairment, consulted for a singular large inoperable cSCC on the left cheek, measuring 4.5 cm × 4.5 cm in size (cT3 cN0 cMx) (Fig. 1). Biopsy confirmed a well-differentiated cSCC. Radiological assessment revealed no loco-regional lymph node involvement, and there were no distant metastasis. Treatment with radiotherapy was decided at a multidisciplinary team meeting. Based on tumor characteristics—circular shape, indented margins, 25 mm thickness and anatomic location—and surrounding normal tissue considerations, the physical properties of MeV electron therapy— rapid dose falloff sparing deeper structures, such as oral cavity and mandible bone—were preferred. A total dose of 64 Gy in 8 weekly fractions of 8 Gy was prescribed—biological equivalent dose (BED) equal to 92.1 Gy with α/β = 10 for early responding tissues [to note we completed the calculations for tumor BED, using the seventh LQ formula allowing for
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