Polanowski Paweł, Howorus Marlena, Nasiek Aleksandra, Kozub Anna, Pietruszka Agnieszka, Drosik-Rutowicz Katarzyna, Polanowska Katarzyna, Składowski Krzysztof
1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland.
Holy Cross Cancer Center, Kielce, Poland.
Case Rep Oncol. 2024 Dec 6;17(1):1366-1373. doi: 10.1159/000542321. eCollection 2024 Jan-Dec.
Recurrent oral squamous cell carcinoma (SCC) poses significant challenges in treatment, requiring a multifaceted approach for effective management.
We present the case of a 68-year-old patient with a history of keratonizing SCC of the mandibular gingiva, treated with surgical resection, adjuvant radiotherapy (RT) to a total dose of 60 Gy in 30 fractions and 6 cycles of concurrent chemotherapy. After 6 years of follow-up, the patient experienced a local late recurrence in clinical stage rT4N0M0 requiring palliative chemotherapy (6 cycles of PF regimen). Due to progression, nivolumab-based immunotherapy was administered. After the 11th cycle of immunotherapy, high-dose re-irradiation (18 Gy in 3 fractions) was applied due to subsequent progression. The addition of stereotactic RT to the immunotherapy allowed nivolumab to be continued until cycle 64, ensuring long-term disease stabilization with acceptable tolerability. Consecutive palliative chemotherapy included paclitaxel and methotrexate.
This case highlights the complex management of recurrent oral SCC, emphasizing the role of combining stereotactic RT with nivolumab in prolonging the administration of immunotherapy.
复发性口腔鳞状细胞癌（SCC）在治疗方面带来了重大挑战，需要采取多方面的方法进行有效管理。
我们报告了一名68岁患者的病例，该患者有下颌牙龈角化性SCC病史，接受了手术切除、总剂量60 Gy分30次的辅助放疗（RT）以及6个周期的同步化疗。经过6年的随访，患者出现局部晚期复发，临床分期为rT4N0M0，需要姑息化疗（PF方案6个周期）。由于病情进展，给予了基于纳武利尤单抗的免疫治疗。在免疫治疗第11个周期后，因后续进展给予高剂量再程放疗（18 Gy分3次）。在免疫治疗中加入立体定向放疗使得纳武利尤单抗能够持续使用至第64个周期，确保了疾病的长期稳定且耐受性可接受。后续的姑息化疗包括紫杉醇和甲氨蝶呤。
该病例突出了复发性口腔SCC管理的复杂性，强调了立体定向放疗与纳武利尤单抗联合在延长免疫治疗给药时间方面的作用。
