Long-Term Survival after Stereotactic Radiotherapy Combined with Immunotherapy in a Patient with Recurrent Oral Cancer.

INTRODUCTION

Recurrent oral squamous cell carcinoma (SCC) poses significant challenges in treatment, requiring a multifaceted approach for effective management.

CASE PRESENTATION

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.

CONCLUSION

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.