Successful Treatment With Single-Fraction Stereotactic Body Radiotherapy to Lung and Reirradiation of Neck Node Metastases in a Treated Base Tongue Primary.

Abstract

Introduction: Head and neck cancers are one of the most common cancers globally. Locoregional recurrence or distant metastasis is a common mode of recurrence and should be treated curatively, where feasible. We present a case of an elderly gentleman treated with reirradiation for nodal metastases and lung metastases ablated with single-fraction SBRT. Case Summary: An elderly 73-year-old gentleman treated with definitive radiotherapy 3 years ago for carcinoma of the base of the tongue presented with the complaint of left neck swelling for 3 weeks. A 2 × 3 cm left Level II lymph node was palpable with skin involvement. The positron emission tomography (PET) was suggestive of a left Level II cervical node measuring 4 × 4 × 3.2 cm, encasing the carotid artery and involving the skin, and a 3 × 2 cm right lower lobe lung lesion, suggestive of a metachronous lung primary or metastasis. The neck node was deemed unresectable due to more than 180-degree contact with vessels. The patient was unwilling to undergo a biopsy of the lung. Given the age, performance status and oligometastatic presentation, the patient was planned for radical intent treatment to both the neck node and the lung lesion. He was treated with reirradiation to the neck node with a dose of 66 Gy in 33 fractions over 6.5 weeks and SBRT 34 Gy in a single fraction to the lung lesion. He developed neck soft tissue necrosis, at 1.5 years after radiation, which resolved on antibiotics. The patient remains clinically well, and the PET scan performed at 1 and 2 years following radiation showed complete response with no new metastasis. Conclusion: Radical intent can be considered in oligometastatic head and neck cancers. Reirradiation is a treatment option for patients with recurrent head and neck cancers. Single-fraction SBRT is one of the recommended dose schedules for lung metastases.