Exploring treatment complexity in maxillary ameloblastoma: A case study on the efficacy of radiotherapy with transcriptomic and literature insights

In this report, we describe the case of a patient initially experiencing symptoms including nasal obstruction and rhinorrhoea, leading to surgeries and a diagnosis of ameloblastoma. Despite complete surgical resections, MRI follow-ups indicated tumour regrowth, prompting a shift to radiotherapy. The treatment plan involved a high-dose (60 Gy in 30 fractions of 2 Gy) volumetric modulated arc therapy. During treatment, the patient experienced minimal side effects and showed significant clinical improvement, including tumour size reduction and resolution of facial paralysis. Follow-up MRI confirmed shrinkage of the tumour, with some persistent symptoms like diplopia. To better understand the radiosensitivity of ameloblastomas, transcriptomic analysis highlighted the potential of a radiosensitivity index to predict treatment response, indicating ameloblastomas exhibit higher radiosensitivity compared to odontogenic keratocysts. Finally, literature analysis showed a small number of cases with wide range of radiation dose. In conclusion, the case illustrates the complex diagnostic journey of ameloblastomas and underscores the efficacy of radiotherapy for inoperable cases, and the importance of predictive biomarkers to enhance treatment outcomes.