Treating squamous cell carcinoma
An 85-year-old man with squamous cell carcinoma was facing surgical removal of his upper left jaw, eye, and socket. TomoTherapy radiation treatment spared his vision and restored his quality of life.
BACKGROUND
Five years after recovering well from radiosurgery for a brain tumor, an 84-year-old patient began noticing pressure behind his left eye, which caused it to bulge. Soon he was experiencing double and then triple vision. When the vision got so bad that he could no longer work in the family orchard, the patient went to his physician. He was diagnosed with squamous cell carcinoma on his jaw, unrelated to the previous tumor.
Using the precise TomoTherapy ® Hi·Art ® treatment system, the patient‘s radiation oncologist was able to spare the left optic nerve, which had already received the maximum allowable dose of radiation during treatment for the previous brain tumor. Within six months, the patient was tumor-free, his vision was fully restored and his eyeball no longer protruded. He was able to return to work in the orchard and celebrated his 85th birthday at home with family.
CASE SUMMARY
- Institution
- University Hospital, Heidelberg, Germany
- Patient
- Male, 84 years
- Diagnosis
- Squamous cell carcinoma in upper jaw behind left eye
- Plan
- Primary target volume: Median 60 Gy
Left optic nerve: Maximum ~15 Gy
Brain Stem: Maximum ~15 Gy
Optic chiasm: Maximum ~15 Gy
Ipsilateral optic lens: ~20% at 5 Gy
- Treatment
- 30 fractions
PATIENT HISTORY AND PRESENTATION
An 84-year-old male presented with a protruding left eyeball and intraocular pressure that impeded vision and kept him from overseeing the family business, a fruit orchard in the countryside of Dieburg, Germany.
The patient’s physician diagnosed squamous cell carcinoma in the upper left jaw and recommended surgical removal of the jaw, eye and socket.
The patient and his family were concerned about surgery for two key reasons: 1) disfigurement and complete loss of sight in one eye could affect his quality of life and ability to continue working, and 2) the risks to the aging patient, who had undergone radiosurgery years earlier for an unrelated cavernous sinus meningeoma, a type of brain tumor. The family requested options and were referred to Dr. Florian Sterzing, radiation oncologist at University Hospital in Heidelberg.
TREATMENT PLAN AND DELIVERY
Dr. Sterzing examined radiation options, but the case was complex because of the patient’s previous treatment for an unrelated brain tumor years earlier.
The patient’s left optic nerve had already received the maximum allowable dose of radiation, so any new radiation therapy required precise delivery to spare the left optic nerve. The other complication was the protruding eyeball, which made conventional immobilization too painful. The only option was a soft head mask.
To accommodate the need for precision delivery, even when the patient couldn’t be totally immobilized, Dr. Sterzing used the TomoTherapy Hi·Art treatment system.
The patient received a 30-fraction radiation treatment, as well as antibody treatment with Cetuximab to help increase therapy effectiveness by blocking receptors responsible for tumor growth.
OUTCOME
While the patient had a skin reaction to the antibody infusions and experienced discomfort lying still for extended periods, he did not experience other side effects commonly associated with radiation therapy, such as nausea and dry mouth.
Six months after radiation treatments, the tumor was gone. The patient’s optic nerve and vision were spared, and the eyeball no longer protruded.
