Current Oncology (Jul 2023)

Radiation-Induced Oropharyngeal Squamous Cell Carcinoma: Case Report and Review of the Literature

  • Lorenzo Giannini,
  • Andrea Alliata,
  • Valentina Cristofaro,
  • Fabiola Incandela,
  • Madia Pompilio,
  • Arianna Ottini,
  • Stefano Cavalieri,
  • Imperia Nuzzolese,
  • Nicola Alessandro Iacovelli,
  • Marzia Franceschini,
  • Alberto Deganello

DOI
https://doi.org/10.3390/curroncol30070492
Journal volume & issue
Vol. 30, no. 7
pp. 6708 – 6719

Abstract

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Background: Radiation therapy (RT) is a mainstay for the treatment of head and neck (HN) cancers, with 80% of patients receiving such treatment. Radiation-induced malignancies represent a life-threatening long-term effect of RT, with an incidence of 0.5% to 15%. Case Description: After 13 years, a 33-year-old woman treated with chemo-radiotherapy for nasopharyngeal carcinoma developed a locally advanced, radiation-induced, p16-negative oropharyngeal squamous cell carcinoma (SCC) at the base of the tongue. Chemo/immunotherapy was administered as a first-line treatment. Given the optimal response and the feasibility of surgery, after three cycles, the patient underwent a total glossectomy, bilateral neck dissection, and reconstruction with a thoraco-dorsal free flap. A histological examination found SCC with a residual cancer burden of 70% and free margins. Discussion: The mechanisms responsible for carcinogenesis after RT are still not completely clear. Diagnosis may be challenging due to the previous treatment; growth patterns are unusual, and lymphotropism is lower. Prognosis is usually poor since surgical resectability is often not achievable. Conclusions: Radiation-induced malignancies are difficult to treat. Patient management should always be discussed at a multidisciplinary level. Future research is needed to assess whether the promising results of clinical studies with pre-operative immunotherapy in locally advanced HN SCC patients may be translated into radiation-induced cancers.

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