Clinical Case CC02

Thursday, November 13th, 2025 17:50 – 18:05
Speaker Vittoria G. Espeli

A case of relapsed oral squamous cell carcinoma treated with radiotherapy and hyperthermia.

Background
A recent meta-analysis demonstrated a positive impact of hypertermia (HT) combined with radiotherapy (RT) compared to RT alone in the management of patients with head and neck cancer.
Here, we present the case of a patient with relapsed locally advanced oral squamous cell carcinoma progressing to standard systemic treatment treated with a combination of hyperthermia and radiotherapy.

Case description
A 60-year-old male had undergone glossectomy for an oral (tongue) squamous cell cancer in 2022. The pathological stage was pT2 (2.2 cm) with close margins (<0.1cm).
The patient was operated in a private praxis without multidisciplinary discussion and therefore he did not received surgical rechallenge (wider margins and nodal staging) neither adjuvant radiotherapy.
After two years, due to dysphagia and reduced mobility of the tongue, the patients performed a
PET/CT scan which showed a tumor mass of approximatively 33x27mm with sternocleidomastoid muscle involvement and without distant metastasis.
In another private clinic, on January 9th 2025, a surgical rechallenge with cervical mass resection and ipsilateral (left) node dissection (9 nodes) were performed. The pathological showed 1 positive lymph node out of 9 removed, jugular vein involvement with tumoral thrombus (4 mm) and positive margins (R2).
Radiation therapy was recommended but the patient experienced a rapid progression and therefore he received two cycles of chemotherapy with cisplatin, taxotere and 5-fluorouracil with progression disease as best response. He received 1 cycle of carboplatin, 5-fluorouracil and pembrolizumab complicated by grade 3 liver immune-toxicity requiring steroids. Best supportive care was recommended and the patient asked a second opinion at our Institution.
We discussed the case at our tumor board and we decided to offer hyperthermia and radiotherapy.
The treatment was well tolerated without major toxicities.
An IRM performed after two months from the end of treatment demonstrated important necrosis of the lymph nodes mass. A PET-CT is scheduled in two months.

Conclusions
H&N cases may be challenging and often require timely multidisciplinary discussion which should be done in center with high expertise. HT-RT is a viable option in case of treatment refractory tumors.