Induction SBRT followed by chemotherapy/immunotherapy for locally advanced maxillary cancer. Case report

Abstract

Background: We have applied CyberKnife(CK)-based SBRT to hundreds of patients with primary advanced head and neck cancer (AHNC). Thereby although rarely, we experienced emergence of host-tumor interactions suggestive of immunological modulation among high responders such as the abscopal effect or the emergence of autoimmune diseases reminiscent of irAE. There we reasoned that SBRT did not only ablate tumor but exerted as in situ vaccination. Assuming that, it is rational to combine immunotherapy following SBRT. Objective(s): Complete cure was obtained in a patient with locally advanced stage IVB maxillary cancer by CK-SBRT with semi-concurrent chemotherapy followed by nivolumab administration. To report clinical consequence. Case report: 68 year-old male patient with T4bN2bM0 maxillary SCC with intra-dural and severe orbital involvement was treated by IRB-approved SBRT-based clinical practice. Hypofrartionated SBRT was started from the main lesion, then for two sites of N2b. Two course of S-1 / TXT / CDGP was started from the second half of irradiation. Residual lesions were confirmed by PETCT two months after the end of chemotherapy, and nibormab administration was started. CR was confirmed at PETCT at the time of the administration 6 months after the start of nivolumab. Result(s): Facial edema, eczema and systemic urticaria (Grade 2) were transiently observed but improved by antihistamines and topical steroids. CR of all lesions was achieved. To date there are no signs of recurrence at time that 15month passed after completion of SBRT. Active social and occupational life of the patient has been realized andmaintained. Conclusion(s): Induction SBRT with immediately followed by combination chemotherapy comprised a taxoid and a cisplatin-derivative and subsequent inhibition of PD1/ PDL1 axis for residual lesions is feasible and compatible with the current health security system and might be be a most potent strategy for AHNC.