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Journal of Case Reports
An Unusual Presentation of Squamous Cell Carcinoma of Head and Neck Region
Gautam VV, Harish Kumar, Arun Kumar MN, Alexander John
Department of Radiation Oncology, Cancer Institute (Wia), Adyar, Chennai, Tamil Nadu, India.
Corresponding Author:
Dr. Gautam VV
Email: gautam.gv71@gmail.com
Received: 16-APR-2023 Accepted: 14-JUN-2023 Published Online: 16-JUL-2023
DOI: http://dx.doi.org/10.17659/01.2023.0019
Background: Oral cavity cancer, ranking sixth in global cancer prevalence, primarily manifests as Squamous Cell Carcinoma (SCC), accounting for over 90% of cases. Neo-adjuvant chemotherapy (NACT) plays a pivotal role in locally advanced head and neck cancer management, focusing on disease downstaging and distant metastasis reduction. However, little research explores the effects of delayed local treatment post-NACT on oncological outcomes. This report details an exceptional case - a small primary lesion with extensive metastasis. Case Report: A 53-year-old chronic smoker and alcoholic presented with a three-month history of a painful ulcer in the left oral cavity. Initially diagnosed with cT3N2bMx squamous cell carcinoma in the left lower gingiva buccal sulcus at another institution, he received one cycle of NACT with Docetaxel, Cisplatin, and 5-Fluorouracil (TPF). After a two-month delay, he sought care at our facility. Clinical examination revealed grade II trismus, a residual lesion in the left lower gingiva buccal sulcus, and unhealthy mucosa in the left retromolar trigone. An enlarged left level Ib lymph node was notable. Slide review confirmed squamous cell carcinoma, and a PET-CT scan disclosed multiple metastatic sites. Subsequently, the patient developed right hemiparesis. A multidisciplinary tumor board recommended palliative systemic therapy and care, which the patient and spouse accepted. Conclusion: We present an unusual case featuring widespread metastasis in locally advanced squamous cell carcinoma post-one-cycle NACT. This emphasizes the significance of timely locoregional treatment post-NACT, particularly for non-responders. Further prospective studies are crucial to delineate whether NACT defaulters are prone to widespread metastasis and to establish the optimal NACT-to-locoregional treatment interval.
Keywords : Neoadjuvant Chemotherapy, Metastasis, Oral Cancer, Oral Ulcer, PET-CT.
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