Single-fraction high-dose palliative radiotherapy for facial cutaneous squamous cell carcinoma: a case report

Cutaneous squamous cell carcinoma (cSCC) is a common malignancy affecting the skin, and its incidence increases with age; as such, it disproportionately affects the elderly. It is especially difficult to treat advanced skin cancers in elderly patients with dementia, who may not tolerate radiotherapy.

A 100-year-old woman with advanced dementia was referred to dermatology for a large cSCC involving the nasal bridge and abutting the bilateral orbits. She was initially deemed a poor candidate for surgical resection, but over time the tumor grew and became increasingly destructive. Due to tumor growth causing symptoms and threatening vision, her family requested treatment. The patient was therefore referred to radiation oncology, and she received palliative radiation, using a single fraction of 16 gray (Gy) via a single electron field. Within 3 months, she had a clinical complete response, with no residual tumor and no persistent side effects from radiotherapy (RT). Ongoing follow-up revealed durable treatment response with no bothersome late toxicity.

Single-fraction palliative radiotherapy is a suitable treatment option for durable palliation in elderly patients unable to undergo surgery and unable to tolerate conventional, fractionated RT in cases of symptomatic or rapidly-progressing non-melanoma skin cancers (NMSC). It is well-tolerated in frail patients or those with dementia.