SBRT followed by chemotherapy/immunotherapy for stage IVB oropharyngeal cancer with second primary esophageal cancer

Abstract

Abstract Background We have applied CyberKnife(CK)-based Stereotactic irradiation (SBRT) to patients with primary advanced head and neck cancer(AHNC). The immune checkpoint inhibitor(ICI) was approved for head and neck cancer refractory to cDDP. Synergistic effect of SBRT with ICIs is theoretically expected. Case 60-year-old male patient complained right huge cervical swelling. Endoscopic finding revealed large ulcerative tumor centered in the right valecula and inferiorly extending into the upper aero-digestive tract. Diagnosis was T4aN3bM0 stage IVB oropharyngeal squamous cell cancer (p16 negative, PDL 1 Results At the time of 7th course of nivolumab, when GIF was performed, prominent shrinkage of advanced esophageal lesion was recognized. Laryopharyngeal lesions are not observed and CR has been maintained. The epiglottis extinguished but normal deglutition was spared without gastrostomy-dependence. Conclusion Induction SBRT followed by chemotherapy comprised taxoid and cDDP derivative and subsequent ICI based immunotherapy might be a most potent strategy for primary AHNC. The fact that advanced esophageal cancer detected just before nivolumab remarkably shrank, might suggest that it shares neoantigens with pharyngeal cancer, and SBRT might exert as in situ vaccination.