Journal of Radiation and Cancer Research

LETTER TO EDITOR
Year
: 2020  |  Volume : 11  |  Issue : 2  |  Page : 67--68

Squamous cell carcinoma of eyelid treated successfully with radiotherapy in a nonagenarian


Rituparna Biswas, Anirban Halder, Dipanwita Biswas 
 Department of Radiation Oncology, Medica Cancer Hospital, Siliguri, Department of Psychiatry, R G Kar Medical College, Kolkata, West Bengal, India

Correspondence Address:
Dr. Anirban Halder
Department of Radiation Oncology, Medica Cancer Hospital, Siliguri, Department of Psychiatry, R G Kar Medical College, Kolkata, West Bengal
India




How to cite this article:
Biswas R, Halder A, Biswas D. Squamous cell carcinoma of eyelid treated successfully with radiotherapy in a nonagenarian.J Radiat Cancer Res 2020;11:67-68


How to cite this URL:
Biswas R, Halder A, Biswas D. Squamous cell carcinoma of eyelid treated successfully with radiotherapy in a nonagenarian. J Radiat Cancer Res [serial online] 2020 [cited 2020 Aug 15 ];11:67-68
Available from: http://www.journalrcr.org/text.asp?2020/11/2/67/287449


Full Text



Dear Sir,

Cancer is a significant cause of morbidity and mortality in the elderly population and an increasing health-care problem.[1] Cutaneous malignancies are relatively recurrent in the elderly. Available treatment options for managing cutaneous cancers include surgical excision, chemotherapy, electrocautery, and radiotherapy (RT).[2] There are only scarce treatment data available pertaining to the management of skin malignancies in the elderly, especially regarding RT in nonagenarians.[3],[4]

Herein we present a case of a 95-year-old woman with preexisting hypertension who presented with nonhealing ulcer over the left eyelid and forehead for 2 years. Examination revealed a 3-cm ulceroproliferative growth which was bleeding over the left eyelid encroaching over the ipsilateral forehead too [Figure 1]a. No palpable cervical lymph nodes were found. Her vision was impaired in both eyes due to mature cataract. Biopsy from tumor suggested moderately differentiated squamous cell carcinoma. Contrast-enhanced computed tomography scan of the face and neck region showed polypoidal growth over the left eyelid and forehead [Figure 2] with mild postcontrast enhancement. No necrosis or calcification was seen. There was no evidence of distant metastases also on further imaging. She refused surgery due to her tender age. Hence, she was treated with definitive RT with a dose of 64 Gy in conventional fractionation over 6.5 weeks using 6 MeV electrons. A 2-cm margin all around gross tumor (assessed by clinical examination and imaging) was taken into account as field borders. Lead corneal shield and skin bolus were used. She tolerated RT well without significant toxicities. She developed conjunctival injection during treatment which subsided after treatment completion. After 1 month of RT completion, she was followed up when she was doing fine with residual scar only [Figure 1]b.{Figure 1}{Figure 2}

Because of age-related comorbidities, tolerance issues, and logistics, most of the nonagenarian cancer patients receive palliative treatment or suboptimal therapy.[4] The worsening of biological functions due to aging leads to diminished reserve capacity and increased vulnerability to treatment-related side effects;[5] hence, subjecting oldest-old patients to high-end therapies is risky. Before determining treatment modality for a nonagenarian cutaneous cancer patient, it is important to assess life expectancy, performance status (PS), psychological function, and his/her social support system. Although our index case was wheelchair-bound due to impaired vision and age-related debilitation, she had intact emotional strength and wonderful family to support. The sensitivity toward radiation also varies immensely among individuals, so it is not possible to determine the dose fractionation of RT for the elderly based on chronologic age alone. It is prudent to allow curative treatment in a nonagenarian patient with good PS and localized cancer. Hence, the presented case was subjected to radical RT, to which she responded exceedingly well and attained complete clinical response. In keeping with other published literature, though scanty,[3],[4] our observation also adds to the existing evidences that curative-intent radical doses of radiation can be administered in elderly patients of age over 90 years having cutaneous malignancies and favorable outcome may be expected.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the daughter of the patient has given her consent for images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Saltzstein SL, Behling CA, Baergen RN. Features of cancer in nonagenarians and centenarians. J Am Geriatr Soc 1998;46:994-8.
2Locke J, Karimpour S, Young G, Lockett MA, Perez CA. Radiotherapy for epithelial skin cancer. Int J Radiat Oncol Biol Phys 2001;51:748-55.
3Oguchi M, Ikeda H, Watanabe T, Shikama N, Ohata T, Okazaki Y, et al. Experiences of 23 patients>or=90 years of age treated with radiation therapy. Int J Radiat Oncol Biol Phys 1998;41:407-13.
4Chargari C, Moriceau G, Auberdiac P, Guy J, Assouline A, Tinquauet F, et al. Feasibility of radiation therapy in patients 90 years of age and older: A French multicentre analysis. Eur J Cancer 2014;50:1490-97.
5Walsh SJ, Begg CB, Carbone PP. Cancer chemotherapy in the elderly. Semin Oncol 1989;16:66-75.