Spectacular effect of radiotherapy in a 91-year-old man with locally advanced lip cancer: a case report and reflections on palliative care

This case report describes the clinical course in a great age home hospice patient with advanced lip cancer, who was cured as a result of palliative care and radiotherapy specialists’ cooperation. A 91-year-old Caucasian male developed a lip tumor over five years. Given his passive approach to health and challenging living conditions, he opted not to undergo the recommended surgical treatment. As the lip lesion progressed, and pain and trismus increased, making him unable to eat, he was placed under home hospice care. Seeking the best treatment strategy, the hospice physician referred him to a radiotherapist, who qualified him for sequential radiotherapy. Initially, external beam radiotherapy was administered, delivering a total dose of 30 Gy in 10 fractions using the IMRT technique, which resulted in over 60% tumor regression. Subsequently, an HDR 3D interstitial brachytherapy boost was applied, delivering an additional dose of 24 Gy in 6 fractions. This treatment led to a remarkable resolution of the lesion. Throughout this process, comprehensive supportive care was continuously provided as the patient temporarily developed CTCAE grade 3 oral toxicity, which required intensive local and analgesic therapy for five weeks. Ultimately, the patient’s fitness greatly improved. This case report highlights the importance of comprehensive supportive treatment and multidisciplinary cooperation, as well as the effectiveness of radiotherapy in palliative care.