Long-Term Survival Following Palliative Chemoradiotherapy in an Elderly Patient With Advanced Squamous Cell Carcinoma in the Right Mandibular Gingiva

Advanced squamous cell carcinoma (SCC) of the mandibular gingiva in elderly patients is difficult to cure. The treatment policy for elderly patients with advanced SCC of the mandibular gingiva has not been clear. We report a case of right mandibular gingival carcinoma that was successfully treated by palliative chemoradiotherapy. An 83-year-old female complained of pain and an ulcer in her right mandibular gingiva. Oral examination revealed a lesion of about 20 mm in size in the right mandibular gingiva. A diagnosis of SCC in the right mandibular gingiva was made by histology. Imaging findings revealed some right neck lymph node metastases. Based on these findings, a clinical diagnosis before treatment was SCC in the right mandibular gingiva (cT4aN2bM0, stage IV) by the 7th edition of the Union of International Cancer Control. She refused to receive definitive surgery or chemoradiotherapy due to concerns about the invasiveness of these definitive therapies and requested palliative chemoradiotherapy. We delivered S-1 (a combination of tegafur, gimeracil, and oteracil) and radiation therapy (RT) to the primary tumor alone with 30 Gy in 10 fractions using 4-megavoltage equipment via a multiple leaf collimator by three-dimensional RT. Although we could not complete the delivery of S-1 because of an acute side effect, the palliative chemoradiotherapy resulted in a complete response, and the lymph node metastases also disappeared. The patient remains in complete remission for 5 years without surgery or chemotherapy. Palliative chemoradiotherapy for elderly patients with mandibular gingival carcinoma is considered to be one of the therapeutic options.