Remarkable Response to Radiotherapy With Simultaneous Integrated Boost Intensity-Modulated Radiotherapy for Locally Advanced Lymphoepithelial Carcinoma of the Hypopharynx in a Nonagenarian

Lymphoepithelial carcinoma of the head and neck is a rare malignant neoplasm, with primary involvement of the hypopharynx being exceptionally uncommon. While surgery remains the standard treatment, radiotherapy plays a crucial role, particularly for patients who are not surgical candidates. Recent advancements in radiotherapy, such as simultaneous integrated boost (SIB) intensity-modulated radiotherapy, have demonstrated promising outcomes with minimal invasiveness, making them a viable option, especially for elderly patients. This case report describes a 91-year-old female diagnosed with locally advanced lymphoepithelial carcinoma of the hypopharynx who was treated with radiotherapy using SIB intensity-modulated radiotherapy. The patient presented with dysphagia and was found to have a large hypopharyngeal mass with nodal metastasis. Biopsy and immunohistochemical analysis confirmed the diagnosis of lymphoepithelial carcinoma. Given her age and comorbidities, a multidisciplinary team opted for radiotherapy instead of surgery. The prescribed dose was delivered using helical tomotherapy with two gradient doses of 30 gray (Gy) and 35 Gy in 10 fractions utilizing the SIB method. Acute toxicities were mild, and the patient completed the treatment without interruption. Post-treatment imaging revealed a remarkable response, which was sustained for over one year without disease progression.