Palliative Irradiation With CyberKnife and Quad Shot Regimen for an Elderly Patient With Lower Lip Cancer

A 91-year-old woman noticed a mass on her lower lip and was diagnosed with stage II squamous cell carcinoma (cT2N0M0 as per TNM staging). Due to her advanced age, she and her family declined surgery and opted for radiotherapy (RT) alone (76.0 Gy/38 fractions). The tumor showed a partial response, leading to salvage surgery. Over the next three years, the primary tumor recurred twice, but both recurrences were successfully resected, with no further recurrence afterward. However, 15 months after the last recurrence, she developed submandibular lymph node metastasis and underwent stereotactic radiotherapy (30 Gy/5 fractions) using the CyberKnife, achieving a complete response. Subsequently, multiple metastases appeared in both cervical lymph nodes. She then received intensity-modulated radiotherapy using the Quad-shot method, a type of hypofractionated radiotherapy (44.4 Gy/12 fractions in three cycles). Although a temporary complete response was achieved, cervical lymph node recurrence was subsequently observed. She passed away at the age of 97, six months after the final RT. Significantly, she maintained a good quality of life without significant pain or skin metastases and passed away peacefully at home.