Concurrent Vismodegib and Hypofractionated Stereotactic Radiotherapy in a Patient with Recurrent Locally Advanced Basal Cell Carcinoma: Case Report

In this study, we present a patient with recurrent basal cell carcinoma (BCC) located in a high-risk area of the face who was treated with a combination of vismodegib and hypofractionated stereotactic radiotherapy (hSRT). Targeted therapies such as hedgehog pathway inhibitors play an important role in the treatment of advanced BCC, but the duration of response is limited due to resistance. The combination of hedgehog pathway inhibitors and radiotherapy has the potential to achieve a durable and effective therapeutic response, particularly in patients with locally advanced disease. A 68-year-old male patient had a recurrent mass localized to the nasal dorsum and extending to the medial canthus of both eyes, infiltrating the nasal and maxillary bones. Multiple biopsies taken from the lesion edges reported infiltrative BCC and basosquamous cell carcinoma foci. The patient responded well to vismodegib, but surgery was not considered. Considering the tolerance of the organs at risk, concurrent 4200 centigray/14 fractions hSRT was applied with the CyberKnife-M6 device. Acute grade 1 to 2 toxicity was observed during treatment. At the end of treatment, the mass regressed, ptosis in the left eye decreased, and the visual field expanded. Complete radiological and clinical response was achieved four months after treatment. Combination therapy was found to be effective in a patient with recurrent locally advanced BCC. The combination of vismodegib and hSRT should be evaluated in prospective studies.