Adaptive Palliative Stereotactic Body Radiotherapy for a Large Cervical Lymph Node Metastasis in a Near-Centenarian Patient: A Case Report

Palliative radiotherapy for very-elderly patients requires rapid symptom relief, short treatment times, fewer hospital visits, and minimal side effects. We report a 99-year-old woman referred to our department by her home-care physician due to severe pain from a rapidly growing, large cervical lymph node metastasis. The initial plan was stereotactic body radiotherapy (SBRT) with a prescribed dose of 24 Gy in three fractions over seven days. Her pain decreased rapidly after the first fraction. Before the third fraction, pre-treatment cone-beam computed tomography for image-guided radiotherapy showed significant tumor shrinkage, with complete resolution of local pain. To minimize the risk of toxicities, we made an adaptive decision to cancel the third fraction. Ultimately, the treatment was completed with a prescribed dose of 16 Gy in two fractions over four days, without any adverse events. The patient passed away peacefully due to old age 56 days after initiating SBRT, maintaining complete pain control until death. Palliative SBRT incorporating adaptive radiotherapy based on intra-treatment imaging and clinical presentation is an effective and safe option for extremely elderly patients. It is important to raise awareness of this low-risk, high-precision treatment in community and palliative care settings.