Lokal İleri Yinelemiş Bazal Hücreli Karsinom Tanılı Bir Olguda Eşzamanlı Vismodegib ve Hipofraksiyone Stereotaktik Radyoterapi: Olgu Sunumu

Abstract

Bu çalışmada, vismodegib ve hipofraksiyone stereotaktik radyoterapi (hSRT) kombinasyonu ile tedavi edilmiş olan yüzün yüksek riskli bölgesinde yerleşmiş yinelemiş bazal hücreli karsinom (BHK)’ lu bir hasta sunulmaktadır. Hedgehog yolu inhibitörleri gibi hedeflenmiş tedaviler, ileri evre BHK tedavisinde önemli bir rol oynar, ancak direnç nedeniyle yanıt süresi kısadır. Hedgehog yolak inhibitörleri ve radyoterapinin kombinasyonu, özellikle lokal ileri evre hastalarda kalıcı ve etkili bir tedavi yanıtı sağlama potansiyeline sahiptir. 68 yaşında bir erkek hastada, nazal dorsuma lokalize ve her iki gözün medial kantusuna kadar uzanan, nazal ve maksiller kemikleri infiltre eden nüks kitle mevcuttu. Lezyon kenarlarından alınan çoklu biyopsiler, infiltratif BHK ve bazoskuamöz hücreli karsinom odakları şeklinde raporlanmıştı. Vismodegib’e iyi yanıt veren hastaya cerrahi düşünülmemişti. Risk altındaki organların toleransı göz önüne alınarak CyberKnife-M6 cihazı ile eşzamanlı 4200 santigray/14 fraksiyon hSRT uygulandı. Tedavi sırasında akut derece 1-2 toksisite gözlendi. Tedavi sonunda kitle geriledi, sol gözdeki pitozis azaldı ve görme alanı genişledi. Tedaviden 4 ay sonra radyolojik ve klinik tam yanıt elde edildi. Tekrarlayan lokal ileri evre BHK’lu bir hastada kombine tedavi etkin bulundu. Vismodegib ve hSRT kombinasyonu ileri prospektif çalışmalarla değerlendirilmelidir.

Keywords

• bazal hücreli karsinom
• stereotaktik radyoterapi
• vismodegib

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

Abstract

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.

Keywords

• basal cell carcinoma
• stereotactic radiotherapy
• vismodegib

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