Case Reports

. 2022 Oct 4;51(1):37.

doi: 10.1186/s40463-022-00586-6.

Pathologic complete response following low-dose radiation for advanced oral cavity cancer in a patient with human immunodeficiency virus

Amy B Leming^#^{1

2}, Andrea L Johnston^#³, Greg A Krempl^{4

5}, Evan J Fowle⁶, Daniel J Morton^{5

7}, Christina E Henson^{8

9}

Affiliations

¹ College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
² Department of Otorhinolaryngology - Head and Neck Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA.
³ Department of Radiation Oncology, University of Oklahoma Health Sciences Center, 800 NE 10th Street, L100, Oklahoma City, OK, 73104, USA.
⁴ Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁵ Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁶ Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁷ Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁸ Department of Radiation Oncology, University of Oklahoma Health Sciences Center, 800 NE 10th Street, L100, Oklahoma City, OK, 73104, USA. Christina-henson@ouhsc.edu.
⁹ Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Christina-henson@ouhsc.edu.

^# Contributed equally.

PMID: 36192808
PMCID: PMC9531370
DOI: 10.1186/s40463-022-00586-6

Case Reports

Pathologic complete response following low-dose radiation for advanced oral cavity cancer in a patient with human immunodeficiency virus

Amy B Leming et al. J Otolaryngol Head Neck Surg. 2022.

. 2022 Oct 4;51(1):37.

doi: 10.1186/s40463-022-00586-6.

Authors

Amy B Leming^#^{1

2}, Andrea L Johnston^#³, Greg A Krempl^{4

5}, Evan J Fowle⁶, Daniel J Morton^{5

7}, Christina E Henson^{8

9}

Affiliations

¹ College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
² Department of Otorhinolaryngology - Head and Neck Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA.
³ Department of Radiation Oncology, University of Oklahoma Health Sciences Center, 800 NE 10th Street, L100, Oklahoma City, OK, 73104, USA.
⁴ Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁵ Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁶ Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁷ Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
⁸ Department of Radiation Oncology, University of Oklahoma Health Sciences Center, 800 NE 10th Street, L100, Oklahoma City, OK, 73104, USA. Christina-henson@ouhsc.edu.
⁹ Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Christina-henson@ouhsc.edu.

^# Contributed equally.

PMID: 36192808
PMCID: PMC9531370
DOI: 10.1186/s40463-022-00586-6

Abstract

Background: Advanced squamous cell carcinoma (SCCa) of the oral cavity is often not amenable to curative-intent therapy due to tumor location, tumor size, or comorbidities.

Case presentation: A 51-year-old male patient with human immunodeficiency virus and on highly active antiretroviral therapy (HAART) presented with a cT4aN2c SCCa of the tongue. He received a preoperative single course of Quad-Shot radiation therapy to 14 Gy in 4 fractions followed by surgical resection. Patient had no residual carcinoma on surgical pathology and no evidence of disease on subsequent clinical and radiological exams.

Conclusions: To our knowledge, this is the first case of pathologic complete response for a patient on HAART following a single cycle of the Quad-Shot regimen for advanced oral cavity SCCa. Protease inhibitors in HAART can induce spontaneous tumor regression via inhibition of proteasome function and activation of apoptosis, and thus act as a cancer therapeutic.

Keywords: HAART; HIV; Oral cavity cancer; Radiation therapy.

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Conflict of interest statement

The authors declare they have no competing interests.

Figures

**Fig. 1**
PET/CT at diagnosis showing large, hypermetabolic tongue mass (left image) and avid lymph nodes (right image)

**Fig. 2**
Pretreatment tongue biopsy; H&E 4x: Invasive well-differentiated squamous cell carcinoma, keratinizing subtype invading to a depth of 2 mm

**Fig. 3**
Post-radiation CT images with contrast

**Fig. 4**
Pretreatment tongue biopsy; H&E 20x: Nests of infiltrative malignant squamous cells in a background of desmoplastic stroma and mixed inflammation

**Fig. 5**
Post-treatment tongue resection; H&E 2x: Benign overlying squamous mucosa with keratin granulomas to a depth of 7 mm

**Fig. 6**
Post-treatment tongue resection; H&E 20x: Keratin granuloma comprised of multinucleated giant cells arranged around anucelate keratin debris; consistent with complete pathologic response to treatment

**Fig. 7**
Post-treatment tongue resection; p40 IHC 20x: Negative p40 immunohistochemical stain confirming no viable squamous cells

See this image and copyright information in PMC

References

1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7–33. - PubMed
1. Cooper JS, Porter K, Mallin K, Hoffman HT, Weber RS, Ang KK, Gay EG, Langer CJ. National cancer database report on cancer of the head and neck: 10-year update. Head Neck. 2009;31(6):748–758. doi: 10.1002/hed.21022. - DOI - PubMed
1. Dhanuthai K, Rojanawatsirivej S, Thosaporn W, Kintarak S, Subarnbhesaj A, Darling M, Kryshtalskyj E, Chiang CP, Shin HI, Choi SY, et al. Oral cancer: a multicenter study. Med Oral Patol Oral Cir Bucal. 2018;23(1):e23–e29. - PMC - PubMed
1. Kim YJ, Kim JH. Increasing incidence and improving survival of oral tongue squamous cell carcinoma. Sci Rep. 2020;10(1):7877. doi: 10.1038/s41598-020-64748-0. - DOI - PMC - PubMed
1. Paderno A, Morello R, Piazza C. Tongue carcinoma in young adults: a review of the literature. Acta Otorhinolaryngol Ital. 2018;38(3):175–180. doi: 10.14639/0392-100X-1932. - DOI - PMC - PubMed

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Pathologic complete response following low-dose radiation for advanced oral cavity cancer in a patient with human immunodeficiency virus

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Pathologic complete response following low-dose radiation for advanced oral cavity cancer in a patient with human immunodeficiency virus

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Conflict of interest statement

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