VMAT combined with nimotuzumab precision therapy for an 87-year-old patient with locally advanced hypopharyngeal carcinoma: a case report

Management of older adults aged 85 years or above with locally advanced hypopharyngeal carcinoma remains challenging, as frailty and reduced physiological reserve frequently limit eligibility for radical surgery or platinum-based concurrent chemoradiotherapy. However, consensus is lacking regarding safe and effective treatment strategies tailored to this population. An 87-year-old man (KPS 90; CCI 6) with cT3N1M0 hypopharyngeal squamous cell carcinoma (SCC) developed COVID-19 pneumonia during pre-treatment hospitalisation. After the multidisciplinary team (MDT) discussion, he received volumetric modulated arc therapy (VMAT) with concurrent weekly nimotuzumab (200 mg for 8 cycles). A de-escalated total dose of 63 Gy in 35 fractions (1.8 Gy/fraction) was delivered. Following a partial response (PR) at 50.4 Gy (28 fractions), adaptive radiotherapy (ART) was implemented for the remainder of treatment. The patient achieved a complete response (CR), and progression-free survival (PFS) was 774 days at last follow-up. Notably, dysphagia improved during treatment and completely resolved during follow-up. Acute toxicities, graded according to the Radiation Therapy Oncology Group (RTOG) criteria, were limited to grade 2 oral mucositis, the highest grade, and no severe late toxicities were observed. This case suggests that VMAT-based definitive radiotherapy incorporating adaptive replanning and concurrent nimotuzumab may inform individualised non-surgical treatment strategies for selected older adults with locally advanced hypopharyngeal SCC. Durable disease control was achieved with manageable toxicity, while preserving organ function and prioritising quality of life (QoL).