# Metabolism-Guided LATTICE Radiotherapy in an Elderly Patient with Locally Advanced Head and Neck Cancer Treated with Curative Aim: A Case Report

## TL;DR

This case report explores a two-phase radiotherapy approach in an elderly patient with head and neck cancer, showing potential immunological benefits with manageable toxicity.

## Contribution

A novel two-phase radiotherapy regimen combining high-dose localized and low-dose irradiation is proposed for elderly patients with head and neck cancer.

## Key findings

- The two-phase regimen stimulated the tumor's immunogenicity with acceptable toxicity.
- Clinical response suggests potential for improved immunological effects in elderly cancer patients.

## Abstract

Background and clinical Significance: The management of head and neck squamous cell carcinoma in elderly patients is a clinical scenario that is currently under debate. Case Presentation: Patients over 65 years old are particularly vulnerable, and the administration of curative oncological care is challenging. Furthermore, such treatment has the potential to be extremely toxic. Spatially fractionated radiation therapy (SFRT) is a radiotherapy modality that offers a promising approach for treating tumors. This method involves the delivery of a spatially modulated dose, resulting in highly non-uniform dose distributions. This leads to the generation of peaks and valleys of doses within a target volume. In this case study, a patient with an ulcerating lesion on the right cheek was treated with a two-phase radiotherapy regimen. The purpose of the first procedure was to stimulate the immunogenicity of the tumor microenvironment. In the second part of the procedure, standard fractionated irradiation was delivered with curative aim. Conclusions: The clinical response indicates that this combination of high-dose “localized” and low-dose irradiation can produce immunological effects with an acceptable toxicity profile.