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Case of metastatic small cell carcinoma of the oropharynx successfully treated with image-guided volumetric modulated arc therapy (IG-VMAT): pushing the limits of technology to match treatment intent
  1. Irfan Ahmad1,
  2. Pavel Singh2,
  3. Chandi Prasad Bhatt3 and
  4. Irfan Bashir3
  1. 1 Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India
  2. 2 Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
  3. 3 Department of Radiation Oncology, Batra Hospital & Medical Research Centre, New Delhi, Delhi, India
  1. Correspondence to Dr Irfan Ahmad, irfan.a{at}


Extrapulmonary small cell carcinomas (EPSCC) are a rare subtype of neuroendocrine tumours which have been documented to arise from a multitude of sites and treatment outcomes are disappointing. The most common site involved in the head and neck region is the larynx and the oropharynx as a primary site has been infrequently reported. The patient presented with bilateral neck swelling and an ulcerated lesion was noted in the base of tongue (BOT). A biopsy revealed small cell carcinoma (SCC) and was confirmed with immunohistochemistry. The final diagnosis after workup was SCC of BOT stage IVc. He received induction chemotherapy to which the tumour responded partially, followed by curative intent chemoradiotherapy and adjuvant chemotherapy. The patient achieved a radiological complete response to treatment and almost all treatment-induced toxicities resolved. An aggressive approach to managing EPSCC is possible with modern radiotherapy techniques, with tolerable treatment-induced toxicities.

  • head and neck cancer
  • radiotherapy
  • chemotherapy

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  • Contributors IA is the treating attending consultant (Radiation Oncology), author of the paper, responsible for drafting the manuscript and revising it. He is the guarantor. PS is the radiologist and participated in interpreting and drafting the imaging-related portions of the paper. CPB is the physicist responsible for generating the radiation treatment plan, performing quality assurance of delivered plan and also participated in article editing. IB is the supervising treating consultant (Radiation Oncology) and participated in article editing and oversight.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.