A novel approach for the treatment of a rare case of gingival metastasis in renal cell carcinoma using surface-mould brachytherapy.

BACKGROUND

Gingival metastasis in renal cell carcinoma is rare and often results from widespread metastasis. Usually, when managed surgically, general anesthesia and extensive and morbid surgery are required. The present case describes one such mandibular gingival metastasis in a patient with RCC successfully managed using a conservative approach of mould brachytherapy.

CASE DESCRIPTION: A 54-year-old nonhypertensive, nondiabetic male with, a known case of clear cell RCC, on targeted therapy presented with a new proliferative lesion in the mandibular gingiva, with difficulty in chewing food, pain, and bleeding. On examination, an ulceroproliferative friable lesion was seen in the mandibular gingiva on the right side, approximately 3 × 2 cm, which bled on touch. Biopsy showed metastatic carcinoma, diffusely positive for Pan-cytokeratin and PAX8. He was treated with a palliative dose of 20 Gy in 5 Fr, delivered using surface mould high-dose-rate (HDR) brachytherapy twice a day, 6 hours apart along with Lenvatinib. The surface mould was made using an acrylic dental mould with attached interstitial catheters. The lesion started to regress after 1 month and completely disappeared after 3 months of radiation delivery, with a healthy pink gingiva.

CONCLUSION

Although oral metastasis of RCC has a poor prognosis due to the occurrence of concurrent disseminated metastases, HDR brachytherapy may be used as an easier and less invasive method for treating gingival metastasis. It can be sought as an alternative approach to surgery for treating gingival metastases in the future without compromising quality of life. Brachytherapy can be an essential tool for palliative treatment as well.