A young father's brave battle with aggressive tongue cancer: A story of resilience and medical innovation
He underwent standard treatment, beginning with surgical resection in the form of a partial glossectomy (removal of part of the tongue) along with neck dissection. This was followed by simultaneous flap reconstruction of the tongue and subsequent chemoradiation therapy.
Unfortunately, within three months of completing radiation, the cancer recurred. It began from the posterior edge of the flap, involved the base of the tongue, and was found to be abutting the mandible (jaw bone).
There were lymph nodes affected on both sides of the neck.
Major challenges faced
Aggressive Disease Biology: A recurrence within such a short time pointed to a very aggressive form of cancer.
Post-Treatment Morbidity: The patient was still recovering. He had impaired speech and swallowing, a dry mouth due to lack of saliva, and radiation-damaged skin on the neck. His overall health was still weak.
Surgical Risks: A second surgery was extremely risky due to:
Scarred surgical planes from the previous operation, especially around critical blood vessels like the carotid artery.
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Tissue healing compromised by radiation. Surgical intervention within 6 to 12 months post-radiation increases the risk of osteoradionecrosis (bone death), especially if the mandible is involved.
Innovative, individualized treatment plan
Given the complexity of the case, immunotherapy was initially considered. However, due to its high cost, a precision medicine approach using tumor viability and transcriptomic analysis was employed through RGCC Labs in Europe. This cutting-edge test helped determine:
The likely effectiveness of immunotherapy
Which chemotherapy drugs might be most effective
The role of dietary modifications, including Ayurveda, superfoods, and sugar management
Surprisingly, the report indicated limited benefit from immunotherapy, but highlighted the potential effectiveness of targeted therapies against EGFR and VEGF pathways.
The general concept is to start immunotherapy with or without chemotherapy. As immunotherapy is a really expensive treatment, we decided to use the latest technology of tumor viability and transcriptomics from RGCC Labs Europe. This helps us understand whether immunotherapy will be effective or not. It also helps us decipher which chemotherapy drugs to use. It even provides insight into Ayurveda, superfoods, and allows us to tailor the patient's diet, including the role of sugar.
The analysis suggested not much effectiveness of immunotherapy. Instead, targeted medicines against EGFR and VEGF pathways were found to be effective. A protocol comprising chemotherapy + targeted drugs + nutraceuticals (Ayurveda) + dietary modification and supportive medicine such as high-dose Vitamin C was developed and administered.
To our surprise, the patient responded very well. Within three weeks, the neck nodes were not palpable.
Speech and swallowing started to improve dramatically.
But unfortunately, after four weeks, the patient developed acalculous cholecystitis—i.e., inflammation around the gallbladder—for which he had to be hospitalized. Image-guided drain insertion was done, which delayed cancer treatment. Chemotherapy administration was possible only twice and had to be abandoned in view of the ongoing infection.
The ulcer in the posterior tongue was still there, and surgery was an option.
The patient denied an open procedure as he was not willing to accept more morbidity. Therefore, transoral robotic resection of the tongue ulcer was planned. We were skeptical since the ulcer was abutting the jawbone, and it's very difficult to get adequate margins robotically.
Again, to our surprise, the surgical procedure went well. We were able to remove the whole ulcer robotically, and the final histopathology suggested no residual disease—i.e., all cancer cells were dead. The systemic therapy administered had worked very well.
The patient is doing very well. He is eating well and leading a normal life. The gallbladder removal surgery has also been done successfully.
Case study by Dr Mandeep Singh Malhotra, Co founder Art of Healing cancer
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