60 year old hypertensive, nondiabetic female with history of ischemic heart diseases, presented with history of recurrent left gluteal ulcer. Earlier she had non-oncological treatment near her village.
Presently she had a massive chronic gluteal abscess with fistulous tract going upto external genitalia and it was drained. On histopathology she had squamous cell carcinoma with fistulous tract showing chronic inflammation. MRI was done and showed 3.5 cm x 4.9 cm x 6.3 cm (AP X TRANS X SI) large altered signal intensity mass lesion in left gluteal subcutaneous region, which had deep extension and infiltration into adjoining left gluteal muscle. On metastatic work up, no metastasis were found. She was deemed non-operative candidate considering her co-morbidities and as well as extensive local spread of diseases. Therefore, she was planned for radiation therapy. She was given radical radiation with VMAT to the dose of 70 Gy/35# to primary and 50 Gy/25# to inguinofemoral nodes and transit dermal lymphatics. Patient tolerated treatment well with minimal GI and haematological toxicity and grade III skin toxicity, which subsequently resolved well. On follow up, she had a good response clinically and subsequently PET-CT showed no residual diseases. Presently she is on follow- up with minimal morbidity and adequate quality of life. In this patient with recurrent and locally advanced diseases we were able to achieve complete local control with minimal impact on quality of life.