Mandibular metastases in neuroblastoma: Outcomes and dental sequelae

Abstract

Background Although metastatic involvement of bony sites including cranial bones is common in neuroblastoma (NB), mandibular metastases (MM) are uncommon, and specific outcomes have not been reported upon in the modern therapeutic era. Methods In this retrospective study, medical records on patients with MM from NB were reviewed. Statistical analysis was performed using the Kaplan‐Meier method. Results Of 29 patients, nine (31%) had MM at diagnosis, whereas in 20 (69%) MM were first detected at NB relapse at a median time of 26 (6‐89) months from diagnosis. Median maximal diameter of lesions was 3 (range 0.8‐4.9) cm. MM were unilateral in 83% of patients, with ascending ramus (55%) and mandibular body (38%) being the two most common sites. All patients received systemic chemotherapy, and 26 (93%) patients received radiotherapy to MM. At a median follow‐up of 37.3 (24.2‐219.5) months, eight of nine patients with MM at diagnosis did not experience mandibular progressive disease. Eighteen of 20 patients with MM at relapse received therapeutic radiotherapy; objective responses were noted in 78%. Seventy‐two percent (5/18) had not experienced relapse within the radiation field at a median of 12 (2‐276) months postradiotherapy. Dental findings at follow‐up after completion of NB therapy included hypodontia, hypocalcification of enamel, and trismus. Median 3‐year overall survival in patients with relapsed MM was 51 ± 12% months from relapse. Conclusion MM when detected at diagnosis is associated with a prognosis similar to that for other skeletal metastases of NB. Radiotherapy is effective for control of MM detected both at diagnosis and relapse. Significant dental abnormalities posttherapy warrant regular dental evaluations and appropriate intervention.

Mandibular Metastasis in Neuroblastoma in a 3 Year-Old Child: A Case Report

“…The most recent findings 3 show that, in contrast to prior publications, 2 mandibular metastasis in neuroblastomas does not always have a poor prognosis when compared to individuals with metastases at other bone sites. Three-year survival with multimodality therapy in these patients.…”

“…2 Neuroblastoma patients in addition of the palpable abdominal anomalies and/or symptoms associated to mass effect on surrounding organ systems, the mandibular metastasis has the potential for substantial morbidity, potentially interfering with dentition and oral function, and frequently leading to major esthetic problems. 3 The presence of tumor cells in a bone marrow aspirate or a typical histopathologic examination of tumor tissue can be used to confirm the diagnosis of NB. Elevated urine vanyllylmandelic acid (VMA) and homovanillic acid (HVA), dopamine, serum ferritin, and neuron-specific enolase levels can help establish the diagnosis.…”

“…4 CT and MRI are commonly used for definitive imaging of mandibular metastasis, with the latter being the preferred radiographic modality for identifying soft tissue abnormalities because of its higher specificity and sensitivity and stronger soft tissue contrast. 5 Metastatic lesions in neuroblastoma, like other osseous metastases, are generally osteolytic with extraosseous soft tissue expansion, 3 with T2 hyperintense signal, T1 hypointense signal, restricted diffusion, and heterogeneous enhancement after Gado injection.…”

“…Many of these survivors, however, have treatment-related dentofacial abnormalities that require extensive rehabilitation to restore oral function. 3 The recommended strategy for managing neuroblastomas in children involves a comprehensive approach that begins with surgically excising the tumor, followed by targeted radiation therapy directed at the surgical site. This method has proven to be highly effective, particularly for localized tumors, resulting in a commendable cure rate ranging between 85% and 90%.…”

Metastatic Neuroblastoma Presenting as a Submandibular Mass with Mandibular Bone Involvement in a Three-Year-Old Child

“…They also highlighted that due to its rarity, there are very few reports of this clinical presentation and therefore poor data to accurately estimate the frequency. Thus, reinforcing the idea that metastasis to the mandibular bone is very uncommon, let alone as the presenting lesion [12]. A retrospective review of 279 patients presenting to a tertiary care center in China found that bone marrow is the most common site of metastasis for neuroblastoma, with bone being the second most common site.…”