Radiotherapy for mandibular metastases from hepatocellular carcinoma: a single institutional experience

Abstract

Purpose: A mandibular metastasis is uncommon in patients with hepatocellular carcinoma (HCC). We report the clinical features of this rare lesion and evaluate the effectiveness of radiotherapy in affected patients. Materials and Methods: We retrospectively reviewed our institutional medical records for HCC patients who received radiotherapy for bone metastasis, and included cases of mandible metastasis. The clinical features of these cases, and the characteristics and outcomes of the treatments were assessed. Results: A total of 1,498 patients with a bone metastasis from HCC were treated with radiotherapy between July 1998 and April 2012 at our institution. We identified 9 patients (0.6%) in this cohort that received radiotherapy for a mandibular metastasis. The condyle was the most common location of mandibular metastasis. The median radiation dose was 40 Gy (range, 27.5 to 60 Gy), with a daily dose of 2-3 Gy. All of these 9 patients died during a median follow-up of 9 months (range, 1 to 19 months). Symptom relief was achieved in 7 of 8 patients who completed radiotherapy. Tumor size reduction was observed in 2 of 4 patients who underwent radiologic evaluation after radiotherapy. Conclusions: Metastasis to the mandible from HCC has a poor prognosis. Radiotherapy can be an effective local treatment option for symptomatic relief in these cases.

A Rare Case of Isolated Hepatocellular Carcinoma Metastasis in Left Mandibular Region in a Patient with Hepatitis C Virus Liver Cirrhosis Diagnosed after the Onset of COVID-19 Infection

“…In this respect, it is understandable why the lesion itself is prone to bleeding [17,19]. Due to the aforementioned bone metastases with HCC characteristics, special care needs to be taken while performing biopsy; therefore, percutaneous core biopsy or fine needle aspiration (FNA) biopsies are favorable compared to incisional biopsies [9]. This characteristic imaging presentation of bone HCC metastasis was consistent in the presented patient, as evidenced through CT performed in the investigation of a painless jaw swelling.…”

“…Advances in imaging techniques and in the treatment of HCC patients with subsequent prolonged survival allow us to observe extrahepatic metastases more frequently and earlier than we could before [3]. The incidence of extrahepatic metastases is estimated to be 13-36% [8], with the most frequent sites being the lungs (18-55%); lymph nodes (26.7-53%); bones, most commonly including the axial skeleton, (5.8-38%); and the adrenals (8.4-15.4%) [3], while mandibular metastasis is estimated to occur in 0.6% of cases [9]. Extrahepatic metastases of HCC tend to affect males, particularly in patients aged over 60 years, exhibiting the traits of the primary tumor [4].…”

“…Commonly reported clinical findings in patients with a mandibular metastasis of HCC are those of a diffuse, firm and painless swelling in the temporal region [14], which are consistent with our patient. Additionally, symptoms including difficulty in opening of the mouth, numbness of the surrounding regions as well as toothache are observed [4,9,10,15,16]. Since there have been various reports of initial presentation of a metastatic HCC with a solitary orofacial metastasis [15,16], even more commonly than after an HCC diagnosis is established [9,16,17], we emphasize the need to consider this possibility in patients with known risk factors for HCC (liver cirrhosis, viral hepatitis and others).…”

“…Additionally, symptoms including difficulty in opening of the mouth, numbness of the surrounding regions as well as toothache are observed [4,9,10,15,16]. Since there have been various reports of initial presentation of a metastatic HCC with a solitary orofacial metastasis [15,16], even more commonly than after an HCC diagnosis is established [9,16,17], we emphasize the need to consider this possibility in patients with known risk factors for HCC (liver cirrhosis, viral hepatitis and others). However, metastatic disease represents ~1% of all malignancies of the oral area [4].…”

Mandibular metastasis of primary extrahepatic biliary carcinoma: Case report

“…A needle aspiration biopsy of the mandibular mass revealed metastatic adenocarcinoma of the liver. The patient refused the right hemimandibulectomy treatment and opted for radiotherapy, which can be used as a palliative treatment [15] . As the prognosis of metastatic lesions in the mandible is unfavorable, the combination of radio- and chemotherapy to minimize symptoms is also a chosen therapeutic modality, as the case described in the present study.…”