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

  • Park, Jongmoo (Department of Radiation Oncology, Kyungpook National University Chilgok Hospital) ;
  • Yoon, Sang Min (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2019.08.20
  • Accepted : 2019.12.16
  • Published : 2019.12.31


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.


  1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.
  2. Natsuizaka M, Omura T, Akaike T, et al. Clinical features of hepatocellular carcinoma with extrahepatic metastases. J Gastroenterol Hepatol 2005;20:1781-7.
  3. Uchino K, Tateishi R, Shiina S, et al. Hepatocellular carcinoma with extrahepatic metastasis: clinical features and prognostic factors. Cancer 2011;117:4475-83.
  4. He J, Zeng ZC, Tang ZY, et al. Clinical features and prognostic factors in patients with bone metastases from hepatocellular carcinoma receiving external beam radiotherapy. Cancer 2009;115:2710-20.
  5. Seong J, Koom WS, Park HC. Radiotherapy for painful bone metastases from hepatocellular carcinoma. Liver Int 2005;25:261-5.
  6. Dick A, Mead SG, Mensh M, Schatten WE. Primary hepatoma with metastasis to the mandible. Am J Surg 1957;94:846-50.
  7. Ashar A, Khateery SM, Kovacs A. Mandibular metastatic hepatocellular carcinoma: a case involving severe postbiopsy hemorrhage. J Oral Maxillofac Surg 1997;55:547-52.
  8. Junquera L, Rodriguez-Recio C, Torre A, Sanchez-Mayoral J, Fresno MF. Hepatocellular carcinoma metastatic to the mandible: a case involving severe hemorrhage. Med Oral 2004;9:345-9.
  9. Pires FR, Sagarra R, Correa ME, Pereira CM, Vargas PA, Lopes MA. Oral metastasis of a hepatocellular carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:359-68.
  10. Huang SF, Wu RC, Chang JT, et al. Intractable bleeding from solitary mandibular metastasis of hepatocellular carcinoma. World J Gastroenterol 2007;13:4526-8.
  11. Kamatani T, Tatemoto Y, Tateishi Y, Yamamoto T. Isolated metastasis from hepatocellular carcinoma to the mandibular condyle with no evidence of any other metastases: a case report. Br J Oral Maxillofac Surg 2008;46:499-501.
  12. Yu S, Estess A, Harris W, Dillon J. A rare occurrence of hepatocellular carcinoma metastasis to the mandible: report of a case and review of the literature. J Oral Maxillofac Surg 2012;70:1219-23.
  13. Pesis M, Taicher S, Greenberg G, Hirshberg A. Metastasis to the jaws as a first manifestation of hepatocellular carcinoma: report of a case and analysis of 41 cases. J Craniomaxillofac Surg 2014;42:1997-2001.
  14. Bruix J, Sherman M; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011;53:1020-2.
  15. Chow E, Hoskin P, Mitera G, et al. Update of the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases. Int J Radiat Oncol Biol Phys 2012;82:1730-7.
  16. Servato JP, de Paulo LF, de Faria PR, Cardoso SV, Loyola AM. Metastatic tumours to the head and neck: retrospective analysis from a Brazilian tertiary referral centre. Int J Oral Maxillofac Surg 2013;42:1391-6.
  17. Hirshberg A, Shnaiderman-Shapiro A, Kaplan I, Berger R. Metastatic tumours to the oral cavity: pathogenesis and analysis of 673 cases. Oral Oncol 2008;44:743-52.
  18. Tobinick E, Vega CP. The cerebrospinal venous system: anatomy, physiology, and clinical implications. MedGenMed 2006;8:53.
  19. Lomas J, Gurgenci T, Jackson C, Campbell D. Temporomandibular dysfunction. Aust J Gen Pract 2018;47:212-5.
  20. Liddell A, Perez DE. Temporomandibular joint dislocation. Oral Maxillofac Surg Clin North Am 2015;27:125-36.
  21. Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med 2011;365:147-56.
  22. Jung IH, Yoon SM, Kwak J, et al. High-dose radiotherapy is associated with better local control of bone metastasis from hepatocellular carcinoma. Oncotarget 2017;8:15182-92.
  23. Miller ME, McCall AA, Juillard GF, Nadelman CM, Wang MB, Nabili V. Hepatocellular carcinoma metastatic to the mandible. Ear Nose Throat J 2013;92:E17-9.