Mandibular Metastasis from Nasopharyngeal Carcinoma

Abstract

Objective: To describe a case of mandibular metastasis from nasopharyngeal carcinoma and review the literature.
 Methods:
 Design: Case Report
 
 Setting: Tertiary Public University Hospital
 
 Patient: One
 
 Result: A 42 year-old Malay gentleman underwent concurrent chemoradiotherapy (CCRT) for T4N2M0 (Stage IVa) nasopharyngeal carcinoma (NPC) non-keratinizing type (WHO II). Upon completion of CCRT, he developed metastasis to the left body of the mandible that increased in size despite 3 cycles of adjuvant intravenous chemotherapy. Hemi-mandibulectomy was deferred due to recent irradiation and a further 15 fractions of boost radiotherapy reduced the mandibular metastasis in size, but it has remained the same after six months follow up.
 Conclusion: Nasopharyngeal carcinoma (NPC) is a common malignancy in Oriental Asia and the South East Asian regions. It has the highest rates of nodal and distant metastases among all head and neck cancers. Distant metastasis to bone is common, but we could find no previous report of mandibular bone involvement in the literature. Radiotherapy remains the main treatment modality and combination with chemotherapy has been shown to improve survival of patients. There are studies on nasopharyngeal carcinoma tumour markers for diagnosis and disease process follow up, but these are still inconclusive.
 Keywords: Nasopharyngeal carcinoma, Bones, Mandible, Metastasis.