Abstract
It has been recommended that postoperative concurrent chemoradiotherapy （CCRT） be administered to patients with locally advanced oral cancer with a high risk of recurrence according to the NCCN guidelines. These treatments have improved the locoregional control rate. However, a treatment protocol for distant metastasis from oral cancer has not been established, and the prognosis for these patients is extremely poor. In this report, we describe a case of sphenoidal metastasis from intraosseous squamous cell carcinoma of the mandible, and its management.
The patient was a 66-year-old male with intraosseous squamous cell carcinoma of the mandible （T4aN2cM0）. He had undergone tracheotomy, subtotal glossectomy, radical neck dissection of the right side of the neck, modified radical neck dissection of the left side of the neck, and mandibular reconstruction with a vascularized fibular graft after CCRT （S-1: 120mg/day for 4 weeks, external irradiation: total 30Gy/15Fr）. Involvement of multiple cervical lymph nodes with extracapsular spread was found in a pathological specimen, therefore postoperative CCRT was scheduled. CT for radiotherapy planning revealed a sphenoidal metastasis. After consultation with a medical oncologist and a radiologist, CCRT （two cycles of CDDP ［80mg/m2］, external irradiation: total 60.6Gy/22Fr） was administered for the sphenoidal metastasis. In a follow-up examination 1 month after the CCRT, CT revealed progression of the metastatic tumor. Chemotherapy with the anti-epidermal growth factor receptor （anti-EGFR） cetuximab was thus scheduled, but the patient wanted to be treated at a nearby hospital. He has been followed up for 1 year and 2 months since the operation.
