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Chen K, Shi M, Mo S, Liu T, Zhao Y, Zhang L, Zhao S. Clinical features and prognostic factors of nasopharyngeal carcinoma with brain metastases. Oral Oncol 2024; 151:106738. [PMID: 38458037 DOI: 10.1016/j.oraloncology.2024.106738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/09/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Brain metastasis in nasopharyngeal carcinoma is a rare occurrence, and the characteristics of patients in this subgroup remain poorly defined. This study aims to delineate the clinical features, treatment modalities, prognostic factors, and survival of nasopharyngeal carcinoma patients with brain metastasis. METHODOLOGY A retrospective analysis was conducted on patients diagnosed with nasopharyngeal carcinoma who developed brain metastasis and were treated at the Sun Yat-sen University Cancer Center between July 2000 and July 2023. Clinical data from patients were collected and used to assess their survival after brain metastases and prognostic factors. RESULTS Among 82,434 nasopharyngeal carcinoma patients, 40 (0.06 %) developed Brain metastasis with a median follow-up of 5.1 years. The predominant histological subtype was non-keratinizing squamous cell carcinoma (85 %). The median post-BM survival was 25 months. The age, the Eastern Cooperative Oncology Group (ECOG), and the procedural treatment of BM were prognostic factors. Notably, patients receiving local treatments had significantly prolonged post-BM survival compared to those receiving systemic therapy alone (median, 47.00 vs. 11.00 months; p = 0.011). CONCLUSIONS This is the largest cohort of brain metastasis in nasopharyngeal carcinoma to date. Local therapeutic measures after brain metastasis can significantly enhance the prognosis of these patients, particularly when radiotherapy is applied.
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Affiliation(s)
- Kehui Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Mengting Shi
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Silang Mo
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tingting Liu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuanyuan Zhao
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Shen Zhao
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
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Geng X, Hao F, Han G, Zhang Y, Qin P. Dural and Multiple Brain Metastases From Basaloid Nasopharyngeal Carcinoma: Case Report and Literature Review. Front Oncol 2021; 11:665652. [PMID: 34336659 PMCID: PMC8316747 DOI: 10.3389/fonc.2021.665652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background Nasopharyngeal carcinoma is an endemic head and neck cancer in Southern China. The common metastases organs involve bone, lung, and liver. Metastases in the dura and at multiple locations in the brain after a diagnosis of nasopharyngeal carcinoma are extremely rare. Case Presentation We present a case of a 66-year-old man who initially complained of nasal congestion, epistaxis, and hearing impairment. The biopsy of the nasopharynx lesion showed basaloid squamous cell carcinoma. Eight months after conventional therapy, the patient was admitted to our hospital again with the complaint of a headache. A PET/CT scan was performed, revealing multiple metastases. A biopsy of subcutaneous soft tissue from the right upper arm was consistent with the previous biopsy. Palliative chemotherapy was administered. Thereafter, the patient had sudden dysfunction of the right side of the body. MRI demonstrated dural and multiple brain metastases. The therapeutic regimen then consisted of whole-brain radiotherapy, anti-angiogenesis therapy, and immunotherapy. Conclusions This case highlights the diagnosis and treatment of uncommon metastases of nasopharyngeal carcinoma. Clinicians should remain vigilant for metastases during the treatment and follow-up periods.
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Affiliation(s)
- Xiaotao Geng
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
| | - Furong Hao
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
| | - Guiyan Han
- Department of Pathology, Weifang People's Hospital, Weifang, China
| | - Yaping Zhang
- Department of Radiology, Weifang People's Hospital, Weifang, China
| | - Peiyan Qin
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
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Chen X, Ren L, Qiu G, Cao L. Long-term recurrence and brain metastasis of nasopharyngeal carcinoma mimicking cystic radiation encephalopathy relapse: a case report. BMC Neurol 2021; 21:59. [PMID: 33557786 PMCID: PMC7869473 DOI: 10.1186/s12883-021-02088-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During medical imaging, cystic radiation encephalopathy and brain metastasis are difficult to differentiate, and hence they are easily misdiagnosed. To our knowledge, a nasopharyngeal carcinoma recurrence after more than seven years with cerebral metastasis that mimicked cystic radiation encephalopathy has not been reported. CASE PRESENTATION A 52-year-old man was admitted to the hospital owing to weakness of the right limb for one month, which increased in intensity for three days. He had been diagnosed with nasopharyngeal carcinoma in 2011, which was treated by radiotherapy. The patient successively developed cystic radiation encephalopathy and brain metastasis from the nasopharyngeal carcinoma, which mimicked cystic radiation encephalopathy relapse. Left frontotemporal craniotomy, surgical resection of brain metastasis, and repair of the skull base and dura were performed. Postoperative computed tomography showed that midline deviation recovered, and brain edema was reduced. CONCLUSIONS This report is significant because brain metastasis from nasopharyngeal carcinoma can masquerade as a benign entity and cause fatal consequences. In patients presenting with cystic radiation encephalopathy, brain metastasis should be considered as a differential diagnosis.
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Affiliation(s)
- Xuhui Chen
- Department of Neurology, Peking University Shenzhen Hospital, 518000, Shenzhen, China
| | - Lijie Ren
- Department of Neurology, Shenzhen University First Affiliated Hospital, 3002 Sungang West Road, Futian District, 518000, Shenzhen, China.,Department of Neurology, Shenzhen Second People's Hospital, 518000, Shenzhen, China
| | - Guozhen Qiu
- Department of Neurology, The 3rd Affiliated Hospital of Shenzhen University, 518000, Shenzhen, China
| | - Liming Cao
- Department of Neurology, Shenzhen University First Affiliated Hospital, 3002 Sungang West Road, Futian District, 518000, Shenzhen, China. .,Department of Neurology, The 3rd Affiliated Hospital of Shenzhen University, 518000, Shenzhen, China.
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Su Z, Cao X, Zou G. Brain and frontal-bone metastasis from nasopharyngeal carcinoma: Case report and literature review. Head Neck 2019; 41:E153-E158. [PMID: 31265191 DOI: 10.1002/hed.25859] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/06/2019] [Accepted: 06/14/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Metastases to the bones, lungs, and liver are common in patients with nasopharyngeal carcinoma (NPC) but not to the brain and frontal bone (B + FB). METHODS We describe a patient with NPC with B + FB metastasis. He received two cycles of palliative chemotherapy (gemcitabine and cisplatin) and then radiotherapy (60 Gy) for B + FB metastasis. A literature review of previous cases was also undertaken. RESULTS Follow-up 6 months after completion of chemotherapy and radiotherapy showed that our patient experienced a complete response without signs of NPC progression. CONCLUSIONS B + FB metastases from NPC are uncommon. Our case highlights the diagnostic and treatment difficulties clinicians face when dealing with patients with uncommon sites of metastasis. Optimal adjuvant therapy followed by local radiotherapy might elicit long survival in patients with NPC with uncommon sites of metastasis.
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Affiliation(s)
- Zhen Su
- Panyu Central Hospital, Cancer Institute of Panyu, Guangzhou, China
| | - Xiaolong Cao
- Panyu Central Hospital, Cancer Institute of Panyu, Guangzhou, China
| | - Guorong Zou
- Panyu Central Hospital, Cancer Institute of Panyu, Guangzhou, China
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Shen C, Ying H, Lu X, Hu C. Nasopharyngeal carcinoma with central nervous system metastases: Two case reports and a review of the literature. Medicine (Baltimore) 2017; 96:e9175. [PMID: 29245363 PMCID: PMC5728978 DOI: 10.1097/md.0000000000009175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Central nervous system (CNS) metastases are rarely seen in patients with nasopharyngeal carcinoma (NPC). PATIENT CONCERNS Two NPC patients developed CNS metastases were collected in Fudan University Shanghai Cancer Center. The medical records were reviewed to document patients' characteristics, treatment, and outcomes. In addition, we also provide an overview of the literature concerning this scenario. DIAGNOSES Both patients were staged T4N1M0 with pathologically confirmed CNS metastases from nasopharyngeal carcinoma. INTERVENTIONS After the completion of initial chemoradiotherapy, metastases to CNS including brain and/or spine occurred during follow-up. Surgical resection combined with palliative chemoradiation was offered to alleviate the symptoms. OUTCOMES Although multiple treatment modalities were given, both patients succumbed to disease progression. LESSONS The mechanism for CNS metastases is postulated through hematogenous route or cerebral spinal fluid spread. Good symptoms amelioration can be achieved with aggressive treatments such as surgery followed by palliative chemoradiation, but prognoses are ominous due to systematic disease dissemination.
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Affiliation(s)
- Chunying Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongmei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xueguan Lu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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