がんの科学と治療

Leptomeningeal Metastases in Nasopharyngeal Carcinoma: A Rare Case Report and a Review of Literature

Abstract

El Amin Marnouche, Khalid Hadadi, Abdelhak Maghous, Maroua Benlemlih, Mouhcine Hommadi, Mohamed Oukabli, Khalid Saghir Andaloussi, Mohamed Elmarjany and Hassan Sifa

Introduction: The most common sites for distant nasopharyngeal carcinoma metastases are the bone, lung, and liver. Leptomeningeal metastases LM in undifferentiated nasopharyngeal carcinoma are rare.

Case and outcomes: We present a case report of a 36 years old patient treated initially for undifferentiated nasopharyngeal carcinoma (T2N3M0, stage III of AJCC 7th edition) by association of chemotherapy and radiotherapy. Two years and half later, the patient developed a frontal leptomeningeal metastasis in association with subcutaneous and left parotid relapses on MRI. The patient was treated by resection of the leptomeningeal and subcutaneous lesions. These masses turned out to be an undifferentiated carcinoma consistent with nasopharyngeal carcinoma metastasis. The patient refused parotidectomy and adjuvant radiotherapy of leptomeningeal metastasis was performed. She is now being treated with chemotherapy.

Discussion: Leptomeningeal metastases from nasopharyngeal carcinoma are rare and occur in almost 3% of patients. Multifocal neurologic signs are common and indicate multilevel involvement. The treatment of LM is based on chemotherapy and radiation therapy. Even with chemotherapeutic agents active on central neurologic system, the median survival was up to four months.

Conclusion: Leptomeningeal metastases from NPC are rare. The prognosis of patients with LM is poor. However a small subset of patients with low tumor burden and good performance status could be treated more aggressively with multimodal strategy.