Nasopharyngeal carcinoma with central nervous system metastases: Two case reports and a review of the literature

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.