PDF(Pubmed)
Abstract：
Leptomeningeal metastasis is a rare in nasopharyngeal carcinoma, affecting less than 5% of patients with a poor prognosis. The aim of this case report was to present management of palliative radiotherapy in leptomeningeal metastasis of nasopharyngeal carcinoma patient. A 33-year-old female presented with nasopharyngeal carcinoma with stage III, T3N3M0, WHO type III. The patient has received chemoradiation with photon-based intensity-modulated radiotherapy (IMRT) technique at the dose of 70 Gy in 33 fractions and showed a satisfactory outcome in 12 months follow-up. Later, at 18 months after chemoradiation completion, the patient complained of worsening bilateral sciatic pain, particularly during coughing, with slight limitations in bilateral hip flexion observed during straight leg raises. The whole spine contrast-enhanced magnetic resonance imaging (MRI) examination showed nodular enhancement of leptomeningeal thickening at the T4 level of the spinal cord lower than S3. Palliative radiation therapy utilized a three-dimensional conformal radiation therapy (3D-CRT) technique producing 35 Gy in 14 fractions placed in a field spanning the T4-S3 vertebral bodies. Methotrexate was administered intravenously every two weeks for three cycles to ensure central nervous system penetration. After four months of follow-up, no evidence of disease was found at the primary site and metastatic areas on subsequent physical examination or imaging with MRI and there was satisfactory improvement in neurologic symptoms. In conclusion, leptomeningeal metastases with primary nasopharyngeal carcinoma are rare and typically cause neurological impairments in patients. Hematogenous or cerebrospinal fluid-mediated spread of the cancer is considered the most likely pathway for leptomeningeal dissemination. Strategic modalities, such as radiotherapy with chemotherapy, may improve outcomes in symptoms and quality of life.
摘要：
脑膜转移在鼻咽癌中是罕见的，影响不到5%的预后不良患者。该病例报告的目的是介绍鼻咽癌患者软脑膜转移中姑息性放疗的治疗方法。一名33岁女性出现鼻咽癌III期，T3N3M0，WHOⅢ型。该患者接受了33次70Gy剂量的基于光子的调强放疗（IMRT）技术的放化疗，并在12个月的随访中显示出令人满意的结果。稍后，放化疗完成后18个月，患者主诉双侧坐骨神经疼痛恶化,尤其是在咳嗽时,在直腿抬高期间观察到双侧髋关节屈曲的轻微限制。全脊柱对比增强磁共振成像（MRI）检查显示，脊髓T4水平低于S3的软脑膜增厚结节状增强。姑息性放射治疗利用三维适形放射治疗（3D-CRT）技术，在横跨T4-S3椎体的区域中放置14个部分，产生35Gy。甲氨蝶呤每两周静脉内给药三个周期，以确保中枢神经系统渗透。经过四个月的随访，在随后的体格检查或MRI成像中,未发现原发部位和转移部位的疾病证据,神经系统症状得到满意改善.总之,原发性鼻咽癌的软脑膜转移很少见，通常会引起患者的神经系统损害。血源性或脑脊液介导的癌症扩散被认为是最可能的软脑膜扩散途径。战略模式，如放疗和化疗，可以改善症状和生活质量。
