Zhang Xin, Shu Xiaolei, Long Bin
Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China.
Transl Cancer Res. 2022 Sep;11(9):3349-3356. doi: 10.21037/tcr-22-1211.
Leptomeningeal metastasis (LM) have a poor prognosis and rare studies have reported LM from nasopharyngeal carcinoma (NPC). Immune checkpoint inhibitor (ICI) was the standard first line treatment for metastatic NPC and was reported to improve intracranial response and survival in several types of cancer.
In this case presentation, we present a case of a 26-year-old man with metastatic NPC who initially complained of left cervical masses. A PET/CT and MRI scan revealed multiple liver, bone and brain metastasis. The patient received initial anti PD-1 antibody camrelizumab combined with chemotherapy, followed by radiotherapy to local and regional lesions. Two weeks after that, the patient experienced transient unconsciousness, persistent fatigue and pain in both lower limbs. Then MRI revealed leptomeningeal linear enhancement, hydrocephalus and increased multiple intracranial metastatic lesions. So the patient was diagnosed of LM. The therapeutic regimen then consisted of whole brain radiotherapy combined with oral capecitabine. A partial response was demonstrated and the progression-free survival (PFS) was 5 months since the diagnosis of LM. To our knowledge, this is the first case of LM from NPC treatment with ICI.
This case highlights the diagnosis and treatment of LM from NPC, and provides an optional regimen after ICI failure.
软脑膜转移（LM）预后较差，关于鼻咽癌（NPC）导致软脑膜转移的报道较少。免疫检查点抑制剂（ICI）是转移性鼻咽癌的标准一线治疗方法，据报道可改善多种癌症的颅内反应和生存期。
在本病例报告中，我们介绍了一名26岁转移性鼻咽癌男性患者，最初主诉左颈部肿块。PET/CT和MRI扫描显示多发肝、骨和脑转移。患者最初接受抗PD-1抗体卡瑞利珠单抗联合化疗，随后对局部和区域病灶进行放疗。两周后，患者出现短暂意识丧失、持续疲劳及双下肢疼痛。随后MRI显示软脑膜线状强化、脑积水及多发颅内转移病灶增多。因此，该患者被诊断为软脑膜转移。治疗方案随后改为全脑放疗联合口服卡培他滨。出现部分缓解，自软脑膜转移诊断以来无进展生存期（PFS）为5个月。据我们所知，这是首例采用ICI治疗的鼻咽癌导致软脑膜转移的病例。
本病例突出了鼻咽癌导致软脑膜转移的诊断和治疗，并提供了ICI治疗失败后的一种可选方案。
