Long-term survival of a patient with leptomeningeal involvement by nasopharyngeal carcinoma after treatment with high-dose intravenous methotrexate

Abstract

Background: Nasopharyngeal carcinoma with leptomeningeal involvement is rare and typically has poor prognosis.

Methods and results: We present a case report of a patient with nasopharyngeal carcinoma who was treated with high-dose intravenous methotrexate and remains asymptomatic and without clinical evidence of disease 6 years later.

Conclusions: Systemic high-dose methotrexate should be evaluated in the treatment of advanced nasopharyngeal carcinoma with central nervous involvement.

FIGURE 1

High-resolution axial T1-weighted fat-suppressed MR image shows a large mass in the nasopharynx and bilateral parapharyngeal spaces (arrowheads) that infiltrates the clivus and extends into the intracranial compartment (arrows).

FIGURE 2

Histopathology of nasopharyngeal biopsy. (A) Hema-toxylin and eosin stain showed irregular cords of nonkeratinized undifferentiated cells within a background of lymphocytes. (B) The tumor cells were immunoreactive for cytokeratin (immuno-histochemical staining for AE1:AE3). (C) In situ hybridization for Epstein–Barr virus (EBV)-encoding RNA was positive for EBV.

FIGURE 3

Axial, coronal, and sagittal MR image reconstruction representing stereotactic radiosurgical dose delivery to boost portions of the primary tumor adjacent to normal structures with increased conformality. The cluster of colored isodose lines marked by (+) indicates the dose distribution that spares the brain stem posteriorly and optic chiasm cranially.

FIGURE 4

Sagittal postcontrast T1-weighted image of the thoracic and lumbar spine demonstrates multiple enhancing nodules throughout the intradural extramedullary space that are characteristic of leptomeningeal drop metastases.

FIGURE 5

Axial, sagittal, and coronal CT reconstruction representing dose delivery to the spinal axis from T5 to S3.