• A rare case of nasopharyngeal carcinoma with widespread CNS metastases

      Rafee, S; Elamin, YY; Cronin, K; Brennan, S; Osman, N (Irish Medical Journal, 2014-06)
      A 36 year old ex-smoker presented with a twelve month history of right facial discomfort and numbness. PET showed a 4.5 cm soft tissue mass in the nasopharyngeal mucosa, extending into the parapharyngeal space and a 0.8 cm FDG avid right level 2 lymph node, with no evidence of distant metastasis. Lymph node biopsy was consistent with NPC, T4N1M0. Radical chemoradiotherapy was commenced- 70/35 fractions intensity modulated radiation therapy, with concomitant Cisplatin, in accordance with the Intergroup 0099 trial in NPC 4 . Adjuvant treatment involved Cisplatin and 5-Fluorouracil. PET post completion of treatment showed disease resolution. MRI seven months later revealed multiple ring enhancing lesions throughout both cerebral hemispheres, and multiple areas of leptomeningeal enhancement involving the thoracic and lumbar cord. Additionally there was mild focal FDG uptake on PET within the spinal canal at T7 (Figure 1). There was no evidence of disease outside the CNS. Palliative radiotherapy was administered to the spine and brain, for back pain and lower limb weakness, and palliative chemotherapy was commenced on a three weekly basis, with Carboplatin AUC 5 and 5 FU infusion, with weekly Cetuximab and two weekly intrathecal Cytarabine. MRI post six cycles of treatment showed a significant improvement with near resolution of intracranial metastases (Figure 2), however, there was still some persistent leptomeningeal deposit in the lumbar spine, with adjacent leptomeningeal enhancement.