Two case reports on central nervous system metastasis from nasopharyngeal carcinoma and a literature review

Nasopharyngeal carcinoma (NPC) is a common malignant tumor in Southern China. The clinical manifestations, including extensive local invasion and distant metastasis, exhibit certain patterns. As we know, the most common sites of distant failure are bone, liver and lung. Although intracranial invasion by direct extension from the nasopharynx through the skull base in patients with locally advanced disease is not uncommon, metastasis to the central nervous system (CNS) is very scarce. We analyzed and summarized the literature about central nervous system metastasis of NPC by reviewing the English database. Most patients have other common site metastasis at the same time or successively. Spread through the cerebral spinal fluid (CSF) and hematogenous dissemination were common routes of CNS metastasis, and the sites of metastasis were irregular. Aggressive surgical resection with or without postoperative radiotherapy conferred reasonable survival and symptom control. Here, we report two patients with NPC who developed CNS metastases. These two cases highlight the effectiveness of personalized multimodal therapy, including surgery, precision radiotherapy, and chemotherapy, in NPC with CNS metastasis, offering a potential framework for similar cases.