Background/Aim: To describe clinical features, radiotherapy (RT), and symptom outcomes in cancer patients with cranial nerve palsies associated with clival metastases. Patients and Methods: This is a retrospective review of patients with primary metastatic cancers who developed clival metastases and received RT (2000RT ( -2020. Results: Of the 44 patients with primary cancers (manly breast, prostate and multiple myeloma cancers) and distal clival metastases, 32 patients (73%) also had cervical spine metastases. Of the 23 RT-treated patients, 65% and 35% received clivus only and whole brain RT, respectively. Post-RT symptom improvement was observed in patients with diplopia (5/6; 83%), headache (8/10; 80%), chin numbness (2/4; 50%), blurry vision (2/5; 40%), lateral gaze deficit (2/6; 33%), and tongue deviation (1/4; 25%). Conclusion: Early detection and cranial nerve examination, in addition to RT treatment, should be considered in patients with breast, prostate, and multiple myeloma cancers, who developed cervical spine metastases.Breast, prostate, kidney, lung, thyroid, and bladder cancers are cancer types that commonly spread to the bones (1). About 70% of patients with advanced breast cancer and prostate cancer have metastatic bone disease (2). Typically, metastases spread to the bones of the spine, pelvis, ribs, upper arms and thighs. Rarely, metastases can end up at the base of the skull in the clivus region. Clival tumors represent only 0.1-0.4% of all intracranial tumors, and clival metastases are an extremely rare subset of clival tumors, 5001 This article is freely accessible online.

Purpose This study aimed to describe clinical features, radiotherapy (RT), and symptom outcomes in cancer patients with cranial nerve palsies associated with clival metastases. Methods A retrospective record review for the period in between 2000 and 2020 was conducted for patients with primary metastatic cancers, who developed distal clival metastases, or were treated with RT at the Karmanos Cancer Institute (Detroit, Michigan). The patients’ demographics and clinical characteristics, including their symptoms and improvement of symptoms after RT are described. Results Forty-four patients were identified who met inclusion criteria. The most common primary cancers were breast cancer, prostate cancer, and multiple myeloma. Magnetic resonance images and computed tomography scans were used for the diagnosis of clival metastasis, as well as for the evaluation after RT. Thirty-two patients (73%) with clival metastases also had cervical spine metastases. Prevailing neurologic symptoms were headache, diplopia, lateral gaze paralysis, blurry vision, chin numbness, and tongue deviation. Fifteen of 23 RT-treated patients (65%) received clivus only RT, and 8 patients (35%) were given whole brain RT. Post-RT symptom improvement was observed in patients with diplopia (5/6; 83%), headache (8/10; 80%), chin numbness (2/4; 50%), blurry vision (2/5; 40%), lateral gaze deficit (2/6; 33%), and tongue deviation (1/4; 25%). Conclusions These results suggest that early detection and rigorous cranial nerve examination, in addition to RT treatment, should be considered in patients with breast cancer, prostate cancer, and multiple myeloma, who developed bone metastasis, especially cervical spine metastasis.