Symptom Outcomes of Cancer Patients With Clival Metastases Treated With Radiotherapy: A Study of 44 Patients

Abstract

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.

Clival Metastases: Single-Center Retrospective Case Series and Literature Review

“…Thus, the indication for treatment should be based on a careful risk-benefit balance. An alternative therapeutic option can be locoregional RT, which could be reserved for more fragile patients, not suitable for surgery, with a possible symptomatic relief, as demonstrated by Sturgis et al [1,3]. Radiosurgery could also be considered as an alternative or complementary treatment option, proving to be safe and effective, as recently reported by Huq et al [42].…”

“…Clival metastases from distant neoplasms are uncommon occurrences, accounting for 0.02% of intracranial tumors, and they rarely require surgical treatment [1,2]. The available literature concerning these lesions is scarce, with an approximate amount of one-hundred published cases, mostly in scattered series and reports [1,[3][4][5].…”

Current Radiotherapy Concepts Regarding Brain and Bone Metastases in Centers Participating in the German-Danish Interreg-Project TreaT

“…Brain and bone metastases are common situations facing radiation oncologists (11)(12)(13)(14)(15) 10×3 Gy (15×2.5 Gy) 10×3 Gy (14-15×2.5 Gy) 10×3 Gy…”

Short Communication: Results of a Consensus Conference on Radiotherapy for Brain and Bone Metastases Within the Interreg-Project TreaT

“…Depending on the type of primary tumor, up to 70% and up to 40% of adult cancer patients, develop bone metastases or brain metastases, respectively, over the course of their disease (9)(10)(11)(12). Many of these patients receive radiotherapy alone or following surgical intervention (13)(14)(15). Since for both indications, several radiotherapy programs are applied worldwide, standard approaches are often different, even between countries of the same region.…”