Isolated Brain Metastasis from Nasopharyngeal Carcinoma 6 Years after the Initial Diagnosis: A Case Report and a Comprehensive Review of Relevant Literature

Abstract

Abstract Introduction Nasopharyngeal carcinoma (NPC) is a rare malignancy with a distinct geographical distribution, primarily treated with concurrent chemoradiotherapy. While advancements in treatment have improved locoregional control, distant metastasis remains the primary cause of treatment failure. Isolated brain metastasis is exceptionally rare, and clinical experience regarding its management is limited. Case Presentation A 58-year-old male was diagnosed with clinical stage IVA (T4N2M0) non-keratinized NPC in 2016, presenting with skull base invasion and multiple cranial nerve paralyses. Following induction chemotherapy and concurrent chemoradiotherapy, a complete clinical and radiological response was achieved. After 6 years of follow-up, the patient presented with severe headaches, and imaging revealed a solitary mass in the left frontotemporal lobe. Following gross total excision, pathology confirmed NPC metastasis with EBER positivity. Despite postoperative stereotactic body radiation therapy, the patient developed multiple brain metastases 3 months later and succumbed to intracranial progression in September 2022. Notably, quantitative Epstein-Barr virus (EBV) DNA levels remained undetectable during the recurrence of brain metastases. Conclusion This case highlights that brain metastasis from NPC can occur after a long latent period, even in the absence of systemic disease or detectable EBV DNA. Clinicians should consider brain metastasis in the differential diagnosis of NPC patients presenting with neurological symptoms during long-term follow-up.