Top

10-04-2024 | Metastasis | Case Study

Gamma knife radiosurgery for clival metastasis: case series and systematic review

Authors: Sakibul Huq, Regan M. Shanahan, Samuel Adida, Othman Bin-Alamer, Hussam Abou-Al-Shaar, Ajay Niranjan, Constantinos G. Hadjipanayis, L. Dade Lunsford

Published in: Journal of Neuro-Oncology

Abstract

Purpose

Clival metastatic cancer is rare and has limited literature to guide management. We describe management of clival metastasis with Gamma Knife radiosurgery (GKRS). We augment our findings with a systematic review of all forms of radiation therapy for clival metastasis.

Methods

Records of 14 patients with clival metastasis who underwent GKRS at the University of Pittsburgh Medical Center from 2002 to 2023 were reviewed. Treatment parameters and clinical outcomes were assessed. A systematic review was conducted using evidence-based guidelines.

Results

The average age was 61 years with male predominance (n = 10) and average follow-up of 12.4 months. The most common primary cancers were prostate (n = 3) and lung (n = 3). The average time from cancer diagnosis to clival metastasis was 34 months. The most common presenting symptoms were headache (n = 9) and diplopia (n = 7). Five patients presented with abducens nerve palsies, and two presented with oculomotor nerve palsies. The median tumor volume was 9.3 cc, and the median margin dose was 15 Gy. Eleven patients achieved tumor control after one procedure, and three with progression obtained tumor control after repeat GKRS. One patient recovered abducens nerve function. The median survival from cancer diagnosis and GKRS were 49.7 and 15.3 months, respectively. The cause of death was progression of systemic cancer in six patients, clival metastasis in one, and unknown in four. The systematic review included 31 studies with heterogeneous descriptions of treatment and outcomes.

Conclusion

Clival metastasis is rare and associated with poor prognosis. GKRS is a safe, effective treatment for clival metastasis.

Available only for authorised users

Sturgis R, Mack A, Kim S, Maier J, Heath EI (2021) Symptom outcomes of Cancer patients with clival metastases treated with Radiotherapy: a study of 44 patients. Anticancer Res 41:5001–5006. https://doi.org/10.21873/anticanres.15314CrossRefPubMed

Jozsa F, Das JM (2022) Metastatic lesions of the Clivus: a systematic review. World Neurosurg 158:190–204. https://doi.org/10.1016/j.wneu.2021.11.105CrossRefPubMed

Wei Z, Yavan S, Deng H, Mallela AN, Gersey ZC, Shariff RK, Fazeli PK, Niranjan A, Lunsford LD, Abou-Al-Shaar H (2022) The role of stereotactic radiosurgery in the multidisciplinary management of pituitary metastases. Pituitary 25:948–958. https://doi.org/10.1007/s11102-022-01279-zCrossRefPubMed

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71CrossRefPubMedPubMedCentral

OCEBM OCEBM Levels of Evidence https://www.cebm.net/index.aspx?o=5653

Agha RA, Sohrabi C, Mathew G, Franchi T, Kerwan A, O’Neill N, Thoma A, Beamish AJ, Noureldin A, Rao A, Vasudevan B, Challacombe B, Perakath B, Kirshtein B, Ekser B, Pramesh CS, Laskin DM, Machado-Aranda D, Pagano D, Roy G, Kadioglu H, Nixon IJ, Mukhejree I, McCaul JA, Chi-Yong Ngu J, Albrecht J, Rivas JG, Raveendran K, Derbyshire L, Ather MH, Thorat MA, Valmasoni M, Bashashati M, Chalkoo M, Teo NZ, Raison N, Muensterer OJ, Bradley PJ, Goel P, Pai PS, Afifi RY, Rosin RD, Coppola R, Klappenbach R, Wynn R, Surani S, Giordano S, Massarut S, Raja SG, Basu S, Enam SA, Manning TG, Cross T, Karanth VKL, Mei Z (2020) The PROCESS 2020 Guideline: updating Consensus Preferred reporting of CasE series in surgery (PROCESS) guidelines. Int J Surg 84:231–235. https://doi.org/10.1016/j.ijsu.2020.11.005CrossRefPubMed

Alessi G, Lemmerling M, Vereecken L, De Waele L (2003) Benign metastasizing leiomyoma to skull base and spine: a report of two cases. Clin Neurol Neurosurg 105:170–174. https://doi.org/10.1016/s0303-8467(03)00002-7CrossRefPubMed

Atallah-Yunes SA, Clark J, Samanani S, Soe M (2019) Small cell Lung Cancer with Pituitary Metastasis presenting as secondary adrenal insufficiency: a Case Report and Literature Review. Am J Case Rep 20:207–211. https://doi.org/10.12659/ajcr.913388CrossRefPubMedPubMedCentral

Barrière J, Thariat J, Vandenbos F, Bondiau PY, Peyrottes I, Peyrade F (2009) Diplopia as the first symptom of an aggressive metastatic rectal stromal tumor. Onkologie 32:345–347. https://doi.org/10.1159/000215712CrossRefPubMed

10.

Bohnstedt BN, Tomcik M, Eads T, Hagen MC, Shah M (2012) Metastasis of soft-tissue myoepithelial carcinoma to clivus. J Neurosurg Pediatr 9:161–164. https://doi.org/10.3171/2011.11.Peds11260CrossRefPubMed

11.

Deconde AS, Sanaiha Y, Suh JD, Bhuta S, Bergsneider M, Wang MB (2013) Metastatic disease to the clivus mimicking clival chordomas. J Neurol Surg B Skull Base 74:292–299. https://doi.org/10.1055/s-0033-1348027CrossRefPubMedPubMedCentral

12.

Dekker SE, Wasman J, Yoo KK, Alonso F, Tarr RW, Bambakidis NC, Rodriguez K (2017) Clival metastasis of a duodenal adenocarcinoma: a Case Report and Literature Review. World Neurosurg 100:62–68. https://doi.org/10.1016/j.wneu.2016.12.078CrossRefPubMed

13.

Douglas JE, Lee JYK, Rajasekaran K (2020) Cranial nerve VI Palsy as Presenting sign of previously undiagnosed metastatic prostate adenocarcinoma to the Clivus. Biomed Hub 5:210–213. https://doi.org/10.1159/000510303CrossRefPubMedPubMedCentral

14.

Endo K, Okano R, Kuroda Y, Yamada S, Tabei K (2001) Renal cell carcinoma with skull base metastasis preceded by paraneoplastic signs in a chronic hemodialysis patient. Intern Med 40:924–930. https://doi.org/10.2169/internalmedicine.40.924CrossRefPubMed

15.

Fukushima M, Katayama Y, Shigemori Y, Miyake H, Hirayama T, Kotani A (2012) Clivus metastasis from gastric signet ring cell carcinoma after a 10-year disease-free interval–case report. Neurol Med Chir (Tokyo) 52:751–753. https://doi.org/10.2176/nmc.52.751CrossRefPubMed

16.

Ho KWD, Drew PA, Chuquilin M (2017) Merkel Cell Carcinoma with distant metastasis to the Clivus causing symptoms mimicking Tolosa-Hunt Syndrome: a Case Report and Literature Review. Front Neurol 8:409. https://doi.org/10.3389/fneur.2017.00409CrossRefPubMedPubMedCentral

17.

Hooker N, Mohanan S, Burks RT (2018) A Rare Presentation of Stage IV Large Cell Neuroendocrine Carcinoma of the Cervix with Metastasis to the Cranium. Case Rep Obstet Gynecol 2018: 2812306 https://doi.org/10.1155/2018/2812306

18.

Isaka T, Maruno M, Suzuki T, Sato M, Yoshimine T (2006) Skull metastases from atypical pulmonary carcinoid tumor in a 19-year-old man. Neurol Med Chir (Tokyo) 46:609–613. https://doi.org/10.2176/nmc.46.609CrossRefPubMed

19.

Kapoor A, Beniwal V, Beniwal S, Mathur H, Kumar HS (2015) Isolated clival metastasis as the cause of abducens nerve palsy in a patient of breast carcinoma: a rare case report. Indian J Ophthalmol 63:354–357. https://doi.org/10.4103/0301-4738.158096CrossRefPubMedPubMedCentral

20.

Kocak Z, Celik Y, Uzal MC, Uygun K, Kaya M, Albayram S (2003) Isolated bilateral sixth nerve palsy secondary to metastatic carcinoma: a case report with a review of the literature. Clin Neurol Neurosurg 106:51–54. https://doi.org/10.1016/j.clineuro.2003.07.002CrossRefPubMed

21.

Kolias AG, Derham C, Mankad K, Hasegawa H, O’Kane R, Ismail A, Phillips NI (2010) Multiple cranial neuropathy as the initial presentation of metastatic prostate adenocarcinoma: case report and review of literature. Acta Neurochir 152:1251–1255. https://doi.org/10.1007/s00701-010-0630-9CrossRefPubMed

22.

Lee A, Chang KH, Hong H, Kim H (2015) Sixth cranial nerve palsy caused by gastric adenocarcinoma metastasis to the clivus. J Korean Neurosurg Soc 57:208–210. https://doi.org/10.3340/jkns.2015.57.3.208CrossRefPubMedPubMedCentral

23.

Machío Castelló M, Escobar Montatixe D, Cenjor Español C, Villacampa Aubá JM, Montoya Bordón J, Carias Calix R, Sáez Pinel R (2017) Incomplete cavernous sinus syndrome as the initial manifestation of a previously undetected metastatic prostate adenocarcinoma. Head Neck 39:E77–e80. https://doi.org/10.1002/hed.24808CrossRefPubMed

24.

McDermott RS, Anderson PR, Greenberg RE, Milestone BN, Hudes GR (2004) Cranial nerve deficits in patients with metastatic prostate carcinoma: clinical features and treatment outcomes. Cancer 101:1639–1643. https://doi.org/10.1002/cncr.20553CrossRefPubMed

25.

Ng ES, Tan SH, Ling WH, Venkatesh SK, Wong CI (2011) Ophthalmoplegia in a patient with breast cancer. Ann Acad Med Singap 40:507–509CrossRefPubMed

26.

Nozaki I, Tsukada T, Nakamura Y, Takanaka T, Yamada M (2010) Multiple skull metastases from hepatocellular carcinoma successfully treated with radiotherapy. Intern Med 49:2631–2634. https://doi.org/10.2169/internalmedicine.49.4236CrossRefPubMed

27.

Ogunlaja O, Zhang N (2019) New Daily Persistent Headache Syndrome secondary to Clival Metastasis within an Osseous Hemangioma. Headache 59:1609–1610. https://doi.org/10.1111/head.13655CrossRefPubMed

28.

Pallini R, Sabatino G, Doglietto F, Lauretti L, Fernandez E, Maira G (2009) Clivus metastases: report of seven patients and literature review. Acta Neurochir 151:291–296. https://doi.org/10.1007/s00701-009-0229-1CrossRefPubMed

29.

Rao AS, Nandennavar M, Narayanan GS (2015) Carcinoma cervix presenting with clivus metastasis. J Cancer Res Ther 11:662. https://doi.org/10.4103/0973-1482.138192CrossRefPubMed

30.

Sako K, Kimura T, Sawamura A, Yonemasu Y, Takahashi M, Miyokawa N (1997) Prevention of CSF Leakage by staged operation for Clival metastatic tumor. Skull Base Surg 7:159–162. https://doi.org/10.1055/s-2008-1058608CrossRefPubMedPubMedCentral

31.

Tsunoda A, Tanaka Y, Sato T, Kirimura S, Kitamura K (2016) Vertigo by breast Cancer metastasis 33 years after treatment. Intern Med 55:311–313. https://doi.org/10.2169/internalmedicine.55.5412CrossRefPubMed

32.

Turner JL, Sweeney P, Hardy R (1980) Ewing’s tumor metastatic to the clivus, simulating meningitis: case report. Neurosurgery 7:619–620. https://doi.org/10.1227/00006123-198012000-00017CrossRefPubMed

33.

Yari N, Espino Barros Palau A, Morgan ML, Levine NB, Lee AG (2016) Metastatic papillary thyroid carcinoma presenting as Abducens Palsy complicated by Ocular Neuromyotonia. Neuroophthalmology 40:97–101. https://doi.org/10.3109/01658107.2015.1132742CrossRefPubMedPubMedCentral

34.

Yoshikawa-Kimura A, Taira K, Katanosaka Y, Nakata A, Nadatani Y, Fukunaga S, Otani K, Hosomi S, Tanaka F, Kamata N, Nagami Y, Watanabe T, Fujiwara Y (2020) A rare case of Clival Metastasis in a patient with gastric Cancer. Intern Med 59:3161–3164. https://doi.org/10.2169/internalmedicine.5457-20CrossRefPubMedPubMedCentral

35.

Zagzoog N, Ra G, Koziarz A, Provias J, Sommer D, Almenawer SA, Reddy K (2017) Metastatic liposarcoma of the Skull Base: a Case Report and Review of Literature. Neurosurgery 80:219–223. https://doi.org/10.1093/neuros/nyw157CrossRefPubMed

36.

Zhang WQ, Bao Y, Qiu B, Wang Y, Li ZP, Wang YB (2018) Clival metastasis of renal clear cell carcinoma: case report and literature review. World J Clin Cases 6:301–307. https://doi.org/10.12998/wjcc.v6.i9.301CrossRefPubMedPubMedCentral

37.

Cathel A, Khan YR, Blais D, Mahato B, Mahato D (2019) Metastatic disease to Clivus: Biopsy or not? Cureus 11:e5658. https://doi.org/10.7759/cureus.5658CrossRefPubMedPubMedCentral

Title: Gamma knife radiosurgery for clival metastasis: case series and systematic review
Authors: Sakibul Huq
Regan M. Shanahan
Samuel Adida
Othman Bin-Alamer
Hussam Abou-Al-Shaar
Ajay Niranjan
Constantinos G. Hadjipanayis
L. Dade Lunsford
Publication date: 10-04-2024
Publisher: Springer US
Keywords: Metastasis
Diplopia
Headache
Radiotherapy
Published in: Journal of Neuro-Oncology
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-024-04648-9

At a glance: The STEP trials

Springer Medicine

Gamma knife radiosurgery for clival metastasis: case series and systematic review

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content