Stereotactic radiosurgery for patients with brain metastases from nasopharyngeal carcinoma

Purpose: The role of stereotactic radiosurgery (SRS) for patients with brain metastases from nasopharyngeal carcinoma (NPC) has yet to be established. The authors present a single-institution experience of NPC brain metastases patients who underwent SRS. Methods: Our SRS database of 18,000 patients from 1989 to 2024 identified 44 metastatic NPC patients (31 male) with 68 total brain metastases (median age: 58.5 years, range: 33–80). Twenty-four patients underwent whole brain fractionated radiation therapy (WBRT) and 20 patients underwent surgical resection before SRS. The median margin dose was 16 Gy (range: 10–25). The median cumulative tumor volume was 7.6 cubic centimeters (cc) (range: 0.032–186.66). Results: The median overall survival (OS) from SRS was 9 months (range: 0–86) with local tumor progression in 11 patients after SRS at a median time of 4 months (range: 2–36). Local tumor control was achieved in 56 of the 68 metastases (82.4%). Five patients developed new brain metastases at a median of 6 months (range: 3–84) following SRS. One patient experienced adverse radiation effects (AREs). Conclusion: Metastatic spread to the brain from NPC occurs late in the course of primary disease. In our experience non-invasive SRS optimized outcomes and preserved quality of life. Although historically used as a salvage option after surgery and radiation therapy, its role as a primary strategy deserves further utilization in patients with brain metastases from primary NPC tumors.