Clival Metastases in Cancer Patients

Abstract 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.