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Management of nasopharyngeal carcinoma: ESMO-EURACAN Guidelines - Page 2
- Stage III and IVA disease are treated by CRT. The standard agent used is cisplatin.
- The most commonly used regimen is cisplatin 100 mg/m2 every 3 weeks concomitantly to RT. Weekly cisplatin (40 mg/m2/week) has also been shown to improve OS. The optimal cumulative total dose of concurrent cisplatin should be higher than 200 mg/m2.
- Concurrent nedaplatin was found to be non-inferior to concurrent cisplatin.
- Concurrent carboplatin is an available option but the evidence is conflicting.
- Intensification of the systemic treatment is needed for stage III-IVA non-keratinising NPC.
- ICT with cisplatin and gemcitabine followed by CRT for locally advanced NPC is associated with a benefit in RFS, OS and distant RFS, with more acute but not late toxicities versus CRT alone.
- The selection of patients to receive more ChT (post-chemotherapy) in addition to CRT in the form of either ICT or AC is a therapeutic area that is being explored in ongoing randomised controlled trials.
- In cases of persistent, high EBV DNA values after definitive treatment, a personalised approach with non-cross-resistant drugs or participation in a clinical trial is suggested.
- Small, local recurrences are potentially curable. The main therapeutic options include nasopharyngectomy, brachytherapy, radiosurgery, SRT, IMRT or a combination of surgery and RT, with or without concurrent ChT.
- Local recurrences not invading the carotid artery or extending intracranially are candidates for nasopharyngectomy; local recurrence, stage rT1-rT3 might benefit more from endoscopic nasopharyngectomy than IMRT.
- Lymphatic recurrences in the neck can be treated with neck dissection.
- In metastatic NPC, palliative ChT should be considered for patients with an adequate PS. A combination of platinum and gemcitabine is the first-line choice and improves OS.
- In patients with newly diagnosed, metastatic NPC, the addition of locoregional RT to systemic therapy improves locoregional control and ultimately OS.
- No standard second-line treatment exists. Active agents include paclitaxel, docetaxel, 5-FU, capecitabine, irinotecan, vinorelbine, ifosfamide, doxorubicin, oxaliplatin and cetuximab, which can be used as single agents or in selected combinations.
- Immunotherapy represents a promising strategy in this setting but its therapeutic positioning is still to be defined.
- CTL adoptive immunotherapy has demonstrated activity in highly pre-treated patients.
- Oligometastatic patients may achieve long-term survival after aggressive treatment, including chemotherapy, surgery or definitive RT to the metastases.
Personalised Medicine
- The first radiological imaging is suggested 3 months after completion of curative treatment. Sensitivity of MRI and PET are similar, whereas the specificity of PET is higher and so helps to differentiate between post-irradiation changes and recurrent tumours.
- Further follow-up for patients includes periodic examination of the nasopharynx and neck, cranial nerve function and evaluation of systemic complaints to identify distant metastasis. For T2-T4 tumours, MRI might be used on a 6-monthly basis for at least for the first 3 years after treatment.
- Plasma EBV DNA is a promising marker for the diagnosis of recurrence [II, B] and should be evaluated at least every year.
- Evaluation of thyroid function in patients who have received RT to the neck is recommended annually; pituitary function should also be evaluated according to signs/symptoms.
Reference:
"Nasopharyngeal carcinoma: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up," is published in the journal journal Annals of Oncology.
DOI: https://www.annalsofoncology.org/article/S0923-7534(20)43210-7/fulltext
Source : Annals of Oncology
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751