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Cancer of the Oral Cavity, Pharynx and Larynx pp 51–63Cite as

Cancer of the Nasopharynx

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Abstract

When managing a patient with nasopharyngeal carcinoma there are a number of clinical and imaging factors a clinician will use to make the appropriate staging evaluation and treatment recommendations. In this chapter a sample case of a patient with a poorly differentiated non-keratinizing carcinoma of the lateral wall of the nasopharynx with palpable lymphadenopathy, clinically staged T2N1M0, is used to assist the reader in formulating decisions about the best methods for assessing skull base involvement, the role of PET imaging, the role of viruses in tumorigenesis, and pertinent decisions regarding the treatment of the primary tumor in both untreated and recurrent disease. The unique decisions pertaining to managing the neck nodes and the role of adjuvant chemotherapy are reviewed as well.

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References

  1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN. Int J Cancer. 2012;136:E359–86.

    Article  Google Scholar 

  2. Liao X-B, Mao Y-P, Liu L-Z, et al. How does magnetic resonance imaging influence staging according to AJCC staging system for nasopharyngeal carcinoma compared with computed tomography? Int J Radiat Oncol Biol Phys. 2008;72:1368–77.

    Article  PubMed  Google Scholar 

  3. You R, Zou X, Hua Y-J, et al. Salvage endoscopic nasopharyngectomy is superior to intensity-modulated radiation therapy for local recurrence of selected T1–T3 nasopharyngeal carcinoma—a case-matched comparison. Radiother Oncol. 2015;115:399–406.

    Article  PubMed  Google Scholar 

  4. Anthony TC, Chan RKCN, Hui EP, Leung SF, Poon P, Sin VC, Tung SY, Cheng ACK, Yau TK, Lee V, Ma B, Cheng HC, Yuen KK, Lee C, Kam MK, Yau S, Ng AW-Y, Mo F, Zee BCY, Lo DYM, Hong Kong NPC Study Group. A multicenter randomized controlled trial (RCT) of adjuvant chemotherapy (CT) in nasopharyngeal carcinoma (NPC) with residual plasma EBV DNA (EBV DNA) following primary radiotherapy (RT) or chemoradiotherapy (CRT). J Clin Oncol. 2012;30.

    Google Scholar 

  5. King AD, Ma BB, Yau YY, et al. The impact of 18F-FDG PET/CT on assessment of nasopharyngeal carcinoma at diagnosis. Br J Radiol. 2008;81:291–8.

    Article  CAS  PubMed  Google Scholar 

  6. Shen G, Zhang W, Jia Z, Li J, Wang Q, Deng H. Meta-analysis of diagnostic value of 18F-FDG PET or PET/CT for detecting lymph node and distant metastases in patients with nasopharyngeal carcinoma. Br J Radiol. 2014;87:20140296.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Chen C, Chen S, Le Q-T, et al. Prognostic model for distant metastasis in locally advanced nasopharyngeal carcinoma after concurrent chemoradiotherapy. Head Neck. 2015;37:209–14.

    Article  PubMed  Google Scholar 

  8. Chan A, Grégoire V, Lefebvre J-L, et al. Nasopharyngeal cancer: EHNS–ESMO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23:vii83–5.

    Google Scholar 

  9. Young LS, Dawson CW. Epstein-Barr virus and nasopharyngeal carcinoma. Chin Cancer. 2014;33:581–90.

    CAS  Google Scholar 

  10. Chan KCA, Hung ECW, Woo JKS, et al. Early detection of nasopharyngeal carcinoma by plasma Epstein-Barr virus DNA analysis in a surveillance program. Cancer. 2013;119:1838–44.

    Article  CAS  PubMed  Google Scholar 

  11. Lee AWM, Ma BBY, Ng WT, Chan ATC. Management of nasopharyngeal carcinoma: current practice and future perspective. J Clin Oncol. 2015;33:3356–64.

    Article  PubMed  Google Scholar 

  12. Chua ML, Wee JT, Hui EP, Chan AT. Nasopharyngeal carcinoma. Lancet. 2016;387:1012–24.

    Article  PubMed  Google Scholar 

  13. Leung S, Chan K, Ma B, et al. Plasma Epstein–Barr viral DNA load at midpoint of radiotherapy course predicts outcome in advanced-stage nasopharyngeal carcinoma. Ann Oncol. 2014;25:1204–8.

    Article  CAS  PubMed  Google Scholar 

  14. Stenmark MH, McHugh JB, Schipper M, et al. Nonendemic HPV-positive nasopharyngeal carcinoma: association with poor prognosis. Int J Radiat Oncol Biol Phys. 2014;88:580–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dogan S, Hedberg ML, Ferris RL, Rath TJ, Assaad AM, Chiosea SI. Human papillomavirus and Epstein–Barr virus in nasopharyngeal carcinoma in a low-incidence population. Head Neck. 2014;36:511–6.

    Article  PubMed  Google Scholar 

  16. Chan ATC, Hsu M-M, Goh BC, et al. Multicenter, phase II study of cetuximab in combination with carboplatin in patients with recurrent or metastatic nasopharyngeal carcinoma. J Clin Oncol. 2005;23:3568–76.

    Article  CAS  PubMed  Google Scholar 

  17. Hui EP, Lui VWY, Wong CSC, et al. Preclinical evaluation of sunitinib as single agent or in combination with chemotherapy in nasopharyngeal carcinoma. Invest New Drugs. 2010;29:1123–31.

    Article  PubMed  Google Scholar 

  18. Xu Y-D, Ou Y-K, Zheng Y-Q, Chen Y, Ji S-F. The treatment for postirradiation otitis media with effusion: a study of three methods. Laryngoscope. 2008;118:2040–3.

    Article  PubMed  Google Scholar 

  19. Liang K-L, Su M-C, Twu C-W, Jiang R-S, Lin J-C, Shiao J-Y. Long-term result of management of otitis media with effusion in patients with post-irradiated nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol. 2010;268:213–7.

    Article  PubMed  Google Scholar 

  20. Kuo C-L, Wang M-C, Chu C-H, Shiao A-S. New therapeutic strategy for treating otitis media with effusion in postirradiated nasopharyngeal carcinoma patients. J Chin Med Assoc. 2012;75:329–34.

    Article  PubMed  Google Scholar 

  21. Peng G, Wang T, Yang K-Y, et al. A prospective, randomized study comparing outcomes and toxicities of intensity-modulated radiotherapy vs. conventional two-dimensional radiotherapy for the treatment of nasopharyngeal carcinoma. Radiother Oncol. 2012;104:286–93.

    Article  PubMed  Google Scholar 

  22. Pierre Blanchard AWML, Leclercq J, Marguet S, Ng WT, Ma J, Chan ATC, Huang P, Zhu G, Chua DTT, Mai HQ, Wee J, Kwong DLW, Moon J, Chi KH, Fountzilas G, Hareyama M, Zhang L, Bourhis J, Pignon J-P. Meta-analysis of chemotherapy in nasopharyngeal carcinoma (MAC-NPC): an update on 4,798 patients. J Clin Oncol. 2014;32:5s.

    Google Scholar 

  23. Chan AT. Et al. Nasopharyngeal cancer: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 23 Suppl 2012;7:83–5.

    Google Scholar 

  24. Hui EP, Ma BB, Leung SF, et al. Randomized phase II trial of concurrent cisplatin-radiotherapy with or without neoadjuvant docetaxel and cisplatin in advanced nasopharyngeal carcinoma. J Clin Oncol. 2009;27:242–9.

    Article  CAS  PubMed  Google Scholar 

  25. Fountzilas G, Ciuleanu E, Bobos M, et al. Induction chemotherapy followed by concomitant radiotherapy and weekly cisplatin versus the same concomitant chemoradiotherapy in patients with nasopharyngeal carcinoma: a randomized phase II study conducted by the Hellenic Cooperative Oncology Group (HeCOG) with biomarker evaluation. Ann Oncol. 2012;23(2):427–35.

    Article  CAS  PubMed  Google Scholar 

  26. Lee AWM, Ngan RKC, Tung SY, et al. Preliminary results of trial NPC-0501 evaluating the therapeutic gain by changing from concurrent-adjuvant to induction-concurrent chemoradiotherapy, changing from fluorouracil to capecitabine, and changing from conventional to accelerated radiotherapy fractionation in patients with locoregionally advanced nasopharyngeal carcinoma. Cancer. 2015;121:1328–38.

    Article  CAS  PubMed  Google Scholar 

  27. Chen L, Hu C-S, Chen X-Z, et al. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2012;13:163–71.

    Article  PubMed  Google Scholar 

  28. Yen R-F, Hung R-L, Pan M-H, et al. 18-Fluoro-2-deoxyglucose positron emission tomography in detecting residual/recurrent nasopharyngeal carcinomas and comparison with magnetic resonance imaging. Cancer. 2003;98:283–7.

    Article  PubMed  Google Scholar 

  29. Lin Q, Yang R, Sun L, Chen S, Wu H. Biological response of nasopharyngeal carcinoma to radiation therapy: a pilot study using serial 18F-FDG PET/CT scans. Cancer Invest. 2012;30:528–36.

    Article  CAS  PubMed  Google Scholar 

  30. Lai V, Khong PL. Updates on MR imaging and 18F-FDG PET/CT imaging in nasopharyngeal carcinoma. Oral Oncol. 2014;50:539–48.

    Article  PubMed  Google Scholar 

  31. Grégoire V, Ang K, Budach W, et al. Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol. 2014;110:172–81.

    Article  PubMed  Google Scholar 

  32. Wang X, Hu C, Ying H, et al. Patterns of lymph node metastasis from nasopharyngeal carcinoma based on the 2013 updated consensus guidelines for neck node levels. Radiother Oncol. 2015;115:41–5.

    Article  PubMed  Google Scholar 

  33. Lee AWM, Sham JST, Poon YF, Ho JHC. Treatment of stage I nasopharyngeal carcinoma: Analysis of the patterns of relapse and the results of withholding elective neck irradiation. Int. J. Radiat. Oncol. Biol. Phys. 1989;17:1183–90.

    Google Scholar 

  34. He X, Pan Z, Guo X, et al. The pattern of relapse and survival of elective irradiation of the upper neck for stage N0 nasopharyngeal carcinoma. Radiat Oncol. 2012;7:1–5.

    Article  Google Scholar 

  35. Li J-G, Yuan X, Zhang L-L, et al. A randomized clinical trial comparing prophylactic upper versus whole-neck irradiation in the treatment of patients with node-negative nasopharyngeal carcinoma. Cancer. 2013;119:3170–6.

    Article  PubMed  Google Scholar 

  36. Leung T-W, Tung SY, Sze W-K, et al. Treatment results of 1070 patients with nasopharyngeal carcinoma: an analysis of survival and failure patterns. Head Neck. 2005;27:555–65.

    Article  PubMed  Google Scholar 

  37. Huang S-C, Lui LT, Lynn T-C. Nasopharyngeal cancer: study III. A review of 1206 patients treated with combined modalities. Int J Radiat Oncol Biol Phys. 1985;11:1789–93.

    Google Scholar 

  38. Palazzi M, Guzzo M, Bossi P, et al. Regionally advanced nasopharyngeal carcinoma: long-term outcome after sequential chemotherapy and radiotherapy. Tumori. 2004;90:60–5.

    PubMed  Google Scholar 

  39. Yao M, Luo P, Hoffman HT, et al. Pathology and FDG PET correlation of residual lymph nodes in head and neck cancer after radiation treatment. Am J Clin Oncol. 2007;30:264–70.

    Article  PubMed  Google Scholar 

  40. Wei WI, Mok VW. The management of neck metastases in nasopharyngeal cancer. Curr Opin Otolaryngol Head Neck Surg. 2007;15:99–102.

    Article  PubMed  Google Scholar 

  41. Lee NY, Zhang Q, Pfister DG, et al. Addition of bevacizumab to standard chemoradiation for locoregionally advanced nasopharyngeal carcinoma (RTOG 0615): a phase 2 multi-institutional trial. Lancet Oncol. 2012;13:172–80.

    Article  CAS  PubMed  Google Scholar 

  42. Tsang J, Lee VH, Kwong DL. Novel therapy for nasopharyngeal carcinoma—where are we. Oral Oncol. 2014;50:798–801.

    Article  PubMed  Google Scholar 

  43. Lan MY, Yang WL, Lin KT, et al. Using computational strategies to predict potential drugs for nasopharyngeal carcinoma. Head Neck. 2014;36:1398–407.

    PubMed  Google Scholar 

  44. Gottschalk S, Heslop HE, Rooney CM. Adoptive immunotherapy for EBV-associated malignancies. Leuk Lymphoma. 2005;46:1–10.

    Article  CAS  PubMed  Google Scholar 

  45. Haque T, Wilkie GM, Jones MM, et al. Allogeneic cytotoxic T-cell therapy for EBV-positive posttransplantation lymphoproliferative disease: results of a phase 2 multicenter clinical trial. Blood. 2007;110:1123–31.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, College of Medicine, The University of Oklahoma, Oklahoma City, OK, USA

    Greg Krempl M.D.

  2. Department of Radiological Sciences, College of Medicine, The University of Oklahoma, Oklahoma City, OK, USA

    Anthony Alleman M.D.

Authors
  1. Greg Krempl M.D.
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  2. Anthony Alleman M.D.
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Correspondence to Greg Krempl M.D. .

Editor information

Editors and Affiliations

  1. Department of Otolaryngology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA

    Jesus E. Medina

  2. College of Medicine, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA

    Nilesh R. Vasan

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© 2016 Springer International Publishing Switzerland

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Krempl, G., Alleman, A. (2016). Cancer of the Nasopharynx. In: Medina, J., Vasan, N. (eds) Cancer of the Oral Cavity, Pharynx and Larynx. Springer, Cham. https://doi.org/10.1007/978-3-319-18630-6_4

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  • DOI: https://doi.org/10.1007/978-3-319-18630-6_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-18629-0

  • Online ISBN: 978-3-319-18630-6

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