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Comparison of clinical and molecular surveillance in patients with advanced nasopharyngeal carcinoma after primary therapy
Author(s) -
Hong RueyLong,
Lin ChinYu,
Ting LaiLei,
Ko JenqYuh,
Hsu MowMing
Publication year - 2004
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.20129
Subject(s) - medicine , nasopharyngeal carcinoma , primary (astronomy) , carcinoma , oncology , radiation therapy , dermatology , physics , astronomy
BACKGROUND The importance of detecting recurrence at an early stage in patients with malignant disease is well recognized. Circulating Epstein–Barr virus (EBV) DNA can be detected in patients with nasopharyngeal carcinoma (NPC). The objective of the current study was to assess the effectiveness of plasma EBV DNA monitoring in the early detection of NPC recurrence compared with conventional methods. METHODS Patients with NPC in two prospective clinical trials who had locoregional recurrences or distant metastases were recruited into the study. Clinical data on these patients were scrutinized for evidence of recurrence. EBV DNA copy numbers in the prospectively collected plasma samples were assayed retrospectively with real‐time quantitative polymerase chain reaction analysis. RESULTS At the time of clinical recurrence, 65% of 26 patients with locoregional recurrences and all but 1 of 28 patients with distant failure had circulating EBV DNA. The difference between the time from completion of treatment to positivity for circulating EBV DNA and the time from completion of treatment to the first observed clinical abnormality was not statistically significant for patients with local recurrence ( P = 0.84). However, the time to the first detection of circulating EBV DNA was significantly shorter among patients with distant metastases ( P < 0.0001). The Kaplan–Meier estimated median time to the emergence of plasma EBV DNA was 190 days, with a 95% confidence interval (CI) of 95–300 days, and the median time to the first observed clinical abnormality was 295 days (95% CI, 276–361 days). CONCLUSIONS Monitoring plasma EBV DNA levels surpassed traditional methods for the early detection of distant failure in patients with NPC. The role of this technique should be evaluated in prospective studies that incorporate complementary advanced imaging technology. Cancer 2004;100:1429–37. © 2004 American Cancer Society.