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Potential pitfalls in incorporating plasma Epstein‐Barr virus DNA in the management of nasopharyngeal carcinoma
Author(s) -
Wong Edwin C. Y.,
Hung Jessica L. C.,
Ng Wai T.
Publication year - 2020
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.26018
Subject(s) - nasopharyngeal carcinoma , medicine , gastroenterology , radiation therapy , virus , oncology , distant metastasis , endoscopy , epstein–barr virus , carcinoma , metastasis , cancer , immunology
Background This study identifies potential pitfalls in incorporating plasma Epstein‐Barr virus (EBV) DNA into the management of nasopharyngeal carcinoma (NPC). Methods A total of 208 NPC patients without distant metastasis who received radical treatment and had measurements of EBV DNA at baseline, 8 weeks and 26 weeks postradiotherapy were analyzed. Prognostic and predictive values at each time‐point were compared. Results Risk stratification by pretreatment level failed to identify a poor prognostic group. Detectable EBV DNA at 8 weeks and 26 weeks postradiotherapy were both associated with significantly poorer 5‐year disease‐free survival (HR 0.30, P < .001 and HR 0.03, P < .001, respectively) and overall survival (HR 0.27, P = .009 and HR 0.03, P < .001, respectively). Eighty percentage had detectable EBV DNA at recurrence (53.3% for local only, 100% for regional only, and 100% for distant failure). Conclusions Posttreatment EBV DNA, particularly at 26 weeks post‐radiotherapy, has high prognostic and predictive values. Surveillance endoscopy/imaging are recommended for the detection of local recurrence.