xRead - Nasal Obstruction (September 2024) Full Articles

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KUANetal.

TABLE XXV.2 (Continued)

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Wanget al. 1643

1. CR 2. OS

1. Clearance rates of plasma EBV DNA during the first month of chemotherapy predict treatment response and survival 2. Half-life of EBV DNA clearance rate ≤ 4versus > 4 days: CR rate 70.6% versus 11.8% ( p = 0.0017); 2-year OS 79.4% versus 29.4% ( p = 0.0055) 1. Circulating EBV DNA useful in screening for early asymptomatic NPC compared to historical cohort (stage I or II 71% vs. 20%, p < 0.001) 2. Outcomes were better in participants who were identified by screening than those of the historical cohort (3-year PFS 97% vs. 70%, p < 0.001)

2010 4

Retrospective case series

34

recurrent/metastatic NPCs

2. Screening role of circulating EBV DNA Chanet al. 1646 2017 3

20,174 participants

PFS

Sensitivity 97.1%, specificity 98.6%

Nonrandomized cohort

Abbreviations: AIC, Akaike information criterion; CR, complete response; mid-DNA, mid-treatment plasma EBV DNA; NPC, nasopharyngeal carcinoma; OS, overall survival; PRFS, progression-free survival; pre-DNA, pretreatment plasma EBV DNA; post-DNA, posttreatment plasma EBV DNA; RFS, relapse-free survival; RPA, recursive partitioning analysis.

no cases showed coinfection. OS was insignificant between the two groups of patients after adjusting for the Karnofsky Performance Scale and age. 1652 Further studies are needed to elucidate how HPV infection interplays with EBV and its role in NPC. Aggregate grade of evidence : C (Level 1: one study; Level 2: one study; Level 4: 11 studies) 4 Role of surgery in NPC RT and CRT are the main treatment strategies for patients with primary NPC, 1658 whereas surgery is typically con sidered in patients with local residual or recurrent dis ease. Recently, endoscopic nasopharyngectomy (ENPG) has become an effective treatment for NPC, demon strating good survival outcomes and low complication rates compared with re-irradiation and various traditional open surgical treatments, such as the maxillary swing, transpalatal, midface degloving, and transinfratemporal fossa approaches (Table XXV.4). 5,1659–1661 ENPG is also cov ered in ICSB 2019 (Section VIII.E) and this section serves as an update. 5 ENPG can be used to resect radioresistant and/or recurrent tumors directly, thereby avoiding the severe side effects of re-irradiation. However, because of the infiltrative behavior of NPC and the complex structures adjacent to the recurrent tumor, especially with scarring and inflammation following RT, the identification of key anatomical landmarks during ENPG is paramount for

achieving maximal tumor resection as well as for pre venting complications such as ICA injury. Meticulous preoperative evaluation and a full understanding of the surgical anatomy are essential to prevent damage to nearby critical neurovascular structures. 1662 The first ENPG was reported in 2005. 1663 In 2013, Castel nuovo et al. reported the first classification of ENPGs into three types. 1664 In 2020, Liu et al. categorized ENPG into four types based on anatomical structures and the NPC staging system. 1665 Both studies reported promising out comes with the technique. In their study on 410 patients with recurrent NPC, Zou et al. found that ENPG and IMRT were associated with improvements in both OS and distant metastasis-free survival compared with conven tional two-dimensional RT in early recurrent disease. 1666 Yang et al. conducted the largest meta-analysis involving 23 studies with a combined 792 patients with recurrent NPC, whereupon they revealed that ENPG had compara ble and possibly better outcomes than IMRT. 1667 Although there have been several studies focusing on ENPG out comes, only one RCT conducted in China has been carried out to date. 1668 The study showed better 3-year OS in the ENPG group than in the IMRT group in patients with resectable locally recurrent NPC as well as better DFS and RFS. 1668 Currently available data suggest that ENPG is a promising option for many patients with early-stage local recurrent NPC, with minimal complications. For patients with advanced-stage recurrent NPC, long-term follow-up is needed to evaluate the eventual morbidity from and efficacy of the procedure.