xRead - Nasal Obstruction (September 2024) Full Articles

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KUANetal.

Value

Cumulative evidence suggests that EBV DNA serum testing can provide valuable information to guide clinical decision-making. However, elevated circulating EBV DNA levels during posttreatment follow-up only suggested tumor relapse and did not indicate the tumor location. Diagnostic imaging studies such as CT, MRI, and PET may aid to localize the exact site and extent of the recurrence. Another problem is that PCR-based techniques may produce discrepancies in different laboratories, even when using the same primer/probe sets and experimental conditions. Harmonization between international laboratories, which involves the standardization of buffers and calibrators, is feasible and significantly reduces the variability.

Cost

ENPG may have a lower cost than re-irradiation because of the relatively shorter treatment duration and ensuring faster recovery.

judgments

Benefits–harm assessment

Balance of benefits and harms.

Value

Current data suggest that ENPG is a promising treatment option for most patients with early-stage local recurrent NPC, with minimal complications. However, only one RCT has been conducted. Although selected patients with advanced-stage recurrent NPC may benefit from ENPG, long-term follow-up is needed to evaluate the eventual morbidity from and efficacy of the procedure.

judgments

Policy level Option. Intervention ENPG is a good option for early local

recurrent NPC (rT1 and rT2 and select rT3 lesions), with limited complications and promising outcomes. Meticulous preoperative evaluation and a full understanding of the surgical anatomy are

Policy level Recommendation. Intervention The EBV DNA serum test should be used as a

routine clinical test for patients with NPC for screening, diagnosis, and monitoring treatment response.

important to prevent significant complications such as ICA injury.

Role of nasopharyngectomy for NPC

Role of IMRT in treatment of NPC

Aggregate grade of evidence

C (Level 2: two studies; Level 4: 17 studies)

Aggregate grade of evidence

A (Level 1: two studies; Level 3: one study)

Benefit

Endoscopic nasopharyngectomy (ENPG) has become an effective treatment for patients with early local recurrent NPC, demonstrating good survival outcomes and low complication rates. It avoids not only the severe side effects caused by re-irradiation but also complications (e.g., functional problems and cosmetic morbidities) that may be encountered during traditional open approaches. Positive margins, especially around critical neurovascular structures; risk of ICA injury, leading to intraoperative and postoperative hemorrhage; wound infection; injury to surrounding critical neurovascular structures. (Continued)

Benefit

IMRT improves OS and LRC in locally advanced NPC and reduces long-term toxicities including xerostomia, trismus, and temporal lobe neuropathy in all stages. IMRT has no additional harm compared to conventional two-dimensional RT. IMRT significantly increases the time needed for radiotherapy planning and the direct cost of RT. However, reduction in late toxicities translates to long-term cost savings, which would be very hard to measure. Exact cost comparison analyses accounting for those would be very difficult to perform. Preponderance of benefits over harms.

Harm

Cost

Harm

Benefits–harm assessment

Value

Patients should be treated with IMRT whenever possible.

judgments

Policy level Strong recommendation. Intervention IMRT is the current standard of care for primary radiation treatment of NPC.