What changes do you make in the management of non-endemic nasopharynx cancer compared to endemic?
For example, do you favor using different induction chemotherapy (gemcitabine/cisplatin or TPF) for endemic vs non-endemic disease?
Do you favor using pre- or post-induction volumes for high-dose radiation for endemic vs non-endemic disease?
Do you cover the whole neck or upper neck only in N0/1 disease?
2 Answers
Mednet MemberInvited Expert
Radiation Oncology · University of Texas MD Anderson Cancer Center
Answered on
a) There are 3 varieties of NPC; EBER +ve, HPV +, and non-viral
There is only decent data for Induction (IC) for EBER +ve for a small survival benefit with cis-gem, and the group's follow-up suggested that pre-treatment DNA titers only showed benefit for those with high titers.
I am not a HN med onc...
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Mednet MemberInvited Expert
Radiation Oncology · University of Michigan
Answered on
Agree with Dr. @Dr. First Last. I would note that in our experience with non-endemic EBV- NPC, the prognosis was worse than the endemic ones, with local recurrence a major pattern and with a lesser metastasis risk compared with the EBV+ ones (Stenmark et al., PMID 24521676). Surprisingly, those who ...
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