Adjuvant chemotherapy in advanced nasopharyngeal carcinoma based on plasma EBV load

Abstract

Nasopharyngeal carcinoma (NPC) has been shown to be a radio- and chemosensitive tumor and combined chemoradiotherapy is the standard of care for advanced-stage patients. Different chemotherapy strategies (neoadjuvant, concurrent, adjuvant) are incorporated with radiotherapy to enhance treatment outcome and each mode of combined therapy has advantages and disadvantages. There are many randomized clinical trials investigating the role of adding chemotherapy in NPC management. So far, concurrent and neoadjuvant chemotherapy are more frequently used for locoregionally advanced tumors. However, the current reality is that (1) distant failure is the most frequent site of relapse reported in all studies, (2) patients have already received neoadjuvant and/or concurrent chemotherapy, and (3) only some tumors recur after previous neoadjuvant/concurrent chemotherapy with radiotherapy. So, adjuvant chemotherapy is a reasonable timing to consolidate the treatment outcome for selected patients. Recently, several tumor markers can predict tumors with high probability of recurrence. Among these markers, plasma EBV DNA assay is a simple and reliable one in predicting prognosis. In this mini-review, I will focus on the role of adjuvant chemotherapy based on plasma EBV DNA load. © 2012 Springer-Verlag.