Nasopharyngeal carcinoma medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]Faizan Sheraz, M.D. [3]

Overview

The mainstay of therapy for nasopharyngeal carcinoma is external beam radiotherapy, supplemented in some cases with chemotherapy. Chemotherapy drugs that are used in treatment of nasopharyngeal carcinoma are vast, but the two ones which are used more include Cisplatin and 5-Fluorouracil.

Medical Therapy

The mainstay of therapy for nasopharyngeal carcinoma is external beam radiotherapy.^[1]^[2]^[3]^[4]

Treatment according to Stages


Stage	Treatment

Stage 1	External beam radiation
Stage 2	Chemotherapy given with radiation therapy, followed by more chemotherapy Radiation therapy to the tumor and lymph nodes in the neck
Stage 3	Chemotherapy given with radiation therapy, which may be followed by more chemotherapy Radiation therapy Radiation therapy followed by surgery to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy
Stage 4	Chemotherapy given with radiation therapy, followed by more chemotherapy Radiation therapy Radiation therapy followed by surgery to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy Chemotherapy for cancer that has metastasized (spread) to other parts of the body

Medical Therapy

Chemotherapy drugs that are used in treatment of nasopharyngeal carcinoma are vast, but the two ones which are used more include Cisplatin and 5-Fluorouracil.

Cisplatin:^[5]^[6]
- Preferred regimen: 80-100 mg/m² slow IV with enough hydration. Repeat every 3 weeks.
- Contraindications:
  - Hypersensitivity to platinum-containing compounds
  - Renal function impairment
  - Hearing impairment
  - Myelosuppressed patients
  - Nursing or pregnant women
- Side effects:
  - Nephrotoxicity
  - Ototoxicity
  - Myelosuppression
  - Gastrointestinal problems like acute and delayed nausea and vomiting and diarrhea
  - Electrolyte disturbance:
  - Irreversible paresthesias
  - Anaphylaxis

Note (1): Urine output should be maintain more than 100-150 ml/ hr.

Note (2): Anti-emetic treatment should be done in all patients.

5-Fluorouracil:^[7]^[8]
- Preferred regimen: 1000 mg/m²/day IV infusion for 4-5 days and repeated every 3 weeks.
- Contraindications:
  - Hypersensitivity
  - Liver diseases
  - Renal function impairment
  - Myelosuppressed patients
  - Unstable angina
- Side effects:
  - Myelosuppression
  - Gastrointestinal problems like nausea and vomiting and diarrhea
  - Mucositis
  - Angina
  - Alopecia
  - Hand-foot syndrome

Note (1): In patients with liver diseases dose reduction should be considered.

Note (2): Using this drug in familial pyrimidenemia patients can cause fatal neurotoxicity.

References

↑ Pastor, M.; Lopez Pousa, A.; del Barco, E.; Perez Segura, P.; Astorga, B. Gonzalez; Castelo, B.; Bonfill, T.; Martinez Trufero, J.; Grau, J. Jose; Mesia, R. (2017). “SEOM clinical guideline in nasopharynx cancer (2017)”. Clinical and Translational Oncology. 20 (1): 84–88. doi:10.1007/s12094-017-1777-0. ISSN 1699-048X.
↑ Lee, Anne W.M.; Ng, Wai Tong; Chan, Lucy L.K.; Hung, Wai Man; Chan, Connie C.C.; Sze, Henry C.K.; Chan, Oscar S.H.; Chang, Amy T.Y.; Yeung, Rebecca M.W. (2014). “Evolution of treatment for nasopharyngeal cancer – Success and setback in the intensity-modulated radiotherapy era”. Radiotherapy and Oncology. 110 (3): 377–384. doi:10.1016/j.radonc.2014.02.003. ISSN 0167-8140.
↑ Chua, Daniel T.T.; Ma, Jun; Sham, Jonathan S.T.; Mai, Hai-Qiang; Choy, Damon T.K.; Hong, Ming-Huang; Lu, Tai-Xiang; Au, Gordon K.H.; Min, Hua-Qing (2006). “Improvement of survival after addition of induction chemotherapy to radiotherapy in patients with early-stage nasopharyngeal carcinoma: Subgroup analysis of two Phase III trials”. International Journal of Radiation Oncology*Biology*Physics. 65 (5): 1300–1306. doi:10.1016/j.ijrobp.2006.02.016. ISSN 0360-3016.
↑ Ribassin-Majed, Laureen; Marguet, Sophie; Lee, Anne W.M.; Ng, Wai Tong; Ma, Jun; Chan, Anthony T.C.; Huang, Pei-Yu; Zhu, Guopei; Chua, Daniel T.T.; Chen, Yong; Mai, Hai-Qiang; Kwong, Dora L.W.; Cheah, Shie-Lee; Moon, James; Tung, Yuk; Chi, Kwan-Hwa; Fountzilas, George; Bourhis, Jean; Pignon, Jean Pierre; Blanchard, Pierre (2017). “What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis”. Journal of Clinical Oncology. 35 (5): 498–505. doi:10.1200/JCO.2016.67.4119. ISSN 0732-183X.
↑ Decker, David A.; Drelichman, Anibal; Al-Sarraf, Muhyi; Crissman, John; Reed, Melvin L. (1983). “Chemotherapy for nasopharyngeal carcinoma a ten-year experience”. Cancer. 52 (4): 602–605. doi:10.1002/1097-0142(19830815)52:4<602::AID-CNCR2820520404>3.0.CO;2-6. ISSN 0008-543X.
↑ K. Al-Kourainy, J. Crissman, J. Ensley, J. Kish, J. Kelly & M. Al-Sarraf (1988). “Excellent response to cis-platinum-based chemotherapy in patients with recurrent or previously untreated advanced nasopharyngeal carcinoma”. American journal of clinical oncology. 11 (4): 427–430. PMID 2457306. Unknown parameter |month= ignored (help)
↑ Al-Sarraf, Muhyi (1987). “Chemotherapeutic management of head and neck cancer”. Cancer and Metastasis Review. 6 (3): 181–198. doi:10.1007/BF00144263. ISSN 0167-7659.
↑ M. Al-Sarraf (1988). “Head and neck cancer: chemotherapy concepts”. Seminars in oncology. 15 (1): 70–85. PMID 3278391. Unknown parameter |month= ignored (help)

Template:WikiDoc Sources

[PastorLopez_Pousa2017-1] Pastor, M.; Lopez Pousa, A.; del Barco, E.; Perez Segura, P.; Astorga, B. Gonzalez; Castelo, B.; Bonfill, T.; Martinez Trufero, J.; Grau, J. Jose; Mesia, R. (2017). “SEOM clinical guideline in nasopharynx cancer (2017)”. Clinical and Translational Oncology. 20 (1): 84–88. doi:10.1007/s12094-017-1777-0. ISSN 1699-048X.

[LeeNg2014-2] Lee, Anne W.M.; Ng, Wai Tong; Chan, Lucy L.K.; Hung, Wai Man; Chan, Connie C.C.; Sze, Henry C.K.; Chan, Oscar S.H.; Chang, Amy T.Y.; Yeung, Rebecca M.W. (2014). “Evolution of treatment for nasopharyngeal cancer – Success and setback in the intensity-modulated radiotherapy era”. Radiotherapy and Oncology. 110 (3): 377–384. doi:10.1016/j.radonc.2014.02.003. ISSN 0167-8140.

[ChuaMa2006-3] Chua, Daniel T.T.; Ma, Jun; Sham, Jonathan S.T.; Mai, Hai-Qiang; Choy, Damon T.K.; Hong, Ming-Huang; Lu, Tai-Xiang; Au, Gordon K.H.; Min, Hua-Qing (2006). “Improvement of survival after addition of induction chemotherapy to radiotherapy in patients with early-stage nasopharyngeal carcinoma: Subgroup analysis of two Phase III trials”. International Journal of Radiation Oncology*Biology*Physics. 65 (5): 1300–1306. doi:10.1016/j.ijrobp.2006.02.016. ISSN 0360-3016.

[Ribassin-MajedMarguet2017-4] Ribassin-Majed, Laureen; Marguet, Sophie; Lee, Anne W.M.; Ng, Wai Tong; Ma, Jun; Chan, Anthony T.C.; Huang, Pei-Yu; Zhu, Guopei; Chua, Daniel T.T.; Chen, Yong; Mai, Hai-Qiang; Kwong, Dora L.W.; Cheah, Shie-Lee; Moon, James; Tung, Yuk; Chi, Kwan-Hwa; Fountzilas, George; Bourhis, Jean; Pignon, Jean Pierre; Blanchard, Pierre (2017). “What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis”. Journal of Clinical Oncology. 35 (5): 498–505. doi:10.1200/JCO.2016.67.4119. ISSN 0732-183X.

[DeckerDrelichman1983-5] Decker, David A.; Drelichman, Anibal; Al-Sarraf, Muhyi; Crissman, John; Reed, Melvin L. (1983). “Chemotherapy for nasopharyngeal carcinoma a ten-year experience”. Cancer. 52 (4): 602–605. doi:10.1002/1097-0142(19830815)52:4<602::AID-CNCR2820520404>3.0.CO;2-6. ISSN 0008-543X.

[6] K. Al-Kourainy, J. Crissman, J. Ensley, J. Kish, J. Kelly & M. Al-Sarraf (1988). “Excellent response to cis-platinum-based chemotherapy in patients with recurrent or previously untreated advanced nasopharyngeal carcinoma”. American journal of clinical oncology. 11 (4): 427–430. PMID 2457306. Unknown parameter |month= ignored (help)

[Al-Sarraf1987-7] Al-Sarraf, Muhyi (1987). “Chemotherapeutic management of head and neck cancer”. Cancer and Metastasis Review. 6 (3): 181–198. doi:10.1007/BF00144263. ISSN 0167-7659.

[8] M. Al-Sarraf (1988). “Head and neck cancer: chemotherapy concepts”. Seminars in oncology. 15 (1): 70–85. PMID 3278391. Unknown parameter |month= ignored (help)

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]