Abstract
Nasopharyngeal carcinoma is an uncommon cancer in North America. Its clinical course is typified by locally advanced disease at diagnosis and has a high propensity for both regional and distant spread. It is, therefore, typically treated with a combination of radiation and chemotherapy. This report describes our 10-year clinical and radiological findings in a 48-year-old Vietnamese male patient with locally-advanced T4N1M0 lympho-epithelial carcinoma of the nasopharynx. Despite a long remission period after his initial course of aggressive chemoradiation, his tumor recurred locally after 4 years. Thereafter, throughout a period of over 10 years, he has been treated with multiple courses of re-irradiation and three different trials of chemotherapy. He was ultimately provided with over 30 months of progression-free tumor control with the epidermal growth factor receptor (EGFR)-inhibitor cetuximab. This case illustrates the commonly protracted course of this disease and its responsiveness to multiple treatment modalities.
Highlights
Nasopharyngeal carcinoma (NPC) is a squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx
Histologies of NPC range from well-differentiated squamous carcinoma (WHO type I), to non-keratinizing squamous carcinoma (WHO type II), to lympho-epithelial carcinoma (WHO type III), where non-keratinizing squamous carcinoma cells are mixed with numerous benign lymphocytes
Cisplatin with radiation followed by adjuvant chemotherapy has been reported to be more effective in patients with NPC than with radiation alone [2,3], and this approach has been adopted as current standard of care
Summary
Nasopharyngeal carcinoma (NPC) is a squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx. Posttreatment MRI 06/05 showed an overall reduction in bulk of the right nasopharyngeal mass and stable appearance of tumor extension into the right cavernous sinus, pteryopalatine fossa, and skull base. Repeat MRI 4/2006 revealed no significant disease progression (Figure 3, part H) By this time, the patient had returned to a normal activity level and had pain level ranging 0–2/ 10 without medication. The patient remained stable off any systemic therapy until 7/2008 At that time, he developed clinical local progression of disease resulting in epistaxis, increased odor, and breakdown tissue in preauricular region. MRI revealed increasing abnormal enhancement and mass involving the right nasopharyngeal cavity extending into the right cavernous sinus, middle cranial fossa, and dural surface He was subsequently given 40 mg/m2 methotrexate and clindamycin. A summary of the patient's disease and treatment course can be found in table 1
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