Abstract
BackgroundLoco-regionally advanced nasopharyngeal carcinomas can be cured by the combination of chemotherapy and radiotherapy. In Eastern countries, plasma levels of viral Epstein-Barr deoxyribonucleic acid (DNA) are accurate in predicting recurrence, but few data are available in Western populations. The aim of this prospective study was to evaluate the relationship between viral Epstein-Barr DNA copy numbers in plasma and the response rate, progression-free survival and overall survival in a cohort of Western patients with stage IIb-IVb nasopharyngeal cancer.MethodsWe evaluated plasma samples from 36 consecutive patients treated with induction chemotherapy followed by chemoradiation. EBV copy numbers were determined after DNA extraction using real-time quantitative polymerase chain reaction. Survival curves were estimated using the Kaplan–Meier method.ResultsCirculating Epstein-Barr virus DNA levels were measured before treatment, at the end of concomitant chemo- and radiotherapy, and during the follow-up period. Pre-treatment levels significantly correlated with the initial stage and probability of relapse. Their increase was 100% specific and 71.3% sensitive in detecting loco-regional or metastatic recurrence (an overall accuracy of 94.4%). Three-year progression-free and overall survival were respectively 78.2% and 97.1%.ConclusionsThe results of this study confirm that patients from a Western country affected by loco-regionally advanced nasopharyngeal carcinoma have high plasma Epstein-Barr virus DNA levels at diagnosis. The monitoring of plasma levels is sensitive and highly specific in detecting disease recurrence and metastases.
Highlights
Loco-regionally advanced nasopharyngeal carcinomas can be cured by the combination of chemotherapy and radiotherapy
Epidemiological studies have shown that the gamma– herpes Epstein-Barr virus (EBV) plays a major role in the pathogenesis of Nasopharyngeal carcinomas (NPCs) as they are endemic in areas where EBV infection is endemic [16,17,18]
Following the demonstration of EBV in histological samples of NPCs [21,22] and the presence of high titres of IgA antibody against a viral capside antigen (VCA) [23,24], it has been recently demonstrated that real-time quantitative polymerase chain reaction (PCR) can detect cell-free EBV deoxyribonucleic acid (DNA) in the serum of NPC patients [25,26,27,28,29]
Summary
Loco-regionally advanced nasopharyngeal carcinomas can be cured by the combination of chemotherapy and radiotherapy. In Eastern countries, plasma levels of viral Epstein-Barr deoxyribonucleic acid (DNA) are accurate in predicting recurrence, but few data are available in Western populations. The aim of this prospective study was to evaluate the relationship between viral Epstein-Barr DNA copy numbers in plasma and the response rate, progression-free survival and overall survival in a cohort of Western patients with stage IIb-IVb nasopharyngeal cancer. Nasopharyngeal carcinomas (NPCs) are frequent in South-east Asia, China, the Arctic regions and North Africa, with the highest prevalence being observed in China’s Guangdong province and in Sarawak [1,2,3,4,5,6,7] They are rare in Europe and, in Italy, prevalence is about 1.4 per 100,000 inhabitants [8]. Recurrent/ metastatic disease can be heralded by an increase in plasma EBV DNA levels during follow-up [26]
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