Nasopharyngeal carcinoma medical therapy: Difference between revisions

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__NOTOC__
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{{Nasopharyngeal carcinoma}}
{{Nasopharyngeal carcinoma}}
{{CMG}} {{AE}}{{Faizan}}
{{CMG}} {{AE}}{{Homa}}{{Faizan}}
==Overview==
==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 (injection)|Fluorouracil]].


The mainstay of therapy for nasopharyngeal carcinoma is external beam radiotherapy, supplemented in some cases with chemotherapy.
==Medical Therapy==
==Medical Therapy==
The mainstay of therapy for nasopharyngeal carcinoma is [[external beam radiotherapy]].<ref name="PastorLopez Pousa2017">{{cite journal|last1=Pastor|first1=M.|last2=Lopez Pousa|first2=A.|last3=del Barco|first3=E.|last4=Perez Segura|first4=P.|last5=Astorga|first5=B. Gonzalez|last6=Castelo|first6=B.|last7=Bonfill|first7=T.|last8=Martinez Trufero|first8=J.|last9=Grau|first9=J. Jose|last10=Mesia|first10=R.|title=SEOM clinical guideline in nasopharynx cancer (2017)|journal=Clinical and Translational Oncology|volume=20|issue=1|year=2017|pages=84–88|issn=1699-048X|doi=10.1007/s12094-017-1777-0}}</ref><ref name="LeeNg2014">{{cite journal|last1=Lee|first1=Anne W.M.|last2=Ng|first2=Wai Tong|last3=Chan|first3=Lucy L.K.|last4=Hung|first4=Wai Man|last5=Chan|first5=Connie C.C.|last6=Sze|first6=Henry C.K.|last7=Chan|first7=Oscar S.H.|last8=Chang|first8=Amy T.Y.|last9=Yeung|first9=Rebecca M.W.|title=Evolution of treatment for nasopharyngeal cancer – Success and setback in the intensity-modulated radiotherapy era|journal=Radiotherapy and Oncology|volume=110|issue=3|year=2014|pages=377–384|issn=01678140|doi=10.1016/j.radonc.2014.02.003}}</ref><ref name="ChuaMa2006">{{cite journal|last1=Chua|first1=Daniel T.T.|last2=Ma|first2=Jun|last3=Sham|first3=Jonathan S.T.|last4=Mai|first4=Hai-Qiang|last5=Choy|first5=Damon T.K.|last6=Hong|first6=Ming-Huang|last7=Lu|first7=Tai-Xiang|last8=Au|first8=Gordon K.H.|last9=Min|first9=Hua-Qing|title=Improvement of survival after addition of induction chemotherapy to radiotherapy in patients with early-stage nasopharyngeal carcinoma: Subgroup analysis of two Phase III trials|journal=International Journal of Radiation Oncology*Biology*Physics|volume=65|issue=5|year=2006|pages=1300–1306|issn=03603016|doi=10.1016/j.ijrobp.2006.02.016}}</ref><ref name="Ribassin-MajedMarguet2017">{{cite journal|last1=Ribassin-Majed|first1=Laureen|last2=Marguet|first2=Sophie|last3=Lee|first3=Anne W.M.|last4=Ng|first4=Wai Tong|last5=Ma|first5=Jun|last6=Chan|first6=Anthony T.C.|last7=Huang|first7=Pei-Yu|last8=Zhu|first8=Guopei|last9=Chua|first9=Daniel T.T.|last10=Chen|first10=Yong|last11=Mai|first11=Hai-Qiang|last12=Kwong|first12=Dora L.W.|last13=Cheah|first13=Shie-Lee|last14=Moon|first14=James|last15=Tung|first15=Yuk|last16=Chi|first16=Kwan-Hwa|last17=Fountzilas|first17=George|last18=Bourhis|first18=Jean|last19=Pignon|first19=Jean Pierre|last20=Blanchard|first20=Pierre|title=What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis|journal=Journal of Clinical Oncology|volume=35|issue=5|year=2017|pages=498–505|issn=0732-183X|doi=10.1200/JCO.2016.67.4119}}</ref>


The mainstay of therapy for nasopharyngeal carcinoma is external beam radiotherapy, supplemented in some cases with chemotherapy. Undifferentiated subtype of NPC is highly radiosensitive.
===Treatment according to Stages===
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Treatment}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
Stage 1
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[External beam radiotherapy|External beam radiation]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
Stage 2
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Chemotherapy]] given with [[radiation therapy]], followed by more [[chemotherapy]]
*[[Radiation therapy]] to the [[tumor]] and [[lymph nodes]] in the [[neck]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
Stage 3
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[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]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
Stage 4
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[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]]
|-
|}


<ref name="Weidner's">{{cite book |author=Richard Cote, Saul Suster, Lawrence Weiss, Noel Weidner (Editor) |title=Modern Surgical Pathology (2 Volume Set) |publisher=W B Saunders |location=London |year= |pages= |isbn=0-7216-7253-1 |oclc= |doi=}
==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 (injection)|Fluorouracil]].
</ref>
 
Standard treatments for patients with nasopharyngeal cancer include the following:


*Radiation therapy alone
* '''Cisplatin:'''<ref name="DeckerDrelichman1983">{{cite journal|last1=Decker|first1=David A.|last2=Drelichman|first2=Anibal|last3=Al-Sarraf|first3=Muhyi|last4=Crissman|first4=John|last5=Reed|first5=Melvin L.|title=Chemotherapy for nasopharyngeal carcinoma a ten-year experience|journal=Cancer|volume=52|issue=4|year=1983|pages=602–605|issn=0008-543X|doi=10.1002/1097-0142(19830815)52:4<602::AID-CNCR2820520404>3.0.CO;2-6}}</ref><ref>{{Cite journal
| author = [[K. Al-Kourainy]], [[J. Crissman]], [[J. Ensley]], [[J. Kish]], [[J. Kelly]] & [[M. Al-Sarraf]]
| title = Excellent response to cis-platinum-based chemotherapy in patients with recurrent or previously untreated advanced nasopharyngeal carcinoma
| journal = [[American journal of clinical oncology]]
| volume = 11
| issue = 4
| pages = 427–430
| year = 1988
| month = August
| pmid = 2457306
}}</ref>
** Preferred regimen: 80-100 mg/m<sup>2</sup>  slow [[Intravenous therapy|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
** [[Adverse effect (medicine)|Side effects]]:
*** [[Nephrotoxicity]]
*** [[Ototoxicity]]
*** [[Myelosuppression]]
*** [[Gastrointestinal]] problems like [[Acute (medicine)|acute]] and delayed [[nausea and vomiting]] and [[diarrhea]]
*** [[Electrolyte disturbance]]:
**** [[Hypomagnesemia]]
**** [[Hypocalcemia]]
**** [[Hyponatremia]]
**** [[Hypokalemia]]
**** [[Hypophosphatemia]]
*** [[Irreversible]] [[paresthesias]]
*** [[Anaphylaxis]]
'''Note (1):''' [[Urine output]] should be maintain more than 100-150 ml/ hr.


*Concurrent chemoradiation followed by adjuvant chemotherapy
'''Note (2):''' [[Antiemetic|Anti-emetic]] treatment should be done in all [[patients]].


*Surgery for residual nodal disease
* '''5-Fluorouracil:'''<ref name="Al-Sarraf1987">{{cite journal|last1=Al-Sarraf|first1=Muhyi|title=Chemotherapeutic management of head and neck cancer|journal=Cancer and Metastasis Review|volume=6|issue=3|year=1987|pages=181–198|issn=0167-7659|doi=10.1007/BF00144263}}</ref><ref>{{Cite journal
| author = [[M. Al-Sarraf]]
| title = Head and neck cancer: chemotherapy concepts
| journal = [[Seminars in oncology]]
| volume = 15
| issue = 1
| pages = 70–85
| year = 1988
| month = February
| pmid = 3278391
}}</ref>
** Preferred regimen: 1000 mg/m<sup>2</sup>/day [[Intravenous therapy|IV]] [[infusion]] for 4-5 days and repeated every 3 weeks.
** [[Contraindications]]:
*** [[Hypersensitivity]]
*** [[Liver diseases]]
*** [[Renal function impairment]]
*** Myelosuppressed patients
*** [[Unstable angina]]
** [[Adverse effect (medicine)|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.


*Chemotherapy alone for metastatic disease
'''Note (2):''' Using this drug in familial pyrimidenemia [[patients]] can cause fatal [[neurotoxicity]].


==References==
==References==
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Latest revision as of 22:53, 29 July 2020

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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

Stage 2

Stage 3

Stage 4

Medical Therapy

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

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

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

  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.
  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.
  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.
  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.
  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)
  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)

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