Clinical Research Papers:
Long-term clinical outcome in nasopharyngeal carcinoma patients with post-radiation persistently detectable plasma EBV DNA
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Abstract
Wen-Yi Wang1,2,*, Tian-Yun Lin3,*, Chih-Wen Twu4,5, Hsiao-Hui Tsou6,7, Po-Ju Lin8, Yi-Chun Liu8, Jing-Wen Huang8, He-Yuan Hsieh8, Jin-Ching Lin5,8,9,10
1Department of Nursing, Hung Kuang University, Taichung, Taiwan
2Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
3Department of Otorhinolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan
4Department of Otorhinolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
5Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
6Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
7Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
8Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
9Institute of Clinical Medicine,School of Medicine, National Yang Ming University, Taipei, Taiwan
10Department of Medicine, China Medical University, Taichung, Taiwan
*These authors contributed equally to this work
Correspondence to:
Jin-Ching Lin, email: [email protected]
Keywords: nasopharyngeal carcinoma, radiotherapy, plasma Epstein-Barr virus DNA, quantitative polymerase chain reaction
Received: October 25, 2015 Accepted: April 18, 2016 Published: May 12, 2016
ABSTRACT
Purpose: To investigate the long-term clinical outcome of nasopharyngeal carcinoma (NPC) patients with persistently detectable plasma EBV (pEBV) DNA after curative radiotherapy (RT).
Results: The post-RT pEBV DNA levels were very lower copy number (median 21, interquartile range 8–206 copies/ml). After long-term follow-up, the relapse rate was 64.8%, the median time to progression 20 months, and 5-year overall survival (OS) 49.6%. Thirty-two of 39 (82.1%) patients with high viral load (≥ 100 copies/ ml) developed tumor relapse, whereas 57.0% (49/86) patients with low viral load (< 100 copies/ml) had tumor relapse (P = 0.0065). The 5-year OS rates were 20.5% and 62.9% for patients with viral load ≥ and < 100 copies/ml (median survival, 20 vs. 100 months; P < 0.0001). Patients who received adjuvant chemotherapy (AdjCT) experienced significant reduction in distant failures (66.2% vs. 31.6%; P = 0.0001) but similar locoregional recurrences (P = 0.2337). The 5-year OS rates were 69.4% for patients who received AdjCT compared with 33.2% for those of without AdjCT (median survival, 111 vs. 32 months; P < 0.0001).
Methods: We screened 931 newly diagnosed NPC patients who finished curative RT and found 125 patients (13.4%) with detectable pEBV DNA one week after RT. The clinical characteristics, treatment modality, subsequent failure patterns and survivals were analyzed.
Conclusions: NPC patients with persistently detectable pEBV DNA after curative RT have a higher rate of treatment failure and poor survivals. Levels of the post-RT pEBV DNA and administration of AdjCT affect the final outcome significantly.
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