Prediction of surgical outcome using plasma Epstein-Barr Virus DNA and 18F-FDG PET-CT scan in recurrent nasopharyngeal carcinoma

Abstract

BACKGROUND: To determine the role of plasma Epstein–Barr Virus (pEBV)-DNA and PET-CT scan in predicting the outcome of nasopharyngectomy and cervical lymphadenectomy for recurrent nasopharyngeal carcinoma (NPC). METHODS: Between 2007 and 2009, we recruited patients who had local or regional recurrent NPC after radiotherapy. Relationship between pre-operative pEBV-DNA level, SUVmax and surgical outcome was analyzed. RESULTS: Forty-two patients had local tumor recurrence. Their median pEBV-DNA level and SUVmax were 348 copies and 4.7, respectively. Both values were significantly lower than those with palliative nasopharyngectomy. Twenty-two patients had regional failure. Their mean pEBV DNA level and tumor SUVmax were 626 copies and 7.6, respectively. The metastatic lymph nodes with extra-capsular spread had significantly higher mean SUVmax. CONCLUSIONS: Pre-operative pEBV-DNA and PET-CT predict a surgical outcome of nasopharyngectomy for recurrent NPC. Similarly, PET-CT scan predicts the presence of extra-capsular spread of metastatic lymph nodes. These patients may warrant further postoperative adjuvant therapy.