Nasopharyngeal Cancer
Carcinoma of the nasopharynx is a relatively uncommon disease in Western countries, but is the most commonly diagnosed head and neck malignancy in Southeast Asia. Most nasopharyngeal cancers are of epithelial origin. The nonkeratinizing poorly or un-diffe
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Nasopharyngeal Cancer Nancy Lee and Lin Kong
CONTENTS 2.1 2.1.1
2.1.2 2.1.3 2.2 2.2.1 2.2.2 2.2.3
2.2.4
2.3 2.3.1 2.3.2 2.3.3 2.4 2.4.1
Diagnosis, Staging, and Prognoses 17 Diagnosis 17 Initial Evaluation 17 Laboratory Tests 18 Imaging Studies 18 Pathology 19 Staging 19 Prognostic Factors 19 Treatment of Nasopharyngeal Cancer 21 General Principles 21 Radiation Therapy for Early Stage Disease 21 Combined Chemoradiation Therapy for Locoregionally Advanced NPC Concurrent Chemoradiation 22 The Role of Neoadjuvant Chemotherapy 23 The Role of Adjuvant Chemotherapy 24 Radiation Therapy Techniques 24 Intensity-Modulated Radiation Therapy 24 Treatment Technique of IMRT (Planning, Imaging, and Localization) 24 Dose Specifications 25 Critical Normal Structures Contour and Dose Limitations 25 Conventional Radiation Therapy 25 Treatment Technique (Simulation and Field Arrangement) 28 Brachytherapy 29 Treatment of Recurrent and Metastatic Nasopharyngeal Cancer 30 Treatment of Local Recurrence 30 Treatment of Regional Recurrence 31 Treatment of Distant Metastasis (Stage IVC) 32 Follow-Ups 32 Post-Treatment Follow-Ups 32 Schedule 32 Work-Ups 32 References 33
N. Lee, MD Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 22, New York, NY 10021, USA L. Kong, MD Department of Radiation Oncology, Cancer Hospital of Fudan University, 270 Dong An Road, Shanghai 200032, P.R. China
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Introduction and Objectives Carcinoma of the nasopharynx is a relatively uncommon disease in Western countries, but is the most commonly diagnosed head and neck malignancy in Southeast Asia. Most nasopharyngeal cancers are of epithelial origin. The nonkeratinizing poorly or un-differentiated squamous cell carcinoma [i.e., World Health Organization (WHO) type II and III diseases] are the more commonly diagnosed pathologies in Asia and account for almost 95% of all cases; however, 75% of cases are WHO type I in North America. Radiation therapy is the primary treatment for nasopharyngeal cancer. As nasopharyngeal cancer tends to present with regional metastasis, and is sensitive to both chemotherapy and radiation therapy, multidisciplinary management is usually required for locally advanced disease. This chapter examines: 쎲 Recommendations for diagnosis and staging procedures for nasopharyngeal cancer 쎲 Staging systems and prognostic factors 쎲 Management of nasopharyngeal cancer using radiation therapy (for early stage disease) and combined treatment based on radiation therapy and cytotoxic chemotherapy, as well as the supporting scientific evidence 쎲 Techniques of radiation therapy including intensity-modulated radiation therapy 쎲 Follow up care and surveillance of survivors
2.1
Diagnosis, Staging, and Prognoses
2.1.1
Diagnosis
Initial Evaluation 쮿 Diagnosis and evaluation of nasopharyngeal cancer initiates with a complete history and physical examination. Attention should be paid to disease-
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N. Lee and L. Kong
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related signs and symptoms. The most common presenting symptom is a neck ma
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