Familial Nasopharyngeal Carcinoma 6

Post-treatment Follow-Up of Patients 18with Nasopharyngeal CancerIvan W. K. Tham and Jiade J. Lu18.1CONTENTS18.1 Introduction 23318.2 Pattern of Pathological Responseto Treatment 23418.3 Detection of Local, Regional, and DistantTreatment Failures and Recurrences 23518.3.1 Clinical Examination and Endoscopy 23518.3.2 Imaging for Locoregional Recurrence 23518.3.3 Imaging for Distant Metastases 23618.3.4 Plasma EBV DNA Measurement 23718.3.5 EBV Serology Measurement 23718.4 Assessment of Treatment-RelatedLate Toxicities 23718.4.1 Endocrine Dysfunction 23818.4.2 Dental Care 23818.4.3 Hearing 23818.4.4 Speech and Swallowing 23818.4.5 Patient Support Groups 23818.5 Summary 238References 239IntroductionNasopharyngeal carcinoma (NPC) is one of the mostradiosensitive malignancies, and radiation therapy isits mainstay modality for definitive treatment. Withthe advances of diagnostic and treatment technologies,as well as the utilization of concurrent chemoradiationtherapy for locoregionally advanced disease,the majority of patients with non-metastatic NPCIvan W.K. Tham, MDJiade J. Lu, MD, MBADepartment of Radiation Oncology, National University CancerInstitute, National University Health System, National Universityof Singapore, 5 Lower Kent Ridge Road, Singapore 119074,Republic of Singaporesurvive after definitive radiation therapy or combinedchemoradiation therapy. Nevertheless, local,regional, and/or distant metastasis can occur despiteaggressive treatment. Early detection of locoregionaltreatment failure is important in the management ofNPC as limited locoregional recurrent foci can usuallybe effectively salvaged (Chua et al. 1998).High-dose radiation inevitably induces acute andlate toxicities to the normal organs within or adjacentto the irradiation field. Late toxicities from radiationor chemoradiation therapy can emerge months, evenyears after the completion of treatment. Assessmentand prompt management of treatment-related toxicitiesare important for the long-term well-being of survivors.Furthermore, patients may continue to havepsychosocial difficulties secondary to the disease orits therapy after successful treatment of the cancer(Ma 1996), especially in the first year following treatment.Even among those who had resumed normal ornear-normal living, many patients may still note asubdued fear of disease recurrence (Lee et al. 2007).All issues mentioned above make close follow-upcrucial in the management of NPC and need to beaddressed in the context of the long-term physician–patient relationship developed over the follow-upperiod. However, despite an evident necessity, the optimalfollow-up schedule and regimen for patientstreated for non-metastatic NPC have not been thoroughlyaddressed. A number of professional organizationshave proposed guidelines for the management ofNPC, and universally provided follow-up recommendationsafter treatment (Table 18.1). However, some ofthe recommendations were derived from those usedfor non-nasopharyngeal squamous cell carcinoma ofhead and neck (SCCHN) after radiation treatment.Furthermore, differences in treatment strategy andtechnique, at least in part, have caused substantialvariations in those recommendations on follow-upmanagement. As the biological behavior, treatment,and mode of recurrence of NPC differ substantially