Familial Nasopharyngeal Carcinoma 6

Post-treatment Follow-Up of Patients with Nasopharyngeal Cancer 239Table 18.2. A proposed recommendation for follow-up management of NPC patients after definitive treatmentModality Tests ScheduleClinicalLaboratoryImagingOthersPhysical examination, includingnasoendoscopySpeech, hearing, swallowing evaluationwhen indicatedTSH, free T4Other endocrine tests when clinicallyindicatedEBV DNA monitoring (optional)MRI of the head and neckChest X-ray, CT of the thorax/abdomen,US liver, bone scan, PET/CT scan whenclinically indicatedSmoking cessation counselingDental evaluationPatient support groupYear 1: every 1–3 monthsYear 2: every 2–4 monthsYear 3–5: every 4–6 months>5 years: every 6–12 monthsEvery 6–12 months3 months after RT, then annuallyTSH thyroid-stimulating hormone; EBV Epstein–Barr virus; MRI magnetic resonance imaging; RT radiation therapy; CT computedtomography; US ultrasound; PET positron emission tomographyusing MRI may detect early recurrences amenable tosalvage treatment. Post-treatment measurement ofplasma EBV DNA levels may be used to prognosticatepatients. The role of routine body imaging to detectdistant metastases on follow-up is poorly defined.Hypothyroidism is common and should bescreened with thyroid function tests regularly. Thepatient should continue follow-up with a dentist andother members of the multi-disciplinary team whereindicated. Other investigations and interventions forlate toxicity should be offered if necessary. Thepatient should also continue to be supported in thepsychosocial domain. The proposed recommendationsare summarized in Table 18.2.ReferencesAl-Sarraf M, LeBlanc M, Giri PGS, et al (1998) Chemoradiotherapyversus radiotherapy in patients with advanced nasopharyngealcancer: phase III randomized intergroup study0099. J Clin Oncol 16:1310–1317American Head and Neck Society Practice Guidelines (2009)http://www.headandneckcancer.org/ clinicalresources/ docs/nasopharynx.php. Accessed 23 Feb 2009Chan AT, Felip E; ESMO Guidelines Working Group (2008)Nasopharyngeal cancer: ESMO clinical recommendationsfor diagnosis, treatment and follow-up. Ann Oncol 19(Suppl2):ii81–ii82Chan AT, Lo YM, Zee B, et al (2002) Plasma Epstein–Barr virusDNA and residual disease after radiotherapy for undifferentiatednasopharyngeal carcinoma. J Natl Cancer Inst94(21):1614–1619Cheng LC, Sham JS, Chiu CS, et al (1996) Surgical resection ofpulmonary metastases from nasopharyngeal carcinoma.Aust N Z J Surg 66:71–73Chong VFH, Fan YF (1997) Detection of recurrent nasopharyngealcarcinoma: MRI versus CT. Radiology 202: 463–470Chong VFH, Ong CK (2008) Nasopharyngeal carcinoma. EurJ Radiol 66:437–447Chua DT, Sham JS, Kwong DL, et al (1998) Locally recurrentnasopharyngeal carcinoma: treatment results for patientswith computed tomography assessment. Int J Radiat OncolBiol Phys 41(2):379–386Chua ML, Ong SC, Wee JT, et al (2009) Comparison of 4 modalitiesfor distant metastasis staging in endemic nasopharyngealcarcinoma. Head Neck 31(3):346–354Colevas AD, Read R, Thornhill J, et al (2001) Hypothyroidismincidence after multimodality treatment for stage III andIV squamous cell carcinomas of the head and neck. IntJ Radiat Oncol Biol Phys 51(3):599–604Darzy KH, Shalet SM (2009) Hypopituitarism following radiotherapyrevisited. Endocr Dev 15:1–24Fandi A, Bachouchi M, Azli N, et al (2000) Long-term disease-freesurvivors in metastatic undifferentiated carcinomaof nasopharyngeal type. J Clin Oncol 18:1324–1330Fujii M, Kanzaki J (1994) The role of MRI for the diagnosis ofrecurrence of nasopharyngeal cancer. Auris Nasus Larynx2(1):32–37