Radiological, pathological and DNA remission in recurrent metastatic nasopharyngeal carcinoma

• Published in: BMC cancer Vol. 6; no. 1; p. 259
• Main Authors: Chan, Stephen L, Hui, Edwin P, Leung, Sing F, Chan, Anthony T C, Ma, Brigette B Y
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 31-10-2006; BioMed Central; BMC
• Subjects: Adult; Antineoplastic Agents - therapeutic use; Biomarkers, Tumor - blood; Case Report; DNA, Viral - blood; Fluorodeoxyglucose F18; Herpesvirus 4, Human - genetics; Humans; Liver Neoplasms - diagnosis; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - drug therapy; Liver Neoplasms - pathology; Liver Neoplasms - secondary; Liver Neoplasms - virology; Male; Nasopharyngeal Neoplasms - diagnosis; Nasopharyngeal Neoplasms - diagnostic imaging; Nasopharyngeal Neoplasms - drug therapy; Nasopharyngeal Neoplasms - pathology; Nasopharyngeal Neoplasms - virology; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - secondary; Pancreatic Neoplasms - virology; Positron-Emission Tomography; Radiography; Radiopharmaceuticals; Treatment Outcome
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/1471-2407-6-259

Circulating plasma Epstein Barr Virus DNA (EBV-DNA) is a sensitive and specific marker of nasopharyngeal carcinoma (NPC). The mainstay of treatment of metastatic NPC is systemic chemotherapy and resection for solitary metastasis. Despite high response rate to chemotherapy, complete remission is uncommonly seen.
We report a case of recurrent metastatic NPC in a 43-year-old man, who achieved complete remission three times with chemotherapy and surgery. Serial plasma EBV-DNA levels were measured during the course of disease. The patient had three episodes of recurrences of NPC manifested as distant metastasis. Both time, rise in the plasma EBV-DNA level preceded detection of recurrences by imaging. Following systemic chemotherapy, he achieved complete remission each time, of which was confirmed by 18-flourodeoxyglucose positron emission tomography and hepatectomy pathology. The plasma EBV-DNA level dropped to zero copy/ml at the time of each remission.
This case highlights the high chemosensitivity of NPC by illustrating a rare occurrence of complete response of metastatic NPC to chemotherapy. This case also underscores the usefulness of EBV-DNA as a useful tool in monitoring NPC by its ability to detect early recurrence and excellent correlation with treatment response.