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Nasopharyngeal cancer

Key sources
The following summarized guidelines for the evaluation and management of nasopharyngeal cancer are prepared by our editorial team based on guidelines from the European Reference Network on Rare Adult Solid Cancers (EURACAN/ESMO 2023; 2021), the Spanish Group for the Treatment of Head and Neck Tumors (TTCC/SEOM 2022), the American Society of Clinical Oncology (ASCO 2022; 2018), the Chinese Society of Clinical Oncology (CSCO/ASCO 2021), the American College of Radiology (ACR 2019; 2016), the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2017), the United Kingdom National Multidisciplinary Guidelines (UKNMG 2016), and the American Cancer Society (ACS 2016).
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Guidelines

1.Screening and diagnosis

Indications for screening: as per SEOM 2022 guidelines, consider obtaining plasma EBV DNA with a primer/probe assay targeting the BamHI-W region of the EBV genome (carried out in duplicate, at least 4 weeks apart), coupled with endoscopic examination and MRI, for detecting early asymptomatic NPC in individuals at higher risk (males aged 40-62 years) in endemic areas.
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2.Diagnostic investigations

History and physical examination: as per ESMO 2021 guidelines, elicit medical history and perform a physical examination with cranial nerve examination in the initial evaluation and staging of patients with NPC.
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  • Audiometry

  • Baseline laboratory tests

  • EBV DNA

  • Diagnostic imaging

  • Imaging for staging

3.Diagnostic procedures

Nasopharyngoscopy: as per ESMO 2021 guidelines, obtain nasopharyngoscopy for the routine staging of patients with NPC.
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  • Fine-needle aspiration

  • Tumor biopsy

  • Ancillary testing

4.Medical management

Management of local/locoregional disease, radiotherapy, indications, ASCO/CSCO
Offer intensity-modulated radiotherapy with daily image guidance in all patients with NPC.
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Consider offering both sequential boost and simultaneous integrated boost radiotherapy in all patients with NPC.
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  • Management of local/locoregional disease (radiotherapy, target delineation)

  • Management of local/locoregional disease (radiotherapy, dosing)

  • Management of local/locoregional disease (induction chemotherapy)

  • Management of local/locoregional disease (concurrent chemoradiotherapy)

  • Management of local/locoregional disease (adjuvant chemotherapy)

  • Management of local/locoregional disease (surgery)

  • Management of metastatic disease

  • Management of persistent/recurrent disease

5.Follow-up and surveillance

Serial clinical assessment: as per SEOM 2022 guidelines, perform periodic examinations (every 3 months in the first year, every 6 months in the second and third year, and annually thereafter for the first 5 years) of the nasopharynx (with fiberoptic endoscopy), neck, and cranial nerve function, and assess systemic complaints to identify distant metastasis.
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  • Serial imaging assessment

  • Serial laboratory assessment

  • Surveillance for other cancers

  • Survivorship and rehabilitation (lifestyle modifications)

  • Survivorship and rehabilitation (neuromuscular complications)

  • Survivorship and rehabilitation (neurosensory complications)

  • Survivorship and rehabilitation (speech disturbance)

  • Survivorship and rehabilitation (oral and dental care)

  • Survivorship and rehabilitation (gastroesophageal complications)

  • Survivorship and rehabilitation (thyroid dysfunction)

  • Survivorship and rehabilitation (lymphedema)

  • Survivorship and rehabilitation (fatigue)

  • Survivorship and rehabilitation (sleep disorders)

  • Survivorship and rehabilitation (psychosocial distress)