Diagnosis and treatment post chemoradiation: A case report on recurrent nasopharyngeal carcinoma

Abstract

Background: Nasopharyngeal carcinoma (NPC) is a common malignant disease in Southeast Asia and radiotherapy is the preferred treatment. Approximately 10% of patients show local recurrence after radiotherapy. Following radiotherapy, fibrous hyperplasia of the nasopharynx and poor local circulation due to local vascular occlusion often occur, leading to low treatment efficacy and many side effects from re-irradiation. Residual tumor after the first treatment may mutate and other mechanisms can cause the tumor to be resistant to the same treatment. Surgical treatment of residual and recurrent NPC has been advocated. Thus, early detection and accurate residual/recurrent NPC staging are essential for treatment and prognosis. Fluorodeoxyglucose-positron emission tomography-computed tomography (FDG PET-CT) is the most accurate imaging modality for assessing local residual or recurrent NPC but has several limitations. Diffusion weighted imaging-magnetic resonance imaging (DWI-MRI) is an imaging technique that can detect distant metastases of NPC and postradiotherapy biological changes and has a lower cost than FDG PET-CT.

Objective: To determine the right choice in the diagnosis and management of patients with residual/recurrence NPC.

Methods: Literature searching was done in Pubmed and Cochrane for managing residual/ recurrent NPC with seven literature results and one relevant literature.

Conclusion: The combination treatment preceded by surgery is superior to conventional conformal radiotherapy (CRT) alone. For diagnosis, DWI-MRI can provide qualitative and quantitative information about tumor cell levels and identify residues, local fibrosis, and post-radiotherapy recurrence in NPC.