Management of Nasopharyngeal Carcinoma- Current Perspectives

Author(s): Rajeev Gupta1 , Navjot Kaur2 , Arshdeep Singh3 , Shweta Mahajan4

Nasopharyngeal carcinoma is the most common malignant tumour arising from epithelial lining of nasopharynx and is commonly associated with Epstein Barr virus. It is endemic in South-East Asia, Southern China and North Africa. The diagnosis in early stage is infrequent as the symptoms of nasopharyngeal carcinoma are non-specific and patients usually present in later stages. In highrisk group of patients, plasma EBV-DNA level has become a screening tool for the diagnosis of nasopharyngeal carcinoma in its early stage. Under endoscopic guidance, biopsy is to be taken for confirmation of disease. Imaging modalities like PET scan have been the mainstay for the detection of extent of disease. Nasopharyngeal carcinoma is highly radiosensitive and chemosensitive tumour. For all the stages of nasopharyngeal carcinoma without distant metastasis, radiotherapy remains the mainstay of treatment. Concurrent chemoradiation with adjuvant chemotherapy has been recommended as standard treatment for advanced nasopharyngeal carcinoma. The advent of intensity modulated radiotherapy has reduced the incidence of radiotherapy induced complications. For better results of salvage therapy, the early detection of residual or recurrent tumour at primary site or in neck is essential. The salvage therapy has improved the overall outcome of these patients. The use of targeted therapy has been reported to be efficacious in management of metastatic or recurrent nasopharyngeal carcinoma. The advent of immunotherapy based on pembrolizumab and T4 CAR T-cell therapy has shown promising results in phase I and phase II trials. Further studies and clinical trials are needed to include it as mainstay treatment in the management of nasopharyngeal carcinoma.