Plasma Epstein‐Barr virus DNA screening followed by ¹⁸F‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography in detecting posttreatment failures of nasopharyngeal carcinoma

Abstract

BACKGROUND:The authors investigated the clinical implication of plasma Epstein‐Barr virus (EBV) DNA assay and 18F‐fluoro‐2‐deoxy‐D‐glucose (18F‐FDG) positron emission tomography (PET) in the detection of recurrent nasopharyngeal carcinoma (NPC).METHODS:Two hundred forty‐five patients with NPC who had previously received treatment and were in a state of remission were monitored prospectively using a plasma EBV DNA assay every 3 to 6 months. 18F‐FDG PET studies were obtained when abnormal EBV DNA or clinically suggestive signs of recurrence were noted.RESULTS:Thirty‐six of 245 patients (14.7%) patients had abnormal EBV DNA tests and underwent PET scans. In the remaining 209 patients, 3658 blood tests were negative. PET scans also were obtained in 5 patients who had undetectable EBV DNA levels but signs that were clinically suggestive of disease recurrence. Subsequent analyses focused on 41 patients who had PET studies. In lesion‐based analyses, the sensitivity, specificity, and accuracy of PET by visual interpretation were 81.8%, 77.1%, and 79.2%, respectively, for all 125 lesions. In patient‐based analyses, the accuracy of PET by visual interpretation was 51.2%. All 36 patients who had detectable plasma levels of EBV DNA had demonstrable NPC recurrences, whereas no recurrences were noted in 5 patients who had undetectable EBV DNA levels but signs that clinically mimicked a recurrence. Compared with annual PET, the annual cost of blood tests every 3 to 6 months per patient saved approximately 77% ∼ 88% in expenses.CONCLUSIONS:The plasma EBV DNA assay correctly predicted all NPC recurrences, and PET had high capacity to localize potential lesion sites. The authors concluded that applying the strategy of EBV DNA screening followed by PET scanning may guide appropriate further treatment planning in a cost‐effective manner. Cancer 2011;. © 2011 American Cancer Society.

Prognostic Significance of 18F-FDG PET Parameters and Plasma Epstein-Barr Virus DNA Load in Patients with Nasopharyngeal Carcinoma

“…Notably, Ma et al have recently reported that the level of circulating EBV DNA was significantly associated with NPC tumor volume as assessed by MRI as well as SUV of the primary tumor and the metastatic lymph nodes (23), but they did not demonstrate the measurement of other 18 F-FDG PET functional parameters. Wang et al addressed the potential utility of posttreated plasma EBV DNA and 18 F-FDG PET in detecting tumor relapse after treatment, but they did not evaluate any pretreated measurement of EBV DNA load and 18 F-FDG PET as described in the current study (34).…”

Post-Treatment Circulating Free HPV DNA As a Marker of Treatment Outcome in Patients with HPV-Related Propharyngeal Cancer After Radio(chemo)therapy

“…It was suggested that high circulating plasma EBV DNA load assessed 6 weeks post-primary treatment may predict a subsequent relapse [27][28][29]. For patients treated due to NPC persisting, increased, post-treatment viral DNA load or a subsequent rise after a previous drop seems to be an indication for PET/CT scanning for high risk of relapse [30]. Campitelli et al showed an analysis of sequential serum specimens in patients with cervical cancer.…”

Use Of 18F-FDG PET/CT In The Diagnosis, Staging, Response Assessment And Prognosis Of Nasopharyngeal Carcinoma: An Updated Review

“…In addition, PET/CT parameters other than SUV max have been received more and more attentions in the prognosis of solid cancers [64][65][66][67][68][69]. SUV max is a semiquantitative index and can be is theoretically a better predictor of outcome than SUV max [65].…”

“…Total lesion glycolysis represents metabolic activity throughout the entire tumor above a minimum threshold [69], might reflect the metabolic burden better than SUV max . In a study [60] Mä kitie et al [68] performed the first study combing EBV DNA copies and 18 F-FDG PET/CT in response evaluation and prognosis prediction.…”

“…Persistent elevated EBV DNA copies and abnormal PET scans after treatment suggest residual disease. Ma et al [69] tried to explore the relationship between EBV DNA copies and metabolic activity in NPC. The study revealed significant correlation between pretreatment SUV max of primary tumor and pretreatment EBV DNA copies, but further regression analysis did not confirm a significant association between them.…”