Recurrent Nasopharyngeal Carcinoma: A Clinical Dilemma and Challenge

Abstract

Recurrent nasopharyngeal carcinoma, which represents a small proportion of head-and-neck cancers, has a unique set of patho-clinical characteristics. The management of recurrent nasopharyngeal carcinoma remains a challenging clinical problem. Traditional treatments offer limited local control and survival benefits; more seriously, they frequently induce severe late complications. Recently, novel treatment techniques and strategies—including precision radiotherapy, endoscopic surgery or transoral robotic resection, third-generation chemotherapy regimens, and targeted therapies and immunotherapy—have provided new hope for patients with recurrent nasopharyngeal carcinoma. Some of these patients can potentially be cured with modern treatments. However, a lack of adequate evidence makes it difficult for clinicians to apply these powerful techniques and strategies. Individualized management guidelines, full evaluation of quality of life in these patients, and a further understanding of the mechanisms underlying recurrence are future directions for research into recurrent nasopharyngeal carcinoma.

Higher incidence of nasopharyngeal carcinoma in some regions in the world confers for interplay between genetic factors and external stimuli

“…Cytoplasmic interaction of cyclin D1 and cyclin E with EGFR helps in cellular proliferation by the induction of progression through G1/S phase. It has been shown that endocytosis and processing of EGFR is stimulated by EBV infection; thereby the translocated processed parts of EGFR act as transcription factors inside the nucleus and further activates signaling pathways that help cell proliferation (22)(23)(24)91). In latest studies, a few cellular micro RNAs like miR17 through miR92 and miR155, are reported to be upregulated in NPC.…”

“…Novel treatment techniques like precision radiotherapy, endoscopic surgery, transoral robotic resection, immunotherapy, etc. are being practiced recently (18)(19)(20)(21)(22)(23)(24). Nowadays, the staging with any metastasis is diagnosed properly by the help of endoscopy, MRI, PET and CT scans; and then fusion images are formed from different modalities.…”

“…For example, gefitinib and erlotinib for epidermal growth factor receptor (EGFR) and sorafenib for tyrosine-kinase are being tested. Recently, humanized monoclonal antibodies like nimotuzumab against EGFR and bevacizumab against vascular endothelial growth factor (VEGF) are also being tested in clinical trials (22)(23)(24).…”

The Research Progress of Long Noncoding RNAs in Nasopharyngeal Carcinoma

“…Nasopharyngeal carcinoma is generally sensitive to radiotherapy. Although with the development of medical imaging technology progress, at present the main approaches of radiotherapy for nasopharyngeal carcinoma, greatly improve the local control of nasopharyngeal carcinoma and 5 years survival rate, but frequent tumor recurrence and poor prognosis for clinical is still a great challenge [3]. The etiology of nasopharyngeal carcinoma is still unknown, and many years of research at home and abroad confirmed that nasopharyngeal carcinoma may be related to EB virus infection, environmental chemical carcinogens (such as nitrosamines) and genetic factors [4].…”

Value of 18F-FDG heterogeneity for discerning metastatic from benign lymph nodes in nasopharyngeal carcinoma patients with suspected recurrence

“…1 Recent advances in treatment techniques and strategies are providing an opportunity to potentially cure some patients with recurrent NPC. 4 Therefore, prompt identification of recurrence is of paramount importance during follow-up of patients with NPC. 5 Fluorine-18 fludeoxyglucose ( 18 F-FDG) positron emission tomography (PET) has an important role in the diagnosis and management of NPC.…”