Nasopharyngeal carcinoma medical therapy: Difference between revisions

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==Overview==
==Overview==
The mainstay of therapy for nasopharyngeal carcinoma is external beam [[radiotherapy]], supplemented in some cases with [[chemotherapy]].
The mainstay of therapy for nasopharyngeal carcinoma is [[external beam radiotherapy]], supplemented in some cases with [[chemotherapy]]. [[Chemotherapy]] drugs that are used in treatment of nasopharyngeal carcinoma are vast, but the two ones which are used more include [[Cisplatin]] and 5-[[Fluorouracil (injection)|Fluorouracil]].


==Medical Therapy==
==Medical Therapy==
The mainstay of therapy for nasopharyngeal carcinoma is external beam [[radiotherapy]].
The mainstay of therapy for nasopharyngeal carcinoma is [[external beam radiotherapy]].<ref name="PastorLopez Pousa2017">{{cite journal|last1=Pastor|first1=M.|last2=Lopez Pousa|first2=A.|last3=del Barco|first3=E.|last4=Perez Segura|first4=P.|last5=Astorga|first5=B. Gonzalez|last6=Castelo|first6=B.|last7=Bonfill|first7=T.|last8=Martinez Trufero|first8=J.|last9=Grau|first9=J. Jose|last10=Mesia|first10=R.|title=SEOM clinical guideline in nasopharynx cancer (2017)|journal=Clinical and Translational Oncology|volume=20|issue=1|year=2017|pages=84–88|issn=1699-048X|doi=10.1007/s12094-017-1777-0}}</ref><ref name="LeeNg2014">{{cite journal|last1=Lee|first1=Anne W.M.|last2=Ng|first2=Wai Tong|last3=Chan|first3=Lucy L.K.|last4=Hung|first4=Wai Man|last5=Chan|first5=Connie C.C.|last6=Sze|first6=Henry C.K.|last7=Chan|first7=Oscar S.H.|last8=Chang|first8=Amy T.Y.|last9=Yeung|first9=Rebecca M.W.|title=Evolution of treatment for nasopharyngeal cancer – Success and setback in the intensity-modulated radiotherapy era|journal=Radiotherapy and Oncology|volume=110|issue=3|year=2014|pages=377–384|issn=01678140|doi=10.1016/j.radonc.2014.02.003}}</ref><ref name="ChuaMa2006">{{cite journal|last1=Chua|first1=Daniel T.T.|last2=Ma|first2=Jun|last3=Sham|first3=Jonathan S.T.|last4=Mai|first4=Hai-Qiang|last5=Choy|first5=Damon T.K.|last6=Hong|first6=Ming-Huang|last7=Lu|first7=Tai-Xiang|last8=Au|first8=Gordon K.H.|last9=Min|first9=Hua-Qing|title=Improvement of survival after addition of induction chemotherapy to radiotherapy in patients with early-stage nasopharyngeal carcinoma: Subgroup analysis of two Phase III trials|journal=International Journal of Radiation Oncology*Biology*Physics|volume=65|issue=5|year=2006|pages=1300–1306|issn=03603016|doi=10.1016/j.ijrobp.2006.02.016}}</ref><ref name="Ribassin-MajedMarguet2017">{{cite journal|last1=Ribassin-Majed|first1=Laureen|last2=Marguet|first2=Sophie|last3=Lee|first3=Anne W.M.|last4=Ng|first4=Wai Tong|last5=Ma|first5=Jun|last6=Chan|first6=Anthony T.C.|last7=Huang|first7=Pei-Yu|last8=Zhu|first8=Guopei|last9=Chua|first9=Daniel T.T.|last10=Chen|first10=Yong|last11=Mai|first11=Hai-Qiang|last12=Kwong|first12=Dora L.W.|last13=Cheah|first13=Shie-Lee|last14=Moon|first14=James|last15=Tung|first15=Yuk|last16=Chi|first16=Kwan-Hwa|last17=Fountzilas|first17=George|last18=Bourhis|first18=Jean|last19=Pignon|first19=Jean Pierre|last20=Blanchard|first20=Pierre|title=What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis|journal=Journal of Clinical Oncology|volume=35|issue=5|year=2017|pages=498–505|issn=0732-183X|doi=10.1200/JCO.2016.67.4119}}</ref>
*Standard treatments for patients with nasopharyngeal carcinoma include:<ref>http://www.cancer.gov/types/head-and-neck/hp/nasopharyngeal-treatment-pdq#section/_50</ref>
 
**External beam [[radiation therapy]] alone
**Concurrent chemoradiation followed by adjuvant chemotherapy
**Chemotherapy alone for [[metastatic]] disease
*Undifferentiated subtype of nasopharyngeal carcinoma is highly radiosensitive
===Treatment according to Stages===
===Treatment according to Stages===
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
Line 22: Line 18:
Stage 1
Stage 1
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*External beam radiation
*[[External beam radiotherapy|External beam radiation]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
Stage 2
Stage 2
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Chemotherapy given with radiation therapy, followed by more chemotherapy
*[[Chemotherapy]] given with [[radiation therapy]], followed by more [[chemotherapy]]
*Radiation therapy to the tumor and lymph nodes in the neck
*[[Radiation therapy]] to the [[tumor]] and [[lymph nodes]] in the [[neck]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
Stage 3
Stage 3
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Chemotherapy]] given with radiation therapy, which may be followed by more chemotherapy
*[[Chemotherapy]] given with [[radiation therapy]], which may be followed by more [[chemotherapy]]
*[[Radiation therapy]]
*[[Radiation therapy]]
*Radiation therapy followed by surgery to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy
*[[Radiation therapy]] followed by [[surgery]] to remove cancer -containing [[lymph nodes]] in the [[neck]] that remain or come back after [[radiation therapy]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
Stage 4
Stage 4
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Chemotherapy given with radiation therapy, followed by more chemotherapy
*[[Chemotherapy]] given with [[radiation therapy]], followed by more [[chemotherapy]]
*Radiation therapy
*[[Radiation therapy]]
*Radiation therapy followed by [[surgery]] to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy
*[[Radiation therapy]] followed by [[surgery]] to remove cancer -containing [[lymph nodes]] in the [[neck]] that remain or come back after [[radiation therapy]]
*Chemotherapy for cancer that has metastasized (spread) to other parts of the body
*[[Chemotherapy]] for [[cancer]] that has [[metastasized]] (spread) to other parts of the [[body]]
|-
|-
|}
|}


==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapies for nasopharyngeal carcinoma include Cisplatin and 5-Fluorouracil.
*[[Chemotherapy]] drugs that are used in treatment of nasopharyngeal carcinoma are vast, but the two ones which are used more include [[Cisplatin]] and 5-[[Fluorouracil (injection)|Fluorouracil]].


* '''Cisplatin:'''
* '''Cisplatin:'''<ref name="DeckerDrelichman1983">{{cite journal|last1=Decker|first1=David A.|last2=Drelichman|first2=Anibal|last3=Al-Sarraf|first3=Muhyi|last4=Crissman|first4=John|last5=Reed|first5=Melvin L.|title=Chemotherapy for nasopharyngeal carcinoma a ten-year experience|journal=Cancer|volume=52|issue=4|year=1983|pages=602–605|issn=0008-543X|doi=10.1002/1097-0142(19830815)52:4<602::AID-CNCR2820520404>3.0.CO;2-6}}</ref><ref>{{Cite journal
** Preferred regimen: 80- 100 mg/m<sup>2</sup>  slow IV with enough hydration.Repeat every 3 weeks
| author = [[K. Al-Kourainy]], [[J. Crissman]], [[J. Ensley]], [[J. Kish]], [[J. Kelly]] & [[M. Al-Sarraf]]
** Contraindications:
| title = Excellent response to cis-platinum-based chemotherapy in patients with recurrent or previously untreated advanced nasopharyngeal carcinoma
*** Hypersensitivity to platinum-containing compounds
| journal = [[American journal of clinical oncology]]
*** Renal function impairment  
| volume = 11
*** Hearing impairment  
| issue = 4
*** Myelosuppressed patients
| pages = 427–430
*** Nursing or pregnant women
| year = 1988
** Side effects:
| month = August
*** Nephrotoxicity  
| pmid = 2457306
*** Ototoxicity
}}</ref>
*** Myelosuppression
** Preferred regimen: 80-100 mg/m<sup>2</sup>  slow [[Intravenous therapy|IV]] with enough [[hydration]]. Repeat every 3 weeks.
*** Gastrointestinal problems like acute and delayed nausea and vomiting and diarrhea  
** [[Contraindications]]:
*** Electrolyte disturbance:  
*** [[Hypersensitivity]] to [[platinum]]-containing compounds
*** [[Renal function impairment]]
*** [[Hearing impairment]]
*** Myelosuppressed [[patients]]
*** Nursing or [[pregnant]] women
** [[Adverse effect (medicine)|Side effects]]:
*** [[Nephrotoxicity]]
*** [[Ototoxicity]]
*** [[Myelosuppression]]
*** [[Gastrointestinal]] problems like [[Acute (medicine)|acute]] and delayed [[nausea and vomiting]] and [[diarrhea]]
*** [[Electrolyte disturbance]]:  
**** [[Hypomagnesemia]]  
**** [[Hypomagnesemia]]  
**** [[Hypocalcemia]]
**** [[Hypocalcemia]]
Line 69: Line 75:
**** [[Hypokalemia]]  
**** [[Hypokalemia]]  
**** [[Hypophosphatemia]]  
**** [[Hypophosphatemia]]  
*** Irreversible paresthesias
*** [[Irreversible]] [[paresthesias]]
*** Anaphylaxis
*** [[Anaphylaxis]]
'''Note (1):''' Urine output should be maintain more than 100-150 ml/ hr.
'''Note (1):''' [[Urine output]] should be maintain more than 100-150 ml/ hr.


'''Note (2):''' Anti-emetic treatment should be done in all patients.
'''Note (2):''' [[Antiemetic|Anti-emetic]] treatment should be done in all [[patients]].


* '''5-Fluorouracil:'''
* '''5-Fluorouracil:'''<ref name="Al-Sarraf1987">{{cite journal|last1=Al-Sarraf|first1=Muhyi|title=Chemotherapeutic management of head and neck cancer|journal=Cancer and Metastasis Review|volume=6|issue=3|year=1987|pages=181–198|issn=0167-7659|doi=10.1007/BF00144263}}</ref><ref>{{Cite journal
** Preferred regimen: 1000 mg/m<sup>2</sup>/day IV infusion for 4-5 days and repeated every 3 weeks.
| author = [[M. Al-Sarraf]]
** Contraindications:  
| title = Head and neck cancer: chemotherapy concepts
*** Hypersensitivity
| journal = [[Seminars in oncology]]
*** Liver diseases
| volume = 15
*** Renal function impairment  
| issue = 1
| pages = 70–85
| year = 1988
| month = February
| pmid = 3278391
}}</ref>
** Preferred regimen: 1000 mg/m<sup>2</sup>/day [[Intravenous therapy|IV]] [[infusion]] for 4-5 days and repeated every 3 weeks.
** [[Contraindications]]:  
*** [[Hypersensitivity]]
*** [[Liver diseases]]
*** [[Renal function impairment]]
*** Myelosuppressed patients
*** Myelosuppressed patients
*** myelosuppression
*** [[Unstable angina]]
*** Unstable angina
** [[Adverse effect (medicine)|Side effects]]:
** Side effects:
*** [[Myelosuppression]]
*** Myelosuppression
*** [[Gastrointestinal]] problems like [[nausea and vomiting]] and [[diarrhea]]
*** Gastrointestinal problems like nausea and vomiting and diarrhea  
*** [[Mucositis]]
*** Mucositis
*** [[Angina]]
*** Angina
*** Alopecia
*** Alopecia
*** Hand-foot syndrome
*** [[Hand-foot syndrome]]
'''Note (1):''' In [[patients]] with [[liver diseases]] [[dose]] reduction should be considered.


* Main drug interactions: Not compatible with diazepam and droperidol.
'''Note (2):''' Using this drug in familial pyrimidenemia [[patients]] can cause fatal [[neurotoxicity]].


* Main side effects: Myelosuppression, dose-dependent nausea and vomiting, mucositis, angina, alopecia, hand-foot syndrome, and diarrhea.
'''Note (1):''' In patients with liver disease dose reduction should be considered.
'''Note (2):''' Using this drug in familial pyrimidenemia patients, can cause fatal neurotoxicity.
*
**
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 22:53, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]Faizan Sheraz, M.D. [3]

Overview

The mainstay of therapy for nasopharyngeal carcinoma is external beam radiotherapy, supplemented in some cases with chemotherapy. Chemotherapy drugs that are used in treatment of nasopharyngeal carcinoma are vast, but the two ones which are used more include Cisplatin and 5-Fluorouracil.

Medical Therapy

The mainstay of therapy for nasopharyngeal carcinoma is external beam radiotherapy.[1][2][3][4]

Treatment according to Stages
Stage Treatment

Stage 1

Stage 2

Stage 3

Stage 4

Medical Therapy

Note (1): Urine output should be maintain more than 100-150 ml/ hr.

Note (2): Anti-emetic treatment should be done in all patients.

Note (1): In patients with liver diseases dose reduction should be considered.

Note (2): Using this drug in familial pyrimidenemia patients can cause fatal neurotoxicity.

References

  1. ↑ Pastor, M.; Lopez Pousa, A.; del Barco, E.; Perez Segura, P.; Astorga, B. Gonzalez; Castelo, B.; Bonfill, T.; Martinez Trufero, J.; Grau, J. Jose; Mesia, R. (2017). "SEOM clinical guideline in nasopharynx cancer (2017)". Clinical and Translational Oncology. 20 (1): 84–88. doi:10.1007/s12094-017-1777-0. ISSN 1699-048X.
  2. ↑ Lee, Anne W.M.; Ng, Wai Tong; Chan, Lucy L.K.; Hung, Wai Man; Chan, Connie C.C.; Sze, Henry C.K.; Chan, Oscar S.H.; Chang, Amy T.Y.; Yeung, Rebecca M.W. (2014). "Evolution of treatment for nasopharyngeal cancer – Success and setback in the intensity-modulated radiotherapy era". Radiotherapy and Oncology. 110 (3): 377–384. doi:10.1016/j.radonc.2014.02.003. ISSN 0167-8140.
  3. ↑ Chua, Daniel T.T.; Ma, Jun; Sham, Jonathan S.T.; Mai, Hai-Qiang; Choy, Damon T.K.; Hong, Ming-Huang; Lu, Tai-Xiang; Au, Gordon K.H.; Min, Hua-Qing (2006). "Improvement of survival after addition of induction chemotherapy to radiotherapy in patients with early-stage nasopharyngeal carcinoma: Subgroup analysis of two Phase III trials". International Journal of Radiation Oncology*Biology*Physics. 65 (5): 1300–1306. doi:10.1016/j.ijrobp.2006.02.016. ISSN 0360-3016.
  4. ↑ Ribassin-Majed, Laureen; Marguet, Sophie; Lee, Anne W.M.; Ng, Wai Tong; Ma, Jun; Chan, Anthony T.C.; Huang, Pei-Yu; Zhu, Guopei; Chua, Daniel T.T.; Chen, Yong; Mai, Hai-Qiang; Kwong, Dora L.W.; Cheah, Shie-Lee; Moon, James; Tung, Yuk; Chi, Kwan-Hwa; Fountzilas, George; Bourhis, Jean; Pignon, Jean Pierre; Blanchard, Pierre (2017). "What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis". Journal of Clinical Oncology. 35 (5): 498–505. doi:10.1200/JCO.2016.67.4119. ISSN 0732-183X.
  5. ↑ Decker, David A.; Drelichman, Anibal; Al-Sarraf, Muhyi; Crissman, John; Reed, Melvin L. (1983). "Chemotherapy for nasopharyngeal carcinoma a ten-year experience". Cancer. 52 (4): 602–605. doi:10.1002/1097-0142(19830815)52:4<602::AID-CNCR2820520404>3.0.CO;2-6. ISSN 0008-543X.
  6. ↑ K. Al-Kourainy, J. Crissman, J. Ensley, J. Kish, J. Kelly & M. Al-Sarraf (1988). "Excellent response to cis-platinum-based chemotherapy in patients with recurrent or previously untreated advanced nasopharyngeal carcinoma". American journal of clinical oncology. 11 (4): 427–430. PMID 2457306. Unknown parameter |month= ignored (help)
  7. ↑ Al-Sarraf, Muhyi (1987). "Chemotherapeutic management of head and neck cancer". Cancer and Metastasis Review. 6 (3): 181–198. doi:10.1007/BF00144263. ISSN 0167-7659.
  8. ↑ M. Al-Sarraf (1988). "Head and neck cancer: chemotherapy concepts". Seminars in oncology. 15 (1): 70–85. PMID 3278391. Unknown parameter |month= ignored (help)

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