NASOPHARYNGEAL CARCINOMA Irene A Chidothe 3 RD Year Clinical Oncology Registrar University of Cape Town Supervisor: Dr Sameera Dalvie 15/02/2018
DISCLOSURE • Sponsored by CIPLA Oncology
Case: Summary • 40 year old male, Mr SJ – Reviewed Groote Schuur Hospital Combined ENT Clinic – October 2017: Nasopharynx carcinoma
Case: History • Symptoms x 5/12 – Bilateral otalgia, Bilateral neck masses, nasal congestion, tight neck, headache – No systemic symptoms • No comorbidities • Carpenter, smoker (10 pack years)
Examination • ECOG PS 1, Nasal speech, Comfortable • H&N – Right CN XII fallout (LMN) , No trismus, no Horner’s syndrome, CN II - XI normal, no ear effusions – IDL: Normal – Right neck: level II-V, 7x 7 cm fixed node – Left neck: mobile level II-III 6 x 2.5 cm node • Chest/Abdomen: Clear
Work Up - Biopsies • Biopsy Right Neck Node: 07/2017 – Non-keratinizing carcinoma • Biopsy Nasopharynx: 08/2017 - Non-keratinizing carcinoma, undifferentiated ( former WHO III) – EBV and EBER ISH positive
Work Up – Imaging; CT
MRI, FDG – PET/CT
FDG – PET/CT; No Metastatic Disease
Work Up • Bloods – Full blood count, renal function tests, HIV serology – LDH: 212 U/L (100 – 190) – EBV Titers: Not routinely done • Audiogram: – Bilateral asymmetrical mixed hearing loss • Right ear high frequency moderate - severe • Left ear moderate
Summary • Patient Factors – 40 year old male – ECOG 1 – No comorbidities • Tumour Factors – cT3 cN3 cM0; Stage IVA (AJCC 8 th ed.) – Undifferentiated EBV associated – ? EBV Titers
Our Plan • Induction chemotherapy – Cisplatin 100 mg/m 2 d1, 5FU 1000 mg/m 2 d1- 4; 3 weekly x 3 – Monitor audiogram on chemo • Definitive Chemoradiation – Weekly Cisplatin 40 mg/m 2 – TD70Gy/35#, Volumetric Modulated Arc Therapy
Discussion Points • Optimal sequencing of treatment • Choice of chemotherapy – Alternative induction regimens – Dose adjustments – Alternative radiosensitisers • Role of targeted agents – Neoadjuvant, Concurrent RT
Thank you
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