## Nasopharyngeal Carcinoma — Management and Prognostic Markers ### Treatment Strategy by Stage **Key Point:** Nasopharyngeal carcinoma is a **radiosensitive tumour**. Radiotherapy (±chemotherapy) is the cornerstone of treatment across all stages; surgery plays a limited role and is NOT first-line for any stage. ```mermaid flowchart TD A[Nasopharyngeal Carcinoma Diagnosis]:::outcome --> B{Stage?}:::decision B -->|Stage I| C[Radiotherapy alone]:::action B -->|Stage II–IV| D[Concurrent chemoradiotherapy]:::action C --> E[IMRT preferred]:::action D --> E E --> F[Consider adjuvant chemotherapy<br/>for high-risk features]:::action F --> G[Surveillance with EBV DNA]:::action ``` ### Treatment Modalities | Stage | Treatment | Rationale | |-------|-----------|----------| | I (T1 N0) | RT alone (66–70 Gy) | Excellent prognosis; chemotherapy not routinely added | | II–IVB | Concurrent CRT ± adjuvant CT | Improved locoregional control and OS | | Recurrent/Metastatic | Palliative chemotherapy ± RT | Platinum-based regimens (cisplatin + 5-FU) | **High-Yield:** Surgery is reserved for: - **Neck dissection** for residual cervical lymph nodes after chemoradiotherapy - **Salvage surgery** for recurrent disease in the nasopharynx (rare) - Surgery is **NOT** first-line for primary tumour control ### Intensity-Modulated Radiotherapy (IMRT) **Clinical Pearl:** IMRT has become the standard technique for NPC because it: - Delivers higher doses to the tumour with steep dose gradients - Spares surrounding normal tissues (parotid glands, spinal cord, temporal lobes) - Reduces acute and late toxicities compared to 2D conventional radiotherapy - Improves locoregional control rates ### EBV DNA as a Prognostic and Monitoring Biomarker **Key Point:** Plasma EBV DNA titre is a **powerful prognostic marker** in NPC: - **Pre-treatment EBV DNA level** is an independent prognostic factor (high levels → worse prognosis) - **Post-treatment EBV DNA clearance** predicts treatment response - **Rising EBV DNA during follow-up** is highly sensitive for detecting recurrence before imaging changes - Used for surveillance and early detection of relapse **High-Yield:** EBV DNA monitoring is particularly valuable in endemic regions where NPC is common and follow-up imaging may be limited. ### Why Option 4 Is Incorrect Option 4 states that "**Surgery is the first-line treatment for all stages**" — this is fundamentally incorrect. NPC is a radiosensitive tumour, and radiotherapy (with or without chemotherapy) is the primary treatment modality for all stages. Surgery plays only a **secondary role** in neck dissection for residual nodes or salvage therapy for recurrence. Making surgery first-line would result in inadequate treatment and poor outcomes. **Warning:** This is a critical clinical error. A student who selects surgery as first-line for NPC would deliver suboptimal care. The NEET PG examiner expects recognition that NPC is fundamentally a **radiotherapy-based disease**.
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.