Nasopharyngeal Cancer: A Practical Guide on Diagnosis and Treatment (Practical Guides in Radiation Oncology)

This book provides up-to-date guidance that will assist radiation oncologists during the day-to-day management of nasopharyngeal cancer. After discussion of diagnosis and staging, target delineation techniques and treatment planning are described for both intensity-modulated and particle radiation therapy. Detailed information is then presented on the application of radiation therapy in different disease settings, from early stage disease to metastatic disease. Due attention is paid to the role of multimodality treatment and new and advanced technologies in particular circumstances, such as local recurrence. In addition, follow-up and the management of late toxicities are explained and management strategies are documented for special situations and groups, including pediatric patients. The book is published within the Springer series Practical Guides in Radiation Oncology. Like other volumes in the series, it is designed for hands-on use by both radiation oncology residents and practicing radiation oncologists. It will also be of value for head and neck physicians. Contents 1: Diagnosis and Staging of Nasopharyngeal Cancer 1.1 Introduction 1.2 Essential Anatomy of the Nasopharynx 1.3 Natural History and Routes of Tumor Spread 1.4 Presenting Symptoms 1.5 Diagnostic Workup and Staging Investigations 1.6 Staging of NPC—AJCC/UICC TNM Eighth Ed. 1.6.1 Definition of Primary Tumor (T) 1.6.2 Definition of Regional Lymph Node (N) 1.7 Summary References 2: Contouring Methods and Atlas of Organs at Risk 2.1 Introduction 2.2 Window Width and Window Level 2.3 Consensus on Major Disputable Organs at Risk 2.3.1 Temporal Lobe 2.3.2 Middle Ear 2.3.3 Inner Ear 2.3.4 Spinal Cord 2.3.4.1 Parotid Gland 2.4 Derivation of Delineation Atlas 2.5 Dose Constraints References 3: Management of Neck Disease in Early Stage Disease 3.1 Introduction 3.2 Anatomy of Cervical Lymph Node Levels 3.2.1 Level Ia 3.2.2 Level Ib 3.2.3 Level II 3.2.4 Level III 3.2.5 Level IVa 3.2.6 Level IVb 3.2.7 Level Va and Vb 3.2.8 Level Vc 3.3 Patterns of Cervical Lymph Node Metastasis 3.4 Elective Neck Irradiation for NPC Patients References 4: Multimodality Management for Locally Advanced Nasopharyngeal Cancer 4.1 Introduction 4.1.1 Evidence of Combined Treatment Strategy 4.1.1.1 Concurrent Chemotherapy 4.1.1.2 Adjuvant Chemotherapy 4.1.1.3 Induction Chemotherapy 4.1.2 Recommendations for Treatment 4.1.3 Future Directions References 5: Intensity-Modulated Radiation Therapy for Nasopharyngeal Cancer 5.1 Introduction 5.2 Intensity-Modulated Radiation Therapy for NPC: Clinical Evidences 5.3 Techniques of IMRT for NPC 5.3.1 Immobilization, Localization, and Simulation 5.3.2 Definition of Target Volumes 5.3.3 Dose Prescription to PTVs 5.3.4 Dose Constrains for Critical Organs at Risk and Planning Priorities 5.3.5 Delivery, Imaging Guidance, and Verification 5.4 Radiation-Induced Adverse Events and Their Management 5.5 Summary and Future Direction References 6: Particle Beam Radiation Therapy for Nasopharyngeal Cancer 6.1 Introduction 6.2 Characteristics of Charged Particle Beams 6.3 Delivery Technologies of PBRT for Head and Neck Cancers 6.4 Registration and Planning 6.4.1 Patient Registration and Immobilization 6.4.2 Definition and Delineation of Target Volumes 6.4.3 Beam Directions 6.4.4 Dose and Fractionation of PBRT 6.4.5 Dose Constraints for Organs at Risk (OARs) 6.4.6 Re-irradiation 6.4.7 Verification 6.5 The Use of Chemotherapy with PBRT 6.6 Clinical Evidence of the Use of PBRT for Nonmetastatic NPC 6.6.1 Proton Therapy 6.6.2 Carbon-Ion Radiation Therapy 6.7 Future Directions References 7: Treatment of Metastatic Nasopharyngeal Cancer 7.1 Introduction 7.2 Clinical Evidences for Treatment Selection 7.2.1 Cytotoxic Agents 7.2.2 Local Radiation Therapy 7.2.3 Maintenance Chemotherapy 7.3 Second-Line Treatment for mNPC 7.3.1 Cytotoxic Chemotherapy Agents 7.3.2 Molecular Targeted Agents 7.3.3 Immunotherapy Agents 7.4 Recommendation for Treatment 7.5 Future Directions References 8: Salvage Radiation Therapy for Locally Recurrent Nasopharyngeal Cancer 8.1 Introduction 8.2 Intensity-Modulated Radiation Therapy (IMRT) for LR-NPC 8.2.1 Salvage IMRT for LR-NPC: The Clinical Evidence 8.2.2 Treatment Techniques of Salvage IMRT 8.3 Particle Beam Radiation Therapy (PBRT) for LR-NPC 8.3.1 Characteristics of PBRT and Its Advantages for Head and Neck Cancer Treatment 8.3.2 Proton Radiation Therapy for LR-NPC: The Clinical Evidence 8.3.3 Carbon-Ion Radiation Therapy for LR-NPC: The Clinical Evidence 8.3.4 Planning and Delivery of PBRT for LR-NPC Re-irradiation 8.4 Future Direction References 9: The Use of the EBV Blood Test in Clinical Management Decision 9.1 Introduction 9.2 Prior Studies of the Anti-EBV Antibody Test in the NPC Patients 9.3 Diagnostic Role of the EBV DNA Blood Test 9.3.1 Aids in NPC Screening for General Population 9.3.2 Aids in the Differential Diagnosis of Clinically Suspected Subjects 9.3.3 Aids in the Differential Diagnosis of Previously Treated NPC Patients 9.4 Treatment Strategy Guidance for NPC Patients 9.4.1 Aids in the Prognostic Prediction and Risk Grouping 9.4.2 Early Prediction of Treatment Outcomes in Recurrent/Metastatic Patients 9.4.3 Management of Post-RT Residual EBV DNA Patients 9.4.4 Supplement to the TNM Staging 9.4.5 Monitoring Role in Posttreatment Follow-up 9.5 Some Problems to Be Solved for the EBV DNA Blood Tests 9.6 Summary References 10: Management of Radiotherapy-Induced Acute Toxicities 10.1 Introduction 10.2 Oral Mucositis 10.3 Oral Candidiasis 10.4 Pain 10.5 Dysphagia 10.6 Malnutrition 10.7 Radiation Dermatitis 10.8 Dysgeusia 10.9 Ototoxicity 10.10 Rhinosinusitis References 11: Management of Radiation-Induced Late Complications and Evidence-Based Surveillance for Nasopharyngeal Carcinoma 11.1 Introduction 11.2 Management of Radiotherapy-Related Late Complications 11.2.1 Late Oral Complications 11.2.2 Late Dysphagia 11.2.3 Radiation Fibrosis Syndrome (RFS) 11.2.4 Head and Neck Lymphedema 11.2.5 Hypothyroidism 11.2.6 Temporal Lobe Necrosis (TLN) 11.3 Guidelines for Follow-Up After Treatment 11.3.1 Rationale of Follow-Up After Definitive Treatment 11.3.2 The Use of Endoscopy and Imaging Studies 11.3.2.1 Clinical Examination and Endoscopy 11.3.2.2 Imaging for Locoregional Recurrence 11.3.2.3 Imaging for Distant Metastases 11.3.3 Lab Tests 11.3.3.1 Routine Lab and Pituitary Function Studies 11.3.3.2 EBV-DNA Test References 12: Special Consideration in Pediatric Nasopharyngeal Cancer 12.1 Introduction 12.2 Diagnosis and Staging 12.3 Management of Early and Locoregionally Advanced Disease 12.3.1 Multimodality Management for PNCP: The Basic Principles and Evidences 12.3.2 Radiotherapy Technology and Strategy in Toxicity Reduction 12.3.3 The Use of Chemotherapy for PNPC: The Rationales and Suggestions 12.4 Management of Metastatic and Recurrent Disease 12.5 Follow-Up of Pediatric Patients and Management of Treatment-Induced Adverse Effects 12.5.1 Acute Toxicities 12.5.2 Late Toxicities Pertinent to PNPC Management 12.6 Summary References