NASOPHARYNGEAL CARCINOMA Irene A Chidothe 3 RD Year Clinical - - PowerPoint PPT Presentation

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NASOPHARYNGEAL CARCINOMA Irene A Chidothe 3 RD Year Clinical - - PowerPoint PPT Presentation

Feb 11, 2024 164 likes •338 views

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

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NASOPHARYNGEAL CARCINOMA

Irene A Chidothe

3RD Year Clinical Oncology Registrar University of Cape Town

Supervisor: Dr Sameera Dalvie 15/02/2018

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DISCLOSURE

  • Sponsored by CIPLA Oncology
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Case: Summary

  • 40 year old male, Mr SJ

–Reviewed Groote Schuur Hospital Combined ENT Clinic –October 2017: Nasopharynx carcinoma

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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)
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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
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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

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Work Up – Imaging; CT

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MRI, FDG – PET/CT

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FDG – PET/CT; No Metastatic Disease

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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
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Summary

  • Patient Factors

–40 year old male –ECOG 1 –No comorbidities

  • Tumour Factors

–cT3 cN3 cM0; Stage IVA (AJCC 8th ed.) –Undifferentiated EBV associated

–? EBV Titers

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Our Plan

  • Induction chemotherapy

–Cisplatin 100 mg/m2 d1, 5FU 1000 mg/m2 d1- 4; 3 weekly x 3 –Monitor audiogram on chemo

  • Definitive Chemoradiation

–Weekly Cisplatin 40 mg/m2 –TD70Gy/35#, Volumetric Modulated Arc Therapy

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Discussion Points

  • Optimal sequencing of treatment
  • Choice of chemotherapy

– Alternative induction regimens – Dose adjustments – Alternative radiosensitisers

  • Role of targeted agents

– Neoadjuvant, Concurrent RT

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Thank you