Positron Emission Tomography Scanning and Epstein-Barr Virus DNA Levels in the Staging and Follow-Up of Nasopharyngeal Carcinoma.
1. Patients with nasopharyngeal carcinoma are staged according to the 2002 American Joint
Committee on Cancer (AJCC) criteria. MRI is the imaging modality of choice for staging
and follow-up of nasopharyngeal carcinoma. The goal is to conduct a pilot study to
compare the staging findings on MRI with those on PET scanning in both pre- and
post-therapy patients. The end point is to document the degree of concordance between
the two modalities with respect to the anatomic location and volume of disease at the
time of initial staging and on follow up and to determine how any differences observed
may alter staging and management including radiation planning. We hypothesize that PET
scanning will be able to detect recurrence and residual disease within the radiated
tissue earlier than MRI.
2. Nasopharyngeal carcinoma is associated with elevated titers of Epstein Barr virus (EBV)
cell free, plasma DNA. Fluctuation i.e. - elevation in EBV DNA levels following therapy
may serve as a potential marker for recurrent or residual disease. We believe that a
change in EBV DNA titer precedes changes on conventional MRI and possibly PET scans in
patients with recurrent disease. We also predict, that due to its sensitivity, that EBV
titer levels will be more sensitive in the evaluation of tumor response to therapy, as
well predicting tumor recurrence. The second goal is to conduct a trial to compare the
sensitivity of MRI, PET and EBV titers in the assessment of recurrent disease.
Observational Model: Defined Population, Observational Model: Natural History, Time Perspective: Longitudinal, Time Perspective: Prospective
Eugene Yu, MD
University Health Network, University of Toronto
Canada: Health Canada