Use of transoral nasopharyngeal brush biopsy for Epstein-Barr virus DNA detection of local recurrence of nasopharyngeal carcinoma after radiotherapy.

BACKGROUND: The purpose of this study was to evaluate the use of transoral nasopharyngeal brush biopsies and quantitative polymerase chain reaction (qPCR) Epstein-Barr virus (EBV) DNA detection system in surveillance of local recurrence of nasopharyngeal carcinoma (NPC). METHODS: A prospective cohort study was performed to compare the nasopharyngeal epithelial EBV DNA levels of patients with recurrent NPC and the control group of postirradiated patients with NPC disease in remission. RESULTS: Fourteen patients with recurrent NPC and 15 postirradiated patients in disease remission were recruited for transoral brush biopsies. There was a statistically significant difference between the mean EBV detection level (EDL) of the recurrence group (EDL = 2.38) and the control group (EDL = 0.17; p < .0001). There was no significant correlation between the EDL and the recurrence of T classification disease. CONCLUSION: The transoral brush biopsy and qPCR EBV DNA detection system may provide an additional surveillance strategy for recurrence of NPC. Further study is required to validate its sensitivity, specificity, and cost-effectiveness. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1301-E1304, 2016.

Management of pseudoaneurysms of the internal carotid artery in postirradiated nasopharyngeal carcinoma patients.

OBJECTIVES/HYPOTHESIS: Massive epistaxis due to ruptured pseudoaneurysm of the internal carotid artery (ICA) is an often fatal complication of radiation treatment for patients with nasopharyngeal carcinoma. We review the clinical characteristics and predictors of survival in patients suffering from this serious complication after radiotherapy. STUDY DESIGN: Retrospective case series. METHODS: Clinical records and radiological investigations of postirradiated NPC patients with ICA pseudoaneurysm diagnosed with digital subtraction angiography in Queen Mary Hospital from January 2003 to December 2012 were reviewed. Risk factors analyzed for survival included gender, size of initial tumor, history of second course of radiotherapy, history of previous maxillary swing nasopharyngectomy, presence of persistent disease, successful initial hemostasis, successful airway control, and endovascular treatment. RESULTS: Twenty-six were included in the analysis. Twenty-three patients underwent endovascular treatment, and 20 (87%) had successful control of the bleeding. Eighteen (69%) patients survived. Univariate analysis showed that successful temporary control of bleeding and airway control were associated with survival. CONCLUSIONS: Prompt bleeding control and airway management is necessary to improve survival. Endovascular treatment is a good definitive treatment option with a high success rate.