nasopharyngeal carcinoma treatment guidelines

This personal information is used solely to provide you a more personalized experience when using the Guideline Central website and app. The search term nasopharyngeal neoplasm (MeSH) was used. This is the current release of the guideline. This is a specialized surgery that should only be done by a surgeon with a great deal of experience with it, so it’s not available at all medical centers. As detailed in the Guideline Utilization Resource Unit Handbook (see the "Availability of Companion Documents" field), the working group members may decide to adopt the recommendations of another institution without any revisions, adapt the recommendations of another institution or institutions to better reflect local practices, or develop their own set of recommendations by adapting some, but not all, recommendations from different guidelines. Review of Published Meta-Analyses Systematic Review with Evidence Tables. PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other healthcare providers on definitive-intent chemoradiotherapy for patients with stage II-IVA nasopharyngeal carcinoma (NPC). Although phase II studies may be referenced in the discussion section, only phase III randomized studies and meta-analyses were considered for the literature search and review. These NPCS have spread to distant parts of the body and can be hard to treat. Patients with these stages of NPC usually get chemoradiation (chemotherapy given along with radiation therapy) to the nasopharynx and neck lymph nodes. Similar to the American Society of Clinical Oncology (ASCO) methodology for formulating guideline recommendations, the Guideline Utilization Resource Unit (GURU) does not use formal rating schemes for describing the strength of the recommendations, but rather describes, in conventional and explicit language, the type and quality of the research and existing guidelines that were taken into consideration when formulating the recommendations. When the draft guideline document has been completed, revised, and reviewed by the Knowledge Management Specialist and the working group members, it is sent to all members of the Provincial Tumour Team for review and comment. Our team of expert journalists brings you all angles of the cancer story – from breaking news and survivor stories to in-depth insights into cutting-edge research. Other treatment options in these stages include induction chemo followed by chemoradiation or just chemoradiation, or possibly immunotherapy (alone or with chemo). Edmonton (Alberta): CancerControl Alberta; 2013 Dec. 17 p. (Clinical practice guideline; no. There is an unbalanced ethnic and geographic distribution in nasopharyngeal carcinoma (NPC) cases, with the highest incidences occurring in south China and Southeast Asia. With advancements in technology, high target conformality is possible. Members of the Alberta Provincial Head and Neck Tumour Team include medical oncologists, radiation oncologists, head and neck surgeons, head and neck reconstructive surgeons, oral and maxillofacial surgeons, dentists, neuroradiologists, nurses, speech and language pathologists, pathologists, pharmacists, and other allied health professionals. There was no direct industry involvement in the development or dissemination of this guideline. This is usually followed by more chemo, most often with cisplatin plus 5-FU. Experts agree that the best way to treat NPC in the more advanced stages is in a clinical trial. Chemotherapy plus the targeted drug cetuximab (Erbitux) or immunotherapy may be other options. Please visit our privacy policy page for more information. It is invasive with risk of hemorrhage or infection. Participation of members of the Alberta Provincial Head and Neck Tumour Team in the development of this guideline has been voluntary and the authors have not been remunerated for their contributions. It is intended to help you and your family make informed decisions, together with your doctor. BackgroundTransnasal endoscopic nasopharyngectomy (TEN) has become increasingly used for recurrent nasopharyngeal carcinoma (rNPC); however, there is no report on the definitive resectable contour for TEN according to the latest staging system for nasopharyngeal carcinoma. Another option in some cases is to give chemoradiation as the first treatment. Thank you for being a user of Guideline Central! However the developers of this guideline are satisfied it was developed in an unbiased manner. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few. Cancer is called recurrent when it come backs after treatment. For all nasopharyngeal carcinoma (NPC) patients, intensity modulated radiotherapy (IMRT) with daily image guidance should be offered. If NPC returns after treatment, your choices depend on the location and extent of the cancer, which treatments were used the first time around, and your overall health. Nasopharyngeal carcinoma cancer, affecting the upper part of the throat is the most common cancer for younger male. Specific research questions to be addressed by the guideline document were formulated by the guideline lead(s) and Knowledge Management (KM) Specialist using the PICO question format (patient or population, intervention, comparisons, outcomes). We’ve invested more than $4.9 billion in cancer research since 1946, all to find more – and better – treatments, uncover factors that may cause cancer, and improve cancer patients’ quality of life. If IMRT is unavailable, patients should be transferred to institutions that could implement IMRT whenever possible. At the American Cancer Society, we’re on a mission to free the world from cancer. 2013; Available at: http://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Clinical examination provides information on mucosal involvement but is unable to determine the deep extension or the presence of skull base inv … – US Government Rights. Objective: Explore the usefulness of pre-treatment CTperfusion (CTP) and clarify the parameters in predicting the treatment response. By updating our privacy policy with clearer language, our goal is to help you better understand what data we collect and how we use that information. For reprint requests, please see our Content Usage Policy. The treatment information given here is not official policy of the American Cancer Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. Nasopharyngeal carcinoma arises in the lining of the nasal cavity and pharynx, and it accounts for about one-third of all cancers of the upper airways in children. If there are still signs of cancer after the initial chemo, another chemo regimen using different drugs may be tried. All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities. A formal cost analysis was not performed and published cost analyses were not reviewed. This is preventive (prophylactic) radiation. The Alberta Provincial Head and Neck Tumour Team adopted the recommendations of the National Comprehensive Cancer Network (NCCN), with modifications to fit the Alberta context (see the "Adaptation" field). Multimodality Therapy for Locoregional Nasopharyngeal Carcinoma—A Decision Tool ... National Comprehensive Cancer Network guidelines offer multiple treatment options that ... Zhang LL, Xu F, Song D, et al. For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. It's important to understand the goal of any further treatment – whether it's to try to cure the cancer, to slow its growth, or to help relieve symptoms – as well as the likelihood of benefits and risks. After nasopharyngeal cancer (NPC) is found and staged, your cancer care team will discuss treatment options (choices) with you. Different types of programs and support services may be helpful, and can be an important part of your care. Readers with questions regarding guideline content are directed to contact the guideline developer. Three types of standard treatment are used: Radiation therapy Chemotherapy ; Surgery ; New types of treatment are being tested in clinical trials. Treatment should be individualized based on patient performance status and extent of disease. Ideally, this review will occur prior to the annual Provincial Tumour Team meeting, and a discussion of the proposed edits will take place at the meeting. Alberta Provincial Head and Neck Tumour Team. [36 references]. The recommendations contained in this guideline are a consensus of the Alberta Provincial Head and Neck Tumour Team and are a synthesis of currently accepted approaches to management, derived from a review of relevant scientific literature. We couldn’t do what we do without our volunteers and donors. Please see the advanced-stage treatment algorithm in the original guideline document. Patient participation in clinical trials is recommended. Imaging plays an important role in the staging of nasopharyngeal carcinoma. Head and neck examination (note that the ranges are based on risk of relapse, second primaries, treatment sequelae, and toxicities): After 5 years, annually, as clinically indicated, Post-treatment baseline imaging of primary and neck, if treated, within 6 months of treatment for T3–4 or N2–3 disease only; further reimaging, as indicated, Annual thyroid-stimulating hormone (TSH) screening up to 5 years, Speech/swallowing assessment at 6 and 12 months post-RT; additional assessment and rehabilitation, as clinically indicated, Hearing evaluation and rehabilitation, as clinically indicated, Follow-up with a registered dietitian to evaluate nutritional status and until the patient achieves a nutritionally stable baseline, Routine hospital-based dental follow-up and evaluation up to 3 years, Advanced-stage (T1, N1–3, T2–4, Any N, M0 and Any T, N, M1), Unlimited Access to Thousands of Summaries, Personalized Content Recommendations and Alerts, Access Saved Content on All Mobile Devices. For example, if the cancer has spread to the spine, radiation may be given to the area to relieve pain and reduce the chances of further problems. It's done because some patients may have cancer cells in these lymph nodes that can’t be detected. High doses are needed to achieve optimal levels of tumour control, and dosimetric inadequacy remains one of the most important independent factors affecting treatment outcome. As part of our continued efforts towards protecting your privacy and personal information, we’ve made recent updates to our privacy policy. It’s important to weigh the benefits of each treatment option against the possible risks and side effects. Childhood nasopharyngeal cancer treatment options include chemotherapy, external and internal radiation therapy, surgery, and immunotherapy (interferon). Target delineation in NPC often proves challenging because of the notoriously narrow therapeutic margin. Evidence tables containing the first author, year of publication, patient group/stage of disease, methodology, and main outcomes of interest are assembled using the studies identified in the literature search. The usual treatment for these early stage cancers is radiation therapyaimed at the tumor. This step ensures that those intended to use the guideline have the opportunity to review the document and identify potential difficulties for implementation before the guideline is finalized. Even if a cure is not possible, it's important to remember that there are many options to relieve symptoms of advanced cancer. CARCINOMA: CSCO-ASCO GUIDELINE Clinical Question Recommendation Evidence Rating What are the recommended radiotherapy techniques and fractionation regimens for patients with stage II to IVA nasopharyngeal carcinoma? Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes. A detailed description of the methodology followed during the guideline development process can be found in the Guideline Utilization Resource Unit Handbook (see the "Availability of Companion Documents" field). January 6, 2021. Treatment options. NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. The choice of chemotherapy should be individualized based on patient characteristics (performance status and goals of therapy). Purpose: Target delineation in nasopharyngeal carcinoma (NPC) often proves challenging because of the notoriously narrow therapeutic margin. Note: Different principles may apply to pediatric patients. High doses are needed to achieve optimal levels of tumour control, despite the apparent radio-sensitivity of the tumour in many patients. 1 CURRENT TREATMENT OF NASOPHARYNGEAL CARCINOMA Oleh, Prof. Dr. dr. Widodo Ario Kentjono, Sp. Immunotherapy is a newer option to treat some of these cancers, either alone or along with chemo. Background: Direct nasopharyngoscope with biopsy is the gold standard for assessing tumor response of nasopharyngeal carcinoma (NPC). National Comprehensive Cancer Network. The Alberta Provincial Head and Neck Tumour Team adopted the recommendations from the following source, with modifications to fit the Alberta context: National Comprehensive Cancer Network. Referral to palliative care services can be offered to patients. Available Every Minute of Every Day. Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion-criteria.aspx. There are many reasons you might decide not to get cancer treatment, but it’s important to talk to your doctors and you make that decision. Register NPC is commonly treated with radiotherapy (RT) and chemotherapy. Existing guidelines on the topic are assessed by the KM Specialist using portions of the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument (http://www.agreetrust.org) and those meeting the minimum requirements are included in the evidence document. Results were limited to phase III clinical trials, comparative studies, controlled clinical trials, guidelines, meta-analyses, multicenter studies, practice guidelines, randomized controlled trials and systematic reviews involving human subjects (19+ years) and published in English. Cancer.org is provided courtesy of the Leo and Gloria Rosen family. The Alberta Provincial Head and Neck Tumour Team have adopted the recommendations of the National Comprehensive Cancer Network (NCCN), with modifications to fit the Alberta context (see the "Adaptation" field). If available, patients should consider participating in a clinical trial. To recommend a cranial border for level IIb in delineating clinical target volumes (CTV) for nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy and to help reach a consensus on contouring level IIb in CTV. Alberta Provincial Head and Neck Tumour Team. You can help reduce your risk of cancer by making healthy choices like eating right, staying active and not smoking. From basic information about cancer and its causes to in-depth information on specific cancer types – including risk factors, early detection, diagnosis, and treatment options – you’ll find it here. They can help you learn what is known (or not known) about the method, which can help you make an informed decision. You and your doctor work together to devise a treatment plan based on several factors, such as the stage of your cancer, your treatment goals, your overall health and the side effects you're willing to tolerate. Add a note. Nasopharyngeal cancer treatment options include radiation therapy, chemoradiation followed by adjuvant chemotherapy, surgery, and chemotherapy. If the cancer recurs in distant sites, options might include chemotherapy or immunotherapy (or both). If chemo has been given already, different chemo drugs may be tried. Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing. But if doctors believe that more radiation would cause serious side effects or if the cancer didn't respond to radiation the first time, surgery (neck dissection) may be used instead. If the cancer can’t be cured, further treatments may be aimed at slowing its growth or relieving symptoms caused by the cancer. Abstract: Nasopharyngeal carcinoma (NPC) is a unique disease endemic in Asia. Chemotherapy in Combination with Radiotherapy for Definitive-intent Treatment of Stage II to IVA Nasopharyngeal Carcinoma. Based on the stage of the cancer, you may have different types of doctors on your treatment team. The National Guideline Clearinghouse and Standards and Guidelines Evidence (SAGE) Directory of Cancer Guidelines were also searched from 2008 to April 5, 2013 for guidelines on NPC. Although there are too few cancer cells in the lymph nodes to cause them to be enlarged, these cells could continue to grow and spread if … Nasopharyngeal Cancer Treatment (Adult) (PDQ®)–Patient Version. Until we do, we’ll be funding and conducting research, sharing expert information, supporting patients, and spreading the word about prevention. National Cancer Institute. The usual treatment for these early stage cancers is radiation therapy aimed at the tumor. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists. The degree to which a recommendation is based on expert opinion of the working group and/or the Provincial Tumour Team members is explicitly stated in the guideline recommendations. March 1, 2018. The aim of this study was to establish the types of TEN for rNPC.Materials and MethodsA total of 101 … Accurate staging is necessary, as the treatment is directly dependent on stage. HN-003). The 2 main treatments for nasopharyngeal … All rights reserved. It’s important to understand what the side effects are likely to be before starting this treatment. Whether you are thinking about treatment, getting treatment, or not being treated at all,  you can still get supportive care to help with pain or other symptoms. If time permits, it is often a good idea to seek a second opinion. Research. Please see the distant metastatic disease treatment algorithm in the original guideline document. 1,2 NPC cells are highly sensitive to irradiation, which has resulted in radiotherapy (RT) becoming the mainstay treatment modality for nonmetastatic NPC. NPC differs significantly from other cancers of the head and neck in its occurrence, causes, clinical behavior, and treatment. Members of your MDT will discuss with you what they think the best treatment option is in your case. This NGC summary was completed by ECRI Institute on August 12, 2014. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms. Learn more about the risk factors, symptoms, tests to diagnose, and treatment of childhood nasopharyngeal cancer in this expert-reviewed summary. Imagine a world free from cancer. Neuro-Oncology. The distribution of the disease demonstrates a clear regional, racial and gender prevalence. Whether you or someone you love has cancer, knowing what to expect can help you cope. Present the guideline at the local and provincial tumour team meetings and weekly rounds. Incidence, diagnosis, staging and risk assessment, treatment, response evaluation and follow-up of cutaneous melanoma. You may feel that you need to make a decision quickly, but it’s important to give yourself time to absorb the information you have learned. Clinical trials are one way to get state-of-the art cancer treatment. Treatment for nasopharyngeal carcinoma usually begins with radiation therapy or a combination of radiation and chemotherapy. After nasopharyngeal cancer (NPC) is found and staged, your cancer care team will discuss treatment options (choices) with you. American Cancer Society medical information is copyrighted material. Please see the early-stage treatment algorithm in the original guideline document. If you’ve been diagnosed with nasopharyngeal cancer (NPC), your treatment team will discuss your options with you. Where there is clinical evidence of residual disease in the neck, neck dissection is recommended, if feasible. If you're diagnosed with nasopharyngeal cancer, you'll be cared for by a team of different specialists who work together called a multidisciplinary team (MDT). Nasopharyngeal carcinoma (NPC), or nasopharynx cancer, is the most common cancer originating in the nasopharynx, most commonly in the postero-lateral nasopharynx or pharyngeal recess (fossa of Rosenmüller), accounting for 50% of cases.NPC occurs in children and adults. CancerControl Alberta recognizes that although industry support of research, education and other areas is necessary in order to advance patient care, such support may lead to potential conflicts of interest. Electronic copies: Available from the Alberta Health Services Web site. Adjuvant chemotherapy using platinum (cisplatin or carboplatin)/5-fluoruracil (5-FU) can be considered following primary treatment. Still, they're not right for everyone. • Patients with nasopharyngeal carcinoma (NPC) should be assessed with rigid and fibre-optic nasendoscopy. The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site. People with cancer need support and information, no matter what stage of illness they may be in. Recurrent or persistent disease: Restaging should be done to assess local, regional and distant disease. Don't hesitate to ask him or her questions about your treatment options. For the current guideline, the Alberta Provincial Head and Neck Tumour Team reviewed the recommendations of several different guidelines, including those from the European Society for Medical Oncology, the Spanish Society of Medical Oncology and the National Comprehensive Cancer Network (NCCN). If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials. Version 1.2019. All so you can live longer — and better. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. In patients with good performance status, palliative chemotherapy may be considered. The chemo drug most often used is cisplatin, but sometimes it's given along with another drug. Some NPCs diagnosed before the current staging system was in place may have been given the stage IVC. It’s also important to follow recommended screening guidelines, which can help detect certain cancers early. What diagnostic and baseline investigations are recommended for patients with suspected or confirmed nasopharyngeal cancer (NPC)? Head and Neck Cancers. Recurrent NPC in regional (neck) lymph nodes can sometimes be treated with radiation therapy. At any time, you may opt out of tracking or request account deletion. Radiotherapy: For Patients with Stage II to IVA Nasopharyngeal Carcinoma Recommendation 1.1. The information was verified by the guideline developer on September 25, 2014. Diagnosis and Management of ... Clinical practice guidelines serve as a guide for doctors and outline appropriate methods of treatment and care. These guidelines should be applied in the context of the recommendations outlined in CancerControl Alberta guideline. Learn more about these partnerships and how you too can join us in our mission to save lives, celebrate lives, and lead the fight for a world without cancer. METHODS The Chinese Society of Clinical Oncology (CSCO) and ASCO convened an expert panel of radiation oncology, medical oncology, surgery, and … The American Cancer Society couldn’t do what we do without the support of our partners. Depending on the stage of the cancer, your overall health, and other factors, your treatment options may include: Surgery for Nasopharyngeal Cancer Radiation Therapy for Nasopharyngeal Cancer The cancer has not yet spread to lymph nodes in these stages, but the nearby lymph nodes in the neck are usually treated with radiation therapy as well. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf on June 19, 2019. Cigna Smart Health discusses the causes, staging, symptoms and treatment for this type of cancer and shares useful preventative tips. Provincial Nasopharyngeal Cancer Treatment Guidelines Approved at the Provincial Head and Neck Cancer Guideline Meeting May 8, 2015 Clinical practice guidelines have been developed after multi-disciplinary consensus based on best available literature. For standard treatment, all cases should be presented and discussed at a multidisciplinary Tumour Board to decide the best treatment option for each patient. Once the guideline is finalized, it will be officially endorsed by the Provincial Tumour Team Lead and the Executive Director of Provincial Tumour Programs. Clinicians applying these guidelines should, in consultation with the patient, use independent medical judgment in the context of individual clinical circumstances to direct care. *By signing up I agree to the privacy terms listed here, Type of Evidence Supporting the Recommendations, Methods Used to Collect/Select the Evidence, Description of Methods Used to Collect/Select the Evidence, Methods Used to Assess the Quality and Strength of the Evidence, Rating Scheme for the Strength of the Evidence, Description of the Methods Used to Analyze the Evidence, Methods Used to Formulate the Recommendations, Description of Methods Used to Formulate the Recommendations, Description of Method of Guideline Validation, Composition of Group That Authored the Guideline, Financial Disclosures/Conflicts of Interest, *By signing up I agree to the privacy terms listed, Benefits/harms Of Implementing The Guideline Recommendations, Rating Scheme For The Strength Of The Recommendations, Institute Of Medicine (iom) National Healthcare Quality Report Categories, The Organization and Delivery of Healthcare Services for Head and Neck Cancer Patients, Guideline Utilization Resource Unit Handbook, http://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf, http://www.guideline.gov/about/inclusion-criteria.aspx. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help. Some might even be harmful. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life. Most people with NPC get a combination of radiation and chemotherapy.  JAMA Netw Open. If there's no sign of the cancer after chemo, either radiation therapy to the nasopharynx and the lymph nodes in the neck or chemoradiation is given to try to kill any remaining cancer cells. What are the recommended treatment options for NPC? But adding chemo leads to more side effects, which can affect quality of life. Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the nasopharynx. ( Adult ) ( 3 ) tax-exempt organization option against the possible risks and side are... With one of our continued efforts towards protecting your privacy and personal information is used solely to you! 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