The impact of the COVID-19 pandemic on nasopharyngeal carcinoma extent at FDG PET/MR staging: The NPCOVIPET study.

BACKGROUND: To evaluate the impact of coronavirus disease 2019 (COVID-19) pandemic on disease extent in patients with nasopharyngeal carcinoma (NPC) using 18 fuorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance imaging (MRI). METHODS: This retrospective cohort study included biopsy-proven, newly diagnosed NPC patients using whole-body FDG PET/MR staging in two selected intervals: 1 May 2017 to 31 January 2020 (Group A, the pre-COVID-19 period), and 1 February 2020 to 30 June 2021 (Group B, the COVID-19 period). RESULTS: Three-hundred and ninety patients were included. No significant difference was observed in terms of T classification, N classification, overall stage, N stations, and M stations between the two groups (p > 0.05). For the involved neck node levels, more patients had developed level Vc metastasis in the group B (p = 0.044). CONCLUSION: Although the overall stage was not affected, more patients with NPC had developed level Vc metastasis in the era of COVID-19.

Magnetic resonance imaging organ at risk delineation for nasopharyngeal radiotherapy: Measuring the effectiveness of an educational intervention.

INTRODUCTION: Magnetic resonance imaging (MRI) demonstrates superior soft tissue contrast and is increasingly being used in radiotherapy planning. This study evaluated the impact of an education workshop in minimising inter-observer variation (IOV) for nasopharyngeal organs at risk (OAR) delineation on MRI. METHODS: Ten observers delineated 14 OARs on 4 retrospective nasopharyngeal MRI data sets. Standard contouring guidelines were provided pre-workshop. Following an education workshop on MRI OAR delineation, observers blinded to their original contours repeated the 14 OAR delineations. For comparison, reference volumes were delineated by two head and neck radiation oncologists. IOV was evaluated using dice similarity coefficient (DSC), Hausdorff distance (HD) and relative volume. Location of largest deviations was evaluated with centroid values. Observer confidence pre- and post-workshop was also recorded using a 6-point Likert scale. The workshop was deemed beneficial for an OAR if ≥50% of observers mean scores improved in any metric and ≥50% of observers' confidence improved. RESULTS: All OARs had ≥50% of observers improve in at least one metric. Base of tongue, larynx, spinal cord and right temporal lobe were the only OARs achieving a mean DSC score of ≥0.7. Base of tongue, left and right lacrimal glands, larynx, left optic nerve and right parotid gland all exhibited statistically significant HD improvements post-workshop (P < 0.05). Brainstem and left and right temporal lobes all had statistically significant relative volume improvements post-workshop (P < 0.05). Post-workshop observer confidence improvement was observed for all OARs (P < 0.001). CONCLUSIONS: The educational workshop reduced IOV and improved observers' confidence when delineating nasopharyngeal OARs on MRI.

Diagnostic dilemma in a patient with nasopharyngeal tuberculosis: A case report and literature review.

Tuberculosis remains a major cause of morbidity and mortality globally, with a global total of about 10 million people falling ill with it in 2020. Until the coronavirus (COVID-19) pandemic, tuberculosis was the leading cause of death from a single infectious agent. Nasopharyngeal tuberculosis is a rare type of extrapulmonary tuberculosis that may be either primary or secondary to pulmonary tuberculosis. Nasopharyngeal tuberculosis may be mistaken for nasopharyngeal carcinoma as both conditions may present with a nasopharyngeal mass and cervical lymph node enlargement. We present a case of nasopharyngeal tuberculosis secondary to pulmonary tuberculosis who presented without any nasal or respiratory symptoms. The patient presented with a cervical lymph node enlargement and a nasopharyngeal mass was detected on nasal endoscopy. Fine needle cytology from the cervical node and the initial biopsy report from the nasopharyngeal mass were not confirmatory, causing a diagnostic dilemma. A repeat biopsy from the nasopharyngeal mass with the demonstration of caseating granuloma and acid-fast bacilli in the specimen pointed to the diagnosis of nasopharyngeal tuberculosis. The patient responded well to the standard 6-month anti-tubercular regimen. Nasopharyngeal tuberculosis may mimic nasopharyngeal carcinoma and a repeat biopsy may be necessary to confirm the diagnosis.

Association of delayed chemoradiotherapy with elevated Epstein-Barr virus DNA load and adverse clinical outcome in nasopharyngeal carcinoma treatment during the COVID-19 pandemic: a retrospective study.

BACKGROUND: To summarize the impact of radiotherapy (RT) and chemotherapy delays on patients with nasopharyngeal carcinoma (NPC) during the COVID-19 pandemic. METHODS: We retrospectively included 233 patients with stage II-IVa NPC treated with RT and chemotherapy between December 11, 2019 and March 11, 2020. The outcomes were elevation in the EBV DNA load between two adjacent cycles of chemotherapy or during RT, and 1-year disease-free survival (DFS). RESULTS: RT delay occurred in 117 (50%) patients, and chemotherapy delay occurred in 220 (94%) patients. RT delay of ≥ 6 days was associated with a higher EBV DNA elevation rate (20.4% vs. 3.6%, odds ratio [OR] = 6.93 [95% CI = 2.49-19.32], P < 0.001), and worse 1-year DFS (91.2% vs. 97.8%, HR = 3.61 [95% CI = 1.37-9.50], P = 0.006), compared with on-schedule RT or delay of < 6 days. Chemotherapy delay of ≥ 10 days was not associated with a higher EBV DNA elevation rate (12.5% vs. 6.8%, OR = 1.94 [95% CI = 0.70-5.40], P = 0.20), or worse 1-year DFS (93.8% vs. 97.1%, HR = 3.73 [95% CI = 0.86-16.14], P = 0.059), compared with delay of < 10 days. Multivariable analyses showed RT delay of ≥ 6 days remained an independent adverse factor for both EBV DNA elevation and DFS. CONCLUSION: To ensure treatment efficacy for patients with nonmetastatic NPC, initiation of RT should not be delayed by more than 6 days; the effect of chemotherapy delay requires further investigation.

An Exploratory Study of Refining TNM-8 M1 Categories and Prognostic Subgroups Using Plasma EBV DNA for Previously Untreated De Novo Metastatic Nasopharyngeal Carcinoma.

(1) Background: NPC patients with de novo distant metastasis appears to be a heterogeneous group who demonstrate a wide range of survival, as suggested by growing evidence. Nevertheless, the current 8th edition of TNM staging (TNM-8) grouping all these patients into the M1 category is not able to identify their survival differences. We sought to identify any anatomic and non-anatomic subgroups in this study. (2) Methods: Sixty-nine patients with treatment-naive de novo M1 NPC (training cohort) were prospectively recruited from 2007 to 2018. We performed univariable and multivariable analyses (UVA and MVA) to explore anatomic distant metastasis factors, which were significantly prognostic of overall survival (OS). Recursive partitioning analysis (RPA) with the incorporation of significant factors from MVA was then performed to derive a new set of RPA stage groups with OS segregation (Set 1 Anatomic-RPA stage groups); another run of MVA was performed with the addition of pre-treatment plasma EBV DNA. A second-round RPA with significant prognostic factors of OS identified in this round of MVA was performed again to derive another set of stage groups (Set 2 Prognostic-RPA stage groups). Both sets were then validated externally with an independent validation cohort of 67 patients with distant relapses of their initially non-metastatic NPC (rM1) after radical treatment. The performance of models in survival segregation was evaluated by the Akaike information criterion (AIC) and concordance index (C-index) under 1000 bootstrapping samples for the validation cohort; (3) Results: The 3-year OS and median follow-up in the training cohort were 36.0% and 17.8 months, respectively. Co-existence of liver-bone metastases was the only significant prognostic factor of OS in the first round UVA and MVA. Set 1 RPA based on anatomic factors that subdivide the M1 category into two groups: M1a (absence of co-existing liver-bone metastases; median OS 28.1 months) and M1b (co-existing liver-bone metastases; median OS 19.2 months, p = 0.023). When pre-treatment plasma EBV DNA was also added, it became the only significant prognostic factor in UVA (p = 0.001) and MVA (p = 0.015), while co-existing liver-bone metastases was only significant in UVA. Set 2 RPA with the incorporation of pre-treatment plasma EBV DNA yielded good segregation (M1a: EBV DNA ≤ 2500 copies/mL and M1b: EBV DNA > 2500 copies/mL; median OS 44.2 and 19.7 months, respectively, p < 0.001). Set 2 Prognostic-RPA groups (AIC: 228.1 [95% CI: 194.8-251.8] is superior to Set 1 Anatomic-RPA groups (AIC: 278.5 [254.6-301.2]) in the OS prediction (p < 0.001). Set 2 RPA groups (C-index 0.59 [95% CI: 0.54-0.67]) also performed better prediction agreement in the validation cohort (vs. Set 1: C-index 0.47 [95% CI: 0.41-0.53]) (p < 0.001); (4) Conclusions: Our Anatomic-RPA stage groups yielded good segregation for de novo M1 NPC, and prognostication was further improved by incorporating plasma EBV DNA. These new RPA stage groups for M1 NPC can be applied to countries/regions regardless of whether reliable and sensitive plasma EBV DNA assays are available or not.

In silico analysis and experimental validation to exhibit anti-nasopharyngeal carcinoma effects of plumbagin, an anti-cancer compound.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is publicly known as a malignant tumor. Our previous study reported that plumbagin exhibits potent anti-cancer actions. Nevertheless, more mechanical details of plumbagin against NPC remain unknown. The present study aimed to unmask the core targets/genes and anti-NPC mechanisms involved in the signaling pathways of plumbagin prior to biochemical validation. METHODS: A network pharmacology approach was employed to respective identification of mutual and core targets/genes in plumbagin and/treating NPC. Molecular docking determination was used to identify core target proteins for biochemical validation using human and cell line samples. RESULTS: In total, 60 anti-NPC genes of plumbagin were screened out, and then nine core target genes of plumbagin against NPC were identified accordingly. The enrichment findings revealed detailed biological functions and pharmacological pathways of plumbagin against NPC. Moreover, in silico analysis using molecular docking had determined the core targets for further experimental validation, comprising protein kinase B (AKT1) and sarcoma gene (SRC). In human sample validation, clinical NPC sections showed increased positive expression of AKT1 and SRC. Additionally, plumbagin-treated NPC cells resulted in inactivated protein expression of AKT1 and SRC. CONCLUSION: The re-identified core targets/genes in the molecular docking report may function as plumbagin-related pharmacological targets for treating NPC via experimental validation. Furthermore, additional anti-NPC molecular mechanisms of plumbagin action were disclosed on the basis of enrichment findings. © 2022 Society of Chemical Industry.

NASOPHARYNGEAL CARCINOMA TREATMENT EFFECT ON THE COGNITIVE FUNCTION OF THE ATTENTION NETWORK: AN EXAMPLE FROM THE COASTAL CITY OF HANGZHOU (CHINA)

Objective: This study mainly to explore the effect of comprehensive treatment in Hangzhou (China) on cognitive function of attention network in patients with nasopharyngeal carcinoma. Methods: Patients with locally advanced nasopharyngeal carcinoma who were initially diagnosed as the pre-treatment group were collected as the pre-treatment group in Hangzhou (China), and the patients who were reexamined within more than half a year after treatment were the post-treatment group. All patients received behavioral tests of attention network cognitive function. The processing efficiency of three sub-networks (executive control network, alertness system and orientation network) of cognitive function of patients' attention network was compared horizontally. Results: After treatment, the score and ratio of processing efficiency of executive control network in the group after treatment were significantly lower than those in the group before treatment, while the scores and score ratios of alertness system and oriented network processing efficiency did not change significantly. Conclusion: After treatment, the processing efficiency of the alert system and orientation network of NPC patients did not change significantly in Hangzhou (China), but the processing efficiency of the executive control network was improved. Conclusion: We determined that the pneumococcal vaccine, which is mainly administered in family medicine centers, has a positive effect on the course of COVID-19, and adult immunization should be given importance in every period. © 2022 A. CARBONE Editore. All rights reserved.

Diagnostic pathway and stage migration of sinonasal malignancies in the era of the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic bears the risk of delayed cancer diagnoses. METHODS: Study on the diagnostic pathway of sinonasal malignancies during the COVID-19 pandemic. RESULTS: Median time from first symptom to treatment initiation was not increased during the pandemic: 137 days (interquartile range [IQR] 104-193) vs 139 days (IQR 103-219) (P = .60). Median time from first appointment at our institution to treatment initiation was even reduced in 2020: 18 days (IQR 11-25) vs 11 days (IQR 7-17) (P = .02). A trend toward advanced tumor stages during the pandemic was seen: 11/30 patients (36.7%) ≥ stage 4 in 2018 to 2019 vs 12/19 patients (63.2%) ≥ stage 4 in 2020 (P = .064). CONCLUSION: Both, time to diagnosis and time to treatment initiation were similar during the pandemic. However, a higher proportion of advanced tumors stages was observed. Despite the pandemic, we provided a swift diagnostic workflow, including a virtual tumor board decision and a prompt treatment initiation. Level of Evidence: 4.

Positron Emission Tomography With Fluorodeoxyglucose Incidental Detection of Colon Cancer in a Patient's Follow-Up for Nasopharyngeal Carcinoma During the COVID-19 Pandemic: A Case Report.

Colorectal cancer (CRC) is a type of widespread, deadly malignancy that took thousands of lives around the globe. In the last two decades, CRC represented the most common cancer among men and ranked third among women in Saudi Arabia. Positron emission tomography with fluorodeoxyglucose (FDG-PET), can incidentally detect malignancy, as in our case, FDG-PET disclosed high abnormal FDG far away from the first primary malignancy. The current case is of a 65-year-old female who was following up on her nasopharyngeal carcinoma (first primary). During her last management, FDG-PET was requested to find any FDG uptake in the nasopharyngeal region; stunning FDG uptake was incidentally found at the ascending colon diagnosed as early-stage (pT2N0) colon cancer. Colonoscopy was done and India Ink was injected to facilitate localizing the mass during the laparoscopic removal of the tumor, which was delayed due to the pandemic of COVID-19. This took place in March 2020 at King Abdul-Aziz University Hospital in Jeddah.

Concerns of a Post-Chemotherapy/Radiotherapy Patient of Nasopharyngeal Carcinoma Presenting with Sustained COVID-19 Infection.

A 47-year-old patient was referred from otorhinolaryngologist with a chief complaint of hearing loss to the medical oncology department where he was diagnosed to have nasopharyngeal carcinoma (NPC). The patient was given six cycles of chemotherapy and 35# of radiotherapy. After a week of therapies, he developed a low-grade fever. He was suspected of COVID-19, but the reverse transcription polymerase chain reaction test came out to be negative. He developed urinary retention, and he was planned for suprapubic catheterization. Before the procedure, he was retested for COVID-19 which came out to be positive. This case report aims to describe the condition of a patient of NPC with COVID-19 infection and to discuss the outcome of disease in this circumstance.

Recommendations for surgical management of recurrent nasopharyngeal carcinoma during COVID-19 pandemic.

Nasopharyngeal carcinoma is endemic in southern parts of China including Hong Kong. Primary treatment entails radiotherapy ± chemotherapy depending on disease stage at presentation. Surgery is offered as a means of salvage for persistent and recurrent disease. Comprehensive preoperative work-up, careful patient selection, attention to details perioperation and multidisciplinary approach is essential in ensuring optimal outcomes after salvage surgery for recurrent nasopharyngeal carcinoma patients. Since the COVID-19 outbreak, we are faced with unprecedented challenges with priorities of care and resources being shifted to combat the virus. These include patient selection and timing of treatment, while preventing disease transmission to heath care providers. Practices and recommendations made in this document are intended to support safe clinical practice and efficient use of resources during this challenging time.

Effect of COVID-19 Epidemic on Delay of Diagnosis and Treatment Path for Patients with Nasopharyngeal Carcinoma.

INTRODUCTION: 2019 novel coronavirus disease (COVID-19) outbreaks have been occurring in China and other countries in the world. To prevent further spread of the disease, restrictions of population flow from the government and measures to reduce virus transmission from hospitals may lead to the delay of diagnosis and treatment in patients with nasopharyngeal carcinoma (NPC). METHODS: All NPC patients with radiotherapy indications were included from 20 weekdays before (group A) and after (group B) January 31, 2020, when the institute began to take measures against COVID-19. The waiting intervals of each step and variation from the diagnosis and treatment path of NPC between two groups were compared. RESULTS: Significant differences were found between the group A and group B in the median waiting days for pathological biopsy (5 vs 15, P=0.012), radiotherapy immobilization and simulation (3.5 vs 16.5, P<0.001), validation of position and plan (20 vs 61, P<0.001) and initiation of radiotherapy (28 vs 36, P=0.005). During the waiting period of radiotherapy, 32.4% of the NPC patients received an additional one cycle of chemotherapy to the original treatment strategy. CONCLUSION: The prevalence of COVID-19 caused delay in the diagnosis and treatment of NPC patients to a certain extent. Additional chemotherapy could be considered to counteract the effect of treatment delay. More specific measures should be taken to balance the risk of delayed diagnosis and treatment of NPC and infection of COVID-19.