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Open Access Research article

Role of plasma EBV DNA levels in predicting recurrence of nasopharyngeal carcinoma in a western population

Daris Ferrari1*, Carla Codecà1, Cecilia Bertuzzi1, Francesca Broggio1, Francesca Crepaldi1, Andrea Luciani1, Irene Floriani2, Mohssen Ansarin3, Fausto Chiesa3, Daniela Alterio4 and Paolo Foa1

Author Affiliations

1 Division of Medical Oncology and Department of Medicine, Surgery and Dentistry, San Paolo Hospital and University of Milan, Via Di Rudinì 8, Milan, Italy

2 Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa, Milan, Italy

3 Head and Neck Surgery, European Institute of Oncology, Via Ripamonti, Milan, Italy

4 Division of Radiotherapy, European Institute of Oncology, Via Ripamonti, Milan, Italy

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BMC Cancer 2012, 12:208  doi:10.1186/1471-2407-12-208

Published: 30 May 2012

Abstract

Background

Loco-regionally advanced nasopharyngeal carcinomas can be cured by the combination of chemotherapy and radiotherapy. In Eastern countries, plasma levels of viral Epstein-Barr deoxyribonucleic acid (DNA) are accurate in predicting recurrence, but few data are available in Western populations. The aim of this prospective study was to evaluate the relationship between viral Epstein-Barr DNA copy numbers in plasma and the response rate, progression-free survival and overall survival in a cohort of Western patients with stage IIb-IVb nasopharyngeal cancer.

Methods

We evaluated plasma samples from 36 consecutive patients treated with induction chemotherapy followed by chemoradiation. EBV copy numbers were determined after DNA extraction using real-time quantitative polymerase chain reaction. Survival curves were estimated using the Kaplan–Meier method.

Results

Circulating Epstein-Barr virus DNA levels were measured before treatment, at the end of concomitant chemo- and radiotherapy, and during the follow-up period. Pre-treatment levels significantly correlated with the initial stage and probability of relapse. Their increase was 100% specific and 71.3% sensitive in detecting loco-regional or metastatic recurrence (an overall accuracy of 94.4%). Three-year progression-free and overall survival were respectively 78.2% and 97.1%.

Conclusions

The results of this study confirm that patients from a Western country affected by loco-regionally advanced nasopharyngeal carcinoma have high plasma Epstein-Barr virus DNA levels at diagnosis. The monitoring of plasma levels is sensitive and highly specific in detecting disease recurrence and metastases.

Keywords:
Nasopharyngeal carcinoma; Epstein-Barr virus; Chemoradiotherapy; Induction chemotherapy, Plasma EBV DNA copy numbers