Prevention and treatment plan for nasopharyngeal carcinoma

Treatments for nasopharyngeal carcinoma include radiotherapy, surgical treatment, chemotherapy, immunotherapy, and traditional Chinese medicine. Nasopharyngeal carcinoma is sensitive to radiation. The primary lesion and cervical lymph node drainage area of ​​nasopharyngeal carcinoma can be included in the irradiation field. The 5-year survival rate of radiotherapy for nasopharyngeal carcinoma at all stages is about 50%. Chemical anticancer drugs have a certain short-term effect in the treatment of nasopharyngeal carcinoma. High-dose DDP and 5-Fu can achieve a 90% remission rate. However, combined treatment with radiation is still needed after chemotherapy.

What are the treatments for nasopharyngeal carcinoma?

1. Radiotherapy:

Radiotherapy is recognized as the first choice for the treatment of NPC. In 1979, the National Conference on Nasopharyngeal Cancer proposed that stage I NPC should be treated with radiotherapy. Radiotherapy for NPC can be divided into radical radiotherapy and palliative radiotherapy.

Contraindications to radiotherapy are: ① Karnofski grade below 60 points; ② Extensive distant metastasis; ③ Radiation-induced brain and spinal cord injury; ④ Others such as infectious diseases or mental illnesses that have not been controlled.

Radiotherapy for nasopharyngeal carcinoma kills tumor cells, but normal tissues or organs are inevitably exposed to radiation and produce radiation reactions. The radiation reaction is closely related to the dose, irradiation range, number of irradiation courses, and the tolerance of normal tissues or organs.

Radiation reaction:

1) Systemic radiation reaction: including fatigue, dizziness, loss of appetite, nausea, vomiting, tastelessness or change in taste in the mouth, insomnia or drowsiness, etc. Although the degree varies, it can generally be overcome through symptomatic treatment and the course of radiotherapy can be completed.

2) Mucosal reaction: After 40Gy of radiation, the mucosa of the oropharynx, nasopharynx, nasal cavity, and paranasal sinuses may experience mucosal edema or congestion, increased exudation, and in severe cases, may cause punctate or flaky white film. During the irradiation process, sore throat, difficulty eating, nasal congestion, etc. are common. In severe cases, irradiation should be suspended, and appropriate rest should be given, and treatment should be resumed after the reaction subsides.

Generally, the tumors can be gradually absorbed and disappear one year after radiotherapy, but in a few cases, they still exist more than 10 years after radiotherapy.

3) Salivary gland radiation reaction: saliva secretion is significantly reduced, the patient has dry mouth and difficulty eating dry food.

4) Radiation reaction of skin and subcutaneous tissue: The skin in the irradiated area generally develops erythema, pigmentation, hair loss and dry peeling. If the irradiation speed is fast and irradiation continues when the skin is edematous, blisters may form and merge into large areas of moist peeling, and exude and erode into moist dermatitis.

5) Late radiation reactions to radiotherapy: The face and neck often experience atrophy of the skin and subcutaneous tissue, thinning of the skin, dilation of capillaries, and hypopigmentation.

6) Difficulty in opening the mouth: Exposure to the masticatory muscles and temporomandibular joints can cause varying degrees of difficulty in opening the mouth.

7) Radiation-induced dental caries and radiation-induced osteonecrosis of the jaw.

8) Radiation erysipelas of the skin and subcutaneous tissue.

9) Radiation otitis media.

10) Radiation-induced brain and spinal cord injury.

2. Surgical treatment:

Applicable to:

1) Patients with pathological types of well-differentiated squamous cell carcinoma or adenocarcinoma and other cancers that are insensitive to radiation, and whose lesions are confined to the posterior or anterior wall of the roof, and who have no contraindications to surgery, may consider resection of the primary lesion. Patients in stages II, III, and IV are not suitable for surgical treatment.

2) For patients with residual or recurrent lesions in the nasopharynx or neck after radiotherapy, if they are confined to the posterior or anterior wall of the nasopharyngeal roof, without skull base bone destruction, and in good general condition, and who have recently undergone radiotherapy and are not suitable for further radiotherapy, resection of the lesions may be considered.

3) When there is residual or recurrence in the neck, if the area is limited and active, neck lymph node clearance surgery may be considered.

When there are residual cervical lymph nodes after radiotherapy for nasopharyngeal carcinoma, surgery should be performed early. If it is treated promptly within 3-6 months after radiotherapy, the prognosis is better.

3. Chemotherapy:

More than 95% of nasopharyngeal carcinomas are poorly differentiated and undifferentiated, with high malignancy, rapid growth, and easy lymph node or blood metastasis. When nasopharyngeal carcinoma is diagnosed, 75% of patients are already in stage III and IV. The later the disease is, the more chances of distant metastasis and the worse the prognosis. Radiotherapy is a local treatment method that cannot prevent distant metastasis. Therefore, combined use of chemicals or a combination of several drugs may shrink the tumor or eliminate tiny lesions and improve the treatment effect. Main methods:

(1) Combined chemotherapy regimen:

1) CF regimen: Cyclophosphamide and 5-fluorouracil are both broad-spectrum anticancer drugs and have certain therapeutic effects on nasopharyngeal carcinoma.

2) PF regimen: The combined use of cisplatin and 5-fluorouracil has a good effect on nasopharyngeal carcinoma and is effective quickly, but the disadvantage is that the remission period is short. It can be used to shrink the tumor before radiotherapy, or for patients who only receive chemotherapy.

3) PFA regimen: cisplatin, 5-fluorouracil, and doxorubicin, etc. It has a significant effect in shrinking tumors.

4) CBF regimen: mainly uses cyclophosphamide, bleomycin and 5-fluorouracil.

(2) Combined chemotherapy and radiotherapy: The treatment effect is better and the 5-year survival rate is higher.

Chemotherapy has a certain short-term effect in the treatment of nasopharyngeal carcinoma. High-dose DDP and 5-Fu can achieve a 90% remission rate. However, chemotherapy and radiation therapy are still needed after chemotherapy.