title: Nasopharyngeal carcinoma with metastatic disease to mediastinal and hilar lymph nodes: an indication for more aggressive treatment.
abstract: Nasopharyngeal carcinoma (NPC) is a highly chemo- and radiosensitive tumour, distinctive from other head and neck squamous cell carcinomas. Distant metastatic rates correlate directly with T and N stages. The prognosis of metastatic NPC is grave and long term survivors are anecdotal. We encountered an 18-year-old man with locoregionally advanced NPC, who was initially treated with neoadjuvant chemotherapy and radiotherapy, but subsequently relapsed 6 months later in the superior mediastinal and right hilar nodal regions. Further chemotherapy and consolidation radiotherapy resulted in complete remission. He is currently alive and free of disease 5 years and 6 months after the completion of salvage treatment. We recommend aggressive treatment of NPC with isolated intrathoracic nodal relapse and imaging of the mediastinum for non-metastatic Ho's Stage N3 NPC patients.
authors.affiliation: Clinical Oncology Department, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: W H
authors.initials: WH
authors.lastname: Kwan
authors.forename: P M
authors.initials: PM
authors.lastname: Teo
authors.forename: L T
authors.initials: LT
authors.lastname: Chow
authors.forename: P H
authors.initials: PH
authors.lastname: Choi
authors.forename: P J
authors.initials: PJ
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008168:Lung; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008482:Mediastinum; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D009367:Neoplasm Staging; D011379:Prognosis; D011882:Radiotherapy, High-Energy; D012074:Remission Induction; D016879:Salvage Therapy
chemical_list: D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D002945:Cisplatin; D005472:Fluorouracil