title: Plasma EBV DNA clearance rate as a novel prognostic marker for metastatic/recurrent nasopharyngeal carcinoma.
abstract: OBJECTIVE
  To investigate the prognostic effect of the concentrations and clearance rates of plasma EBV DNA in metastatic/recurrent nasopharyngeal carcinoma (NPC).
  
  
  METHODS
  Thirty relapsed and four previously nontreated metastatic NPC patients were treated according to the consensus guidelines of the head and neck cancer team in our hospital (i.v. chemotherapy first, followed by local irradiation boost and oral maintenance chemotherapy where applicable). Multiple plasma samples were collected during the first month of chemotherapy. Circulating EBV DNA concentrations were measured by a real-time quantitative PCR. The half-life values (t(1/2)) of plasma EBV DNA clearance were calculated. The associations between clinical outcome and plasma EBV DNA assays were analyzed.
  
  
  RESULTS
  Tumor response evaluated after 12 weeks of treatment showed 14 complete responses (41.2%), 12 partial responses (35.3%), 7 stable diseases (20.6%), and 1 progression disease (2.9%). The plasma EBV DNA concentrations have no significant effects on outcome prediction. The t(1/2) of plasma EBV DNA clearance ranged from 1.85 to 28.29 days (median, 3.99). Patients with a short t(1/2) of plasma EBV DNA clearance have significantly higher complete response rate and overall survival than those with long t(1/2). Multivariate analysis revealed a significant effect of the t(1/2) of plasma EBV DNA clearance on survival.
  
  
  CONCLUSIONS
  The clearance rates of plasma EBV DNA during the first month of chemotherapy can predict tumor response and patient survival. Early change of chemotherapy regimen may be considered for patients with slow plasma EBV DNA clearance rate.
authors.affiliation: Department of Nursing, Hung Kuang University,Taiwan.
authors.forename: Wen-Yi
authors.initials: WY
authors.lastname: Wang
authors.forename: Chih-Wen
authors.initials: CW
authors.lastname: Twu
authors.forename: Hsin-Hong
authors.initials: HH
authors.lastname: Chen
authors.forename: Jian-Sheng
authors.initials: JS
authors.lastname: Jan
authors.forename: Rong-San
authors.initials: RS
authors.lastname: Jiang
authors.forename: Jeffrey Y C
authors.initials: JY
authors.lastname: Chao
authors.forename: Kai-Li
authors.initials: KL
authors.lastname: Liang
authors.forename: Kuan-Wen
authors.initials: KW
authors.lastname: Chen
authors.forename: Ching-Te
authors.initials: CT
authors.lastname: Wu
authors.forename: Jin-Ching
authors.initials: JC
authors.lastname: Lin
mesh_terms: D004279:DNA, Viral / Q000097:blood*; D004854:Herpesvirus 4, Human / Q000235:genetics*; D006801:Humans; D008657:Metabolic Clearance Rate; D009303:Nasopharyngeal Neoplasms / Q000097:blood / Q000473:pathology / Q000628:therapy / Q000821:virology*; D009362:Neoplasm Metastasis; D011379:Prognosis
chemical_list: D004279:DNA, Viral