Nasopharyngeal carcinoma (NPC) arises from the epithelial lining of the nasopharynx. It is most common in Chinese and North African populations. Radiotherapy is the primary treatment, with chemotherapy added for advanced cases. Follow up care involves regular endoscopy and imaging to monitor response and detect recurrence. Salvage treatments include additional radiotherapy, brachytherapy, surgery, or chemotherapy depending on the location and extent of recurrence. Prognosis depends on stage, with 5-year survival rates ranging from over 70% for early stage to less than 50% for late stage disease.
This is a Central presentation, presented at National Institute of Cancer Research & Hospital(NICRH), Mohakhali, Dhaka, Bangladesh on Metastatic neck node of unknown primary.
Metastasis of Neck Node with Unknown Primary Himanshu Soni
carcinoma of unknown Primary accounts for 5%-10% of all tumours. 3–5% of head and neck cancers presented as cervical squamous cell carcinomas of unknown primary
This is a Central presentation, presented at National Institute of Cancer Research & Hospital(NICRH), Mohakhali, Dhaka, Bangladesh on Metastatic neck node of unknown primary.
Metastasis of Neck Node with Unknown Primary Himanshu Soni
carcinoma of unknown Primary accounts for 5%-10% of all tumours. 3–5% of head and neck cancers presented as cervical squamous cell carcinomas of unknown primary
Brief Review of Surgical management of Early laryngeal cancer e.g glottic and supraglottic cancer.
This presentation describes latest literature evidence of conservative laryngeal surgery as well as radiotherapy in early glottic cancer
Slides prepared by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate MBBS students in the field of otorhinolaryngology. A clear and concise explanation of the basic concepts in the subject matter concerned. He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Nasopharyngeal carcinoma is a non lymphomatous squamous-cell carcinoma that occurs in the epithelial lining of the nasopharynx.
It frequently arises from the pharyngeal recess (fossa of Rosenmuller) posteromedial to the medial crura of the eustachian tube opening in the nasopharynx
Brief Review of Surgical management of Early laryngeal cancer e.g glottic and supraglottic cancer.
This presentation describes latest literature evidence of conservative laryngeal surgery as well as radiotherapy in early glottic cancer
Slides prepared by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate MBBS students in the field of otorhinolaryngology. A clear and concise explanation of the basic concepts in the subject matter concerned. He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Nasopharyngeal carcinoma is a non lymphomatous squamous-cell carcinoma that occurs in the epithelial lining of the nasopharynx.
It frequently arises from the pharyngeal recess (fossa of Rosenmuller) posteromedial to the medial crura of the eustachian tube opening in the nasopharynx
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. Introduction
NPC is a squamous-cell carcinoma arising from epithelial lining of the
nasopharynx.
Most common malignancy in the nasopharynx
Nasopharyngeal malignancies
SCCA (nasopharyngeal carcinoma)
Lymphoma
Salivary gland tumors
Sarcomas
3. Race: More in Chinese & North African people
Sex: Male preponderance of 3:1
Age: -Its incidence rate starts to rise after the second decade of life.
-Median age is 50 years .
Gross: Proliferative, Ulcerative & Infiltrative types
The most common location is Fossa of Rosenmuller
Introduction
8. Lymphatic drainage
Lateral Retropharyngeal L.N also called as
nodes of Röuviere, are the first nodes in the
lymphatic drainage of Nasopharynx.
Extends from base of skull to C3 cervical
vertebra.
12. Etiology
Genetic:
Commonest in Chinese population.
Genomic studies have revealed 3 HLA locus.
HLAA2; HLA B46; HLA B17 are associated with increased risk of NPC
Viruses:
EBV- well documented viral “fingerprints” in tumor cells and also anti-
EBV serologies with WHO type II and III NPC
HPV - possible factor in WHO type I lesions
13. Etiology
Environmental:
salted fish food contain nitrosamines: carcinogen
Lack of vit C in diet
Burning of incense & woods: polyaromatic hydrocarbon:carcinogen
Alcohol consumption & Cigarette smoking
occupational exposure to dust, smoke, and chemical fumes
14. W.H.O. classification of NPC
1- keratinizing squamous cell ( 25% )
2. Type II is non-keratinizing squamous carcinomas 12 %
3. Type III is the undifferentiated carcinomas 60 %
22. Diagnostic Evaluation
High index of suspicion required for early diagnosis
• Clinical evaluation
• Radiological evaluation
• Laboratory evaluation
• Histopathological evaluation
24. Diagnostic Evaluation
Clinical examination of nasophyrnx:
Indirect nasophayrngoscopy with mirror
Direct nasopharyngoscopy with fiber-optic scope
Rigid 0 and 30* Hopkins rod endoscope
27. Diagnostic Evaluation
Radiological Evaluation
Help to make the correct diagnosis
Help To know the disease stage
Help to determine the target volume of radiotherapy
Help to evaluate the treatment results
Follow-up
28. Diagnostic Evaluation
CT Scan
Extent of tumor
Neck node involvement
Skull base erosion
MRI – radiologic modality of choice
Determine if any intracranial extension of the tumour involves the brain
parenchyma or the cavernous sinus
MRI > CT for displaying both superficial and deep nasopharyngeal soft tissue
and for differentiating tumor from soft tissue.
35. Diagnostic Evaluation
Laboratory evaluation
CBC,
LFT’s
Special diagnostic tests (for types II & III)
IgA antibodies for viral capsid antigen (VCA)
IgG antibodies for early antigen (EA)
Antibody Dependent Cellular Cytotoxicity assay.
36. Diagnostic Evaluation
Biopsy : first necessary investigation for NPC
Endoscopic biopsy : Ideally it shuold be carried out
during the patient’s ist outpatient visit in suspected
cases.
The most common sites are roof of nasopharynx and
fossae of Rosenmuller.
FNA biopsy : should be done in suspicious neck
lump.
Histopathological Evaluation
37. T.N.M. staging
T1 = Tumour confined to the nasopharynx or extends to oropharynx and/or nasal cavity
T2 = Tumour with parapharyngeal extension
T3 = invasion of bony structures or P.N.S.
T4 = intracranial, involvement of orbit, cranial nerves, infratemporal fossa,
hypopharynx
38. T.N.M. staging
N0 = no evidence of regional lymph nodes
N1 = unilateral N2 = bilateral
(Both are above supraclavicular fossa & < 6 cm)
N3 = > 6 cm or in supraclavicular foss
N3a- greater than 6 cm in dimension
N3b- extension to the supraclavicular fossa
M0 = no evidence of distant metastasis
M1 = distant metastasis present
39. T.N.M. staging
Stage I = T1 N0 M0
Stage II = T2 or N1 M0
Stage III = T3 or N2 M0
Stage IV = T4 or N3 or M1
41. Treatment
The management of NPC is unique for two reasons:
1-Tumor is in a relatively inaccessible location
2-Tumors is extremely radiosensitive
42. Treatment
Treatment Modalities
Radiotherapy (modality of choice)
Chemotherapy : combination with radiotherapy in advance
disease
Surgery :To salvage local and regional failure
43. Radiotherapy
Modes of radiotherapy
Teletherapy or External beam radiotherapy :Radiation beams projected to the
target area through skin
Brachytherapy :uses radioactive material which are placed in close contact with
tumor tissue .
Interstitial: Radioactive source inserted into tumor tissue
Intracavitary: Radioactive source placed inside catheter or moulds & inserted into
nasopharynx
44. Radiotherapy
Modes of radiotherapy
Intensity modulated radiation therapy (IMRT): recent development in
delivery of radiotherapy where maximum dose can be delivered to the tumor but
saving important normal structure
Stereotactic radiosurgery
delivers radiation therapy precisely to the tumor using a machine called a gamma
knife. This can be used to treat tumors that have invaded the base of the skull, or
tumors that have recurred at the base of the brain or skull.
45. primary treatment
Radiotherapy
External beam radiotherapy is most commonly delivered by opposed lateral fields
to encompass the primary tumor and upper neck
Treatment field has to cover nasopharynx ,paraphryngeal space ,oropharynx
,skull base,sphenoid sinus ,posterior ethmoid ,posterior half of maxillary sinus
Bilateral Cervical nodal irradiation is mandatory even in clinically node-negative
patients
47. primary treatment
Radiotherapy
65-70 GY for primary
65-70 GY for positive L.N
50-60 GY for negative L.N
It should be delivered single fraction daily ,five per week without interruption .
Proper shielding of all critical structures as well as surrounding normal tissue is
important.
48. primary treatment
Radiotherapy
Radiation boosts in the form of intracavitary brachytherapy for T1 to T2 lesions
have been used to improve local control rates
Stereotactic radiosurgery boosts may also be given for T3 and T4 lesions.
49. primary treatment
Chemotherapy
Chemotherapy is believed to act as radiosensitizer.
It helps to reduce the chance of distant metastasis.
For locally advanced disease (stage III-IV ) chemotherapy in addition to
radiotherapy appears to improve overall results.
Combination chemotherapy produces better responses
combination cisplatin/5-flurouracil is the most widely used
Indicates that concurrent chemoradiotherapy has a major role in advanced stage
NPC
51. primary treatment
FOLLOW-UP PLAN:
Close monitoring of the progress during and after treatment is necessary .
Follow-up endoscopy at 6–8 weeks and imaging at 10–12 weeks after
completion of radiotherapy or chemoradiotherapy is recommended to document
tumour responses.
malignancy detected after 10 weeks usually represents viable tumour and salvage
treatment is indicated
52. primary treatment
FOLLOW-UP PLAN:
Close monitoring of the progress during and after treatment is necessary .
The majority of relapses occur in first three years .
After primary treatment, patient should be seen :
Two-monthly for the first year
Three –monthly for 2nd and third year
Six –monthly thereafter.
Lifelong follow-up is needed as very late recurrence may also occur
53. primary treatment
FOLLOW-UP PLAN:
The response of local disease is best followed up by repeated nasoendoscopy .
Post-treatment biopsy indicated if there is any residual swelling at the primary
site .
Imaging is often needed to evaluate regional disease .
54. Salvage treatment
Treatment of recurrence
Recurrence at the primary site can be treated by surgery or re-irradiation.
Further dose of ERT may be considered.
Brachytherapy is preferred.
Cervical nodal recurrences are best treated by surgery .
55. Salvage treatment
surgery
• Due to deep location of nasopharynx, and anatomic proximity to critical
structures, radical surgery is typically not used
• Limited to
biopsy
Neck dissections for persistently enlarged lymph nodes
Nasopharyngectomy in persistent or recurrent disease
58. Salvage treatment
Inferior approaches :
Transplatal :For localized tumour in
the lower part of the posterior wall of the nasopharynx
Mandibular swing
59. lateral infratemporal fossa approach: When the main tumour
bulk is located in the paranasopharyngeal space close or
lateral to internal carotid artery
60. Salvage treatment
Surgical salvage for neck disease:
If a neck node persists in the absence of distant metastasis
,radical neck disection (RND)should be performed