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International recommendations for plasma Epstein-Barr virus DNA measurement in nasopharyngeal carcinoma in resource-constrained settings: lessons from the COVID-19 pandemic

Lee VH 1 , Adham M 2 , Ben Kridis W 3 , Bossi P 4 , Chen MY 5 , Chitapanarux I 6 Show all authors , Gregoire V 7 , Hao SP 8 , Ho C 9 , Ho GF 10 , Kannarunimit D 11 , Kwong DL 12 , Lam KO 12 , Lam WKJ 13 , Le QT 14 , Lee AW 12 , Lee NY 15 , Leung TW 12 , Licitra L 16 , Lim DW 17 , Lin JC 18 , Loh KS 19 , Lou PJ 20 , Machiels JP 21 , Mai HQ 5 , Mesía R 22 , Ng WT 12 , Ngan RK 12 , Tay JK 19 , Tsang RK 23 , Tong CC 24 , Wang HM 25 , Wee JT 26

Affiliations 

  • 1 Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China. Electronic address: vhflee@hku.hk
  • 2 Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • 3 Department of Medical Oncology, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
  • 4 Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy; Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
  • 5 Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
  • 6 Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • 7 Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
  • 8 Department of Otolaryngology, Shin Kong Wu Ho-Su Memorial Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
  • 9 Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
  • 10 Clinical Oncology Unit, University Malaya Cancer Centre, University of Malaya, Kuala Lumpur, Malaysia
  • 11 Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 12 Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
  • 13 Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China; Department of Chemical Pathology, State Key Laboratory of Translational Oncology, and Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
  • 14 Department of Radiation Oncology, Stanford University, Stanford, CA, USA
  • 15 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
  • 16 Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
  • 17 Division of Medical Oncology, National Cancer Centre Singapore, Singapore
  • 18 Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
  • 19 Department of Otolaryngology-Head & Neck Surgery, National University of Singapore, Singapore
  • 20 Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei, Taiwan
  • 21 Service d'Oncologie Médicale, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium
  • 22 Medical Oncology Department, Catalan Institute of Oncology-Badalona, B-ARGO Group, IGTP, Badalona, Spain
  • 23 Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Otolaryngology-Head & Neck Surgery, National University of Singapore, Singapore
  • 24 Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
  • 25 Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
  • 26 Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
Lancet Oncol, 2022 Dec;23(12):e544-e551.
PMID: 36455583 DOI: 10.1016/S1470-2045(22)00505-8

Abstract

The effects of the COVID-19 pandemic continue to constrain health-care staff and resources worldwide, despite the availability of effective vaccines. Aerosol-generating procedures such as endoscopy, a common investigation tool for nasopharyngeal carcinoma, are recognised as a likely cause of SARS-CoV-2 spread in hospitals. Plasma Epstein-Barr virus (EBV) DNA is considered the most accurate biomarker for the routine management of nasopharyngeal carcinoma. A consensus statement on whether plasma EBV DNA can minimise the need for or replace aerosol-generating procedures, imaging methods, and face-to-face consultations in managing nasopharyngeal carcinoma is urgently needed amid the current pandemic and potentially for future highly contagious airborne diseases or natural disasters. We completed a modified Delphi consensus process of three rounds with 33 international experts in otorhinolaryngology or head and neck surgery, radiation oncology, medical oncology, and clinical oncology with vast experience in managing nasopharyngeal carcinoma, representing 51 international professional societies and national clinical trial groups. These consensus recommendations aim to enhance consistency in clinical practice, reduce ambiguity in delivering care, and offer advice for clinicians worldwide who work in endemic and non-endemic regions of nasopharyngeal carcinoma, in the context of COVID-19 and other airborne pandemics, and in future unexpected settings of severe resource constraints and insufficiency of personal protective equipment.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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