A patient completes chemoradiotherapy for EBV-associated nasopharyngeal carcinoma. At 12 weeks, MRI shows post-treatment thickening without a discrete mass, examination is unremarkable and plasma EBV DNA is undetectable. What is the best approach?
Early post-treatment change can mimic tumour. Concordant endoscopy, imaging evolution and EBV DNA should guide targeted biopsy; unplanned deep biopsy can be morbid and low yield.
A. Immediate total nasopharyngectomy: There is no confirmed persistent tumour to justify radical salvage surgery.
B. Declare complete cure and stop follow-up: Late recurrence and treatment toxicity still require specialist surveillance.
C. Start empirical chemotherapy for the thickening: Non-specific post-treatment change without evidence of viable disease is not an indication for systemic treatment.
D. Rely on EBV DNA alone forever: The biomarker complements but does not replace examination and imaging.
E. Structured clinical and imaging surveillance rather than immediate blind salvage biopsy: Early post-treatment change can mimic tumour. Concordant endoscopy, imaging evolution and EBV DNA should guide targeted biopsy; unplanned deep biopsy can be morbid and low yield.
If a focal enlarging enhancing lesion and renewed detectable EBV DNA appeared on serial review, directed biopsy for suspected persistence or recurrence would be required.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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