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EBV DNA NPC Monitoring — SCE Medical Oncology MCQ

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ModerateHead & Neck CancerEBV DNA NPC MonitoringSCE Medical Oncology

A 55-year-old man with nasopharyngeal carcinoma (NPC) has plasma EBV DNA measured before, during and after treatment. Pre-treatment EBV DNA is 15,000 copies/mL. After chemoradiotherapy, EBV DNA becomes undetectable. At 6 months, EBV DNA rises to 500 copies/mL. What does this indicate?

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Correct answer: C — Rising post-treatment plasma EBV DNA in NPC is a highly sensitive biomarker for recurrence — this patient should undergo urgent imaging (MRI nasopharynx + PET-CT) to detect early recurrence, even before symptoms develop

Plasma EBV DNA is the most important biomarker in NPC: pre-treatment levels correlate with tumour burden and prognosis, post-treatment clearance indicates response, and rising levels after treatment predict recurrence (sensitivity ~90%) weeks-months before imaging/clinical detection. EBV DNA monitoring (every 3-6 months post-treatment) is standard practice for NPC surveillance. Rising EBV DNA should trigger immediate imaging. The NPC-0502 trial showed EBV DNA-guided adjuvant chemotherapy improved outcomes.

Reference: ESMO 2024 NPC; NICE NG36; Chan et al NEJM 2004; NPC-0502