On the upside.

An interesting way to look at nasopharyngeal carcinoma (NPC) is by categorizing the disease process as ascending (A) or descending (D). A-NPC typically has aggressive local invasion by the primary tumor with a predominant pattern of local failure. D-NPC has less advanced primary tumors with early nodal spread and a pattern of distant failure. Here’s a look at clinical outcomes based on A versus D status for a large cohort of Chinese patients with NPC. A-NPC was defined as T3-4N0-1, and D-NPC was T1-2N2-3. Type A tumors were much more common (82%), while type D tumors were associated with higher levels of EBV-DNA. Despite their more more aggressive local invasion and higher rate of cranial nerve deficits, patients with type A tumors actually had better disease control and survival possibly due to lower rates of nodal and distant relapse. TBL: NPC with a descending pattern of spread appear to have worse clinical outcomes than those with more advanced local spread, raising interesting questions regarding individualized treatment approaches. | Yao, Radiother Oncol 2019