Ferrari et al. BMC Cancer 2012, 12:208 http://www.biomedcentral.com/1471-2407/12/208 R E S E A R C H A R T I C L E Open Access Role of plasma EBV DNA levels in predicting recurrence of nasopharyngeal carcinoma in a western population Daris Ferrari1*, Carla Codecà1, Cecilia Bertuzzi1, Francesca Broggio1, Francesca Crepaldi1, Andrea Luciani1, Irene Floriani2, Mohssen Ansarin3, Fausto Chiesa3, Daniela Alterio4 and Paolo Foa1 Abstract Background: Loco-regionally advanced nasopharyngeal carcinomas can be cured by the combination of chemotherapy and radiotherapy. In Eastern countries, plasma levels of viral Epstein-Barr deoxyribonucleic acid (DNA) are accurate in predicting recurrence, but few data are available in Western populations. The aim of this prospective study was to evaluate the relationship between viral Epstein-Barr DNA copy numbers in plasma and the response rate, progression-free survival and overall survival in a cohort of Western patients with stage IIb-IVb nasopharyngeal cancer. Methods: We evaluated plasma samples from 36 consecutive patients treated with induction chemotherapy followed by chemoradiation. EBV copy numbers were determined after DNA extraction using real-time quantitative polymerase chain reaction. Survival curves were estimated using the Kaplan–Meier method. Results: Circulating Epstein-Barr virus DNA levels were measured before treatment, at the end of concomitant chemo- and radiotherapy, and during the follow-up period. Pre-treatment levels significantly correlated with the initial stage and probability of relapse. Their increase was 100% specific and 71.3% sensitive in detecting loco- regional or metastatic recurrence (an overall accuracy of 94.4%). Three-year progression-free and overall survival were respectively 78.2% and 97.1%. Conclusions: The results of this study confirm that patients from a Western country affected by loco-regionally advanced nasopharyngeal carcinoma have high plasma Epstein-Barr virus DNA levels at diagnosis. The monitoring of plasma levels is sensitive and highly specific in detecting disease recurrence and metastases. Keywords: Nasopharyngeal carcinoma, Epstein-Barr virus, Chemoradiotherapy, Induction chemotherapy, Plasma EBV DNA copy numbers Background Nasopharyngeal carcinomas (NPCs) are frequent in South-east Asia, China, the Arctic regions and North Africa, with the highest prevalence being observed in China’s Guangdong province and in Sarawak [1-7]. How- ever, they are rare in Europe and, in Italy, prevalence is about 1.4 per 100,000 inhabitants [8]. They are often diag- nosed late because the symptoms are subtle in the early * Correspondence: daris.ferrari@ao-sanpaolo.it 1Division of Medical Oncology and Department of Medicine, Surgery and Dentistry, San Paolo Hospital and University of Milan, Via Di Rudinì 8, Milan, Italy Full list of author information is available at the end of the article stage of disease. In Eastern populations, most stage I-II tumours are successfully treated by means of radiotherapy (RT), and about 50% of the patients with loco-regionally advanced disease (stage III-IV) are cured by means of com- bined chemotherapy and RT [9-12]. There are very few screening procedures for early disease [13], but repeated serological screening can be helpful in endemic regions [14]. A definite diagnosis depends on a combination of clin- ical suspicion, endoscopy with biopsy, and mainly magnetic resonance (MR) and positron emission tomography (PET) imaging techniques. The World Health Organization classi- fies NPCs as keratinising squamous carcinomas, which are characterized by well-differentiated keratin-producing cells © 2012 Ferrari et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.