#Consensus dna trial#

All experts who rejected the use of plasma EBV DNA as the only tool in NPC management maintained that these procedures are essential, and that the patients’ right to receive these standard investigations should not be suppressed, insofar as the health-care system allows. The findings revealed that although plasma EBV DNA (supplemented, when possible, by imaging scans) can be used in most clinical circumstances in the context of resource limitations, it cannot entirely replace nasoendoscopy and tumour biopsy. Even with the availability of imaging tools, 73% of the experts disagreed that the use of plasma EBV DNA should replace nasoendoscopy and biopsy as the only staging investigation for NPC. In particular, all experts (100%) disagreed that the use of plasma EBV DNA and IgA viral capsid antigen, without imaging tools, could replace nasoendoscopy and biopsy as the only staging investigations for NPC in the resource-constrained setting.

#Consensus dna trial#

Therefore, it is sensible to consider whether plasma EBV DNA could replace nasoendoscopy, imaging scans, and even face-to-face clinical consultations during the COVID-19 pandemic and in future when similar or even more devastating pandemics occur, leading to insufficiency of personnel and personal protective equipment.ĭepartment of Clinical Oncology invited 33 top international clinicians from a broad range of clinical disciplines (head and neck surgery or otorhinolaryngology, medical oncology, radiation oncology and clinical oncology), representing 51 international professional societies and national clinical trial groups across four continents (Asia, Africa, Europe, and North America) during the COVID-19 pandemic to complete a modified Delphi consensus process of three rounds with 22 questions on whether plasma EBV DNA can replace the aforesaid routine clinical procedures and consultations in various clinical settings of NPC management when they are substantially restrained. However, the essential personnel, facilities and resources could be exceedingly scarce and constrained during the raging COVID-19 pandemic. Currently, the standard investigations in clinical management of NPC include clinical examinations, imaging scans and nasoendoscopy, a high-risk procedure of aerosol generation. 2 While histological proof is the gold standard in NPC diagnosis, plasma EBV DNA, the secretory DNA fragments of EBV, easily extracted in routine blood taking, has been regarded as the most sensitive and accurate tumour marker that has gained wide popularity and acceptance in NPC screening, diagnosis, stage segregation, treatment response monitoring, and prognostication. 1 It is also common in Hong Kong, closely related to genetic predisposition and dietary factors such as consumption of Chinese-style salted fish, with an age-standardised incidence rate of 5.8 per 100,000 population in 2020, ranked 8th and 17th for males and females respectively. NPC is endemic in Southern China, Southeast Asia, and North and East Africa, which is highly associated with prior Epstein-Barr virus (EBV) infection. The consensus statements of these recommendations were published in the world-leading oncology research journal, The Lancet Oncology. The international recommendations serve as important guidelines on future management of NPC when severe disasters or disruptions arise in future. Led by the Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong (HKUMed), an international group of the world’s top clinicians in managing nasopharyngeal carcinoma (NPC) has recently published recommendations on measuring plasma EBV DNA in managing NPC in an acute setting of serious resource and personnel constraints during the COVID-19 pandemic.