The appropriate use of circulating EBV-DNA in nasopharyngeal carcinoma: Comprehensive clinical practice guidelines evaluation

Background: In EBV-related nasopharyngeal carcinoma (NPC), quantitative determination of circulating EBVDNA (cEBV-DNA) can potentially be applied as disease marker. The aim of the study was to investigate if the clinical utility of cEBV-DNA is established in clinical practice guidelines and if recommendations are provided to standardize the quantitative cEBV-DNA determination. Methods: A systematic literature search for NPC guidelines published since 2011 was performed. Information for cEBV-DNA detection method and use in clinical practice was synthesized in consecutive steps of increasing simplification. Results: From 570 titles and abstracts identified by the search, 16 guidelines were included. The selected documents were further clustered as either being based on a systematic literature revision to generate recommendations (4/16) or not (12/16). cEBV-DNA was evaluated in only one guideline based on a systematic revision and in 8 guidelines without systematic revision. Half of available guidelines provide recommendation for its clinical use. Methodological issues on cEBV-DNA determination are discussed by 31% of guidelines, without providing any recommendation on method standardization. Conclusions: Due to its prognostic value, cEBV-DNA is suggested in the pre-treatment work-up and in the followup. Guideline producers need to take into more consideration methodological aspects impacting the actual reliability and generalizability of laboratory results.

Automated summary

The study investigated the clinical utility of circulating EBV-DNA (cEBV-DNA) in clinical practice guidelines and found that half of the available guidelines provide recommendations for its clinical use, but there are still methodological issues in standardizing the quantitative determination of cEBV-DNA.