A systematic review and recommendations on the use of plasma EBV DNA for nasopharyngeal carcinoma

Anne W.M. Lee, Victor H.F. Lee, Wai Tong Ng, Primož Strojan, Nabil F. Saba, Alessandra Rinaldo, Stefan M. Willems, Juan P. Rodrigo, Arlene A. Forastiere, Alfio Ferlito

Research output: Contribution to journalReview articlepeer-review


Introduction: Nasopharyngeal carcinoma (NPC) is an endemic malignancy in Southeast Asia, particularly Southern China. The classical non-keratinising cell type is almost unanimously associated with latent Epstein–Barr virus (EBV) infection. Circulating plasma EBV DNA can be a useful biomarker in various clinical aspects, but comprehensive recommendations and international guidelines are still lacking. We conducted a systematic review of all original articles on the clinical application of plasma EBV DNA for NPC; we further evaluated its strengths and limitations for consideration as standard recommendations. Methods: The search terms ‘nasopharyngeal OR nasopharynx’, and ‘plasma EBV DNA OR cell-free EBV OR cfEBV’ were used to identify full-length articles published up to December 2020 in the English literature. Three authors independently reviewed the article titles, removed duplicates and reviewed the remaining articles for eligibility. Results: A total of 81 articles met the eligibility criteria. Based on the levels of evidence and grades of recommendation assessed, it is worth considering the inclusion of plasma EBV DNA in screening, pre-treatment work-up for enhancing prognostication and tailoring of treatment strategy, monitoring during radical treatment, post-treatment surveillance for early detection of relapse, and monitoring during salvage treatment for recurrent or metastatic NPC. One major limitation is the methodology of measurement requiring harmonisation for consistent comparability. Conclusions: The current comprehensive review supports the inclusion of plasma EBV DNA in international guidelines in the clinical aspects listed, but methodological issues must be resolved before global application.

Original languageEnglish (US)
Pages (from-to)109-122
Number of pages14
JournalEuropean Journal of Cancer
StatePublished - Aug 2021


  • Clinical application
  • Guideline
  • Levels of evidence
  • Nasopharyngeal carcinoma
  • Plasma EBV DNA
  • Recommendation

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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