Second primary nasopharyngeal carcinoma after high - dose chemotherapy and autologous bone marrow transplantation due to Hodgkin’s lymphoma: Сlinical case with literature overview

A second primary nasopharyngeal carcinoma diagnosed after Hodgkin’s Lymphoma is a rare disease. We present a 47-year old patient with nasopharyngeal carcinoma one year after high-dose chemotherapy and 8 months after autologous bone marrow transplantation due to Hodgkin’s Lymphoma with achieved clinical and hemopoetic remission. The diagnosis of the second primary neoplasm was made after nasopharyngoscopy with biopsy, MRI and PET/CT. The patient was positive for Epstein-Barr viral infection. Intensity-modulated radiotherapy combined with chemotherapy was performed using VMAT technique. In the primary nasopharyngeal tumor was achieved total dose of 70 Gy with 2.12 Gy per fraction while in the regional lymphatic basin (levels IB-V) with the retropharyngeal lymph nodes bilaterally is achieved a total dose of 59.4 Gy with 1.8 Gy per fraction. In the discussion the pathogenetic connection between the Epstein-Barr viral infection and the debut of nasopharyngeal carcinoma is focused on. The follow-up of patients who have undergone chemo- and/or radiotherapy due to Hodgkin’s Lymphoma is importance for the early diagnosis of a second malignant tumor and its proper treatment. Keywords: nasopharyngeal carcinoma; epstein-barr virus; hodgkin’s lymphoma; high-dose chemotherapy; radiotherapy.