Management of nasopharyngeal carcinoma

Abstract

Nasopharyngeal carcinoma (NPC) is a distinctly radiosensitive and chemosensitive tumor. Best quality radiotherapy is demanded to build up the complex concave high-dose zone for this critical location. Intensity-modulated (IMRT) technique is advocated, image guidance to ensure setup precision and adaptive re-planning if major deviations from intended dose distribution occur during the treatment course are useful improvements if resources allow. Stringent dose constraint to organs at risk should be attempted to minimize late toxicities. Addition of cisplatin-based concurrent-adjuvant chemotherapy is recommended for patients with stages III–IVB and high-risk stage IIB diseases. More contemporary series using IMRT together with extensive use of chemotherapy and acceleration reported very encouraging early results with locoregional control in excess of 90% at 2–4 years; the key remaining problem is distant failure. Further improvement of efficacy by changing chemotherapy sequence to induction-concurrent is being explored.The plasma level of Epstein–Barr Viral Deoxyribonucleic Acid is an additional tool for nonkeratinizing carcinoma for prognostication and monitoring disease progress. Integrated fluorodeoxyglucose positron emission tomography and computed tomography is useful for excluding distant metastases and posttreatment persistent/recurrent disease. Early detection of failure is critical for increasing the chance of salvage; aggressive treatment should be attempted as far as possible, long survival can be achieved for patients with limited failure or metastasis. Different salvage methods and reported results are summarized.