Management Of Nasopharyngeal Carcinoma Research Articles

Surgical treatment of nasopharyngeal cancer - a consensus recommendation from two Chinese associations.

Surgical treatment is playing an increasingly important role in the management of nasopharyngeal carcinoma (NPC). This consensus focuses on the indications for optimal surgery, and surgical methods in the whole process of treatment for NPC to provide a useful reference to assist these difficult clinical decisions. A thorough review of available literature on NPC and surgery was conducted by the Association for the prevention and treatment of nasopharyngeal carcinoma in China, international exchange and promotion Association for medicine and healthcare, and the Committee on nasopharyngeal cancer of Guangdong provincial anticancer association. A set of questions and a preliminary draft guideline was circulated to a panel of 1096 experienced specialists on this disease for voting on controversial areas and comments. A refined second proposal, based on a summary of the initial voting and different opinions expressed, was recirculated to the experts in two authoritative medical science and technology academic groups in the prevention and treatment of NPC in China for review and reconsideration. The initial round of questions showed variations in clinical practice even among similar specialists, reflecting the lack of high-quality supporting data and resulting difficulties in formulating clinical decisions. Through exchange of comments and iterative revisions, recommendations with high-to-moderate agreement were formulated on general treatment strategies and details of surgery, including indications and surgical approaches. By standardizing the surgical indications and practice, we hope not only to improve the surgical outcomes, but also to highlight the key directions of future clinical research in the surgical management of NPC.

The Role of Nasopharyngectomy in the Management of Nasopharyngeal Carcinoma

The Role of Nasopharyngectomy in the Management of Nasopharyngeal Carcinoma

Role of neo-adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is a rare type of tumor which arises from the surface and lining epithelium of nasopharynx. Management of nasopharyngeal carcinoma is one of the greatest clinical challenges but it is radiosensitive and chemosensitive; excellent tumor control can be attained with radiotherapy with or without adjuvant therapies concurrent chemoradiation therapy. This review will focus on role of neoadjuvant chemotherapy in nasopharyngeal carcinoma on disease free survival (DFS), distant metastases free survival and overall survival (OS) and systemic toxicities, indications and choice and number of cycles of regimen for neoadjuvant chemotherapy.

Pretreatment [18F]FDG PET/CT and MRI in the prognosis of nasopharyngeal carcinoma.

The present study aimed to assess the prognostic interest of metabolic and anatomic parameters derived from 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) and head and neck magnetic resonance imaging (HN-MRI) for better management of nasopharyngeal carcinoma (NPC). In this study, pre-treatment [18F]FDG PET/CT and HN-MRI parameters of NPC patients diagnosed between January 2017 and December 2018, were prospectively investigated. Correlation between those parameters and 4-year patient's survival outcomes was evaluated using Kaplan-Meier and Cox-regression analyses. Our results revealed a significant association between pre-treatment nodal-maximum standardized uptake value (N-SUV max) and N categories (p = 0.01), between pre-treatment node-to-tumor SUV ratio (NTR) and both tumor size (p = 0.01) and N categories (p = 0.009), as well as between metabolic tumor volume (MTV) and both tumor size and NPC overall stage (p < 0.000). In multivariate analyses, pre-treatment N-SUV max, NTR and MTV were significant independent predictors of overall survival, distant metastasis-free survival, and progression-free survival (PFS) (p < 0.05). N-SUV max and MTV were also found to be significant independent predictors of loco-regional recurrence-free survival (p < 0.05), whereas HN-MRI detection of skull-base bone invasion was an independent factor associated with worse PFS in NPC (p = 0.03). The present study highlights N-SUV max, NTR and MTV derived from [18F]FDG PET/CT, and skull-base bone invasion defined by HN-MRI, as promising metabolic and anatomic prognosis biomarkers for NPC.

Plasma Epstein-Barr virus DNA analysis for personalised management of nasopharyngeal carcinoma—current opportunities and challenges

Plasma Epstein-Barr virus DNA analysis for personalised management of nasopharyngeal carcinoma—current opportunities and challenges

The role of nasopharyngectomy in the management of nasopharyngeal carcinoma.

Recently, endoscopic nasopharyngectomy (ENPG) has become an effective treatment for locally recurrent nasopharyngeal carcinoma (NPC). This article reviews recent publications on ENPG and specifically addresses the surgical anatomy of the nasopharynx and discusses several important issues regarding ENPG. The surgical techniques for ENPG have been previously described in several studies. The latest published data revealed good outcomes of ENPG compared with intensity-modulated radiation therapy (IMRT) in recurrent NPC. In addition, ENPG avoids severe reirradiation side effects. This review highlights the surgical anatomy of ENPG, which is important in preventing possible serious complications. ENPG is a good option for managing recurrent NPC. Careful preoperative evaluation and a full understanding of the surgical anatomy help in preventing damage to nearby critical neurovascular structure. Long-term follow-up is still needed to evaluate its eventual morbidity and efficacy.

The Role of Genetic Pathways in the Development of Chemoradiation Resistance in Nasopharyngeal Carcinoma (NPC) Patients.

Management of nasopharyngeal carcinoma (NPC) remains elusive despite new developments and advancement that has been made in the current management approaches. A patient’s survival and prognosis remain dismal especially for a late-stage disease. This is highly attribute to the chemoradiation resistance. Arrays of genes and molecular mechanisms underlie the development of chemoradiation resistance in NPC. Imperatively, unravelling the true pathogenesis of chemoradiation resistance is crucial as these significant proteins and genes can be modulated to produce an effective therapeutic target. It is pivotal to identify the chemoradiation resistance at the very beginning in order to combat the chemoradiation resistance efficiently. Intense research in the genetic ecosphere is critical, as the discovery and development of novel therapeutic targets can be used for screening, diagnosis, and treating the chemoradiation resistance aggressively. This will escalate the management trajectory of NPC patients. This article highlights the significance of genetic and molecular factors that play critical roles in the chemoradiation resistance and how these factors may be modified for next-generation targeted therapy products.

Indole-thiazolidinone conjugate inhibits nasopharyngeal carcinoma cell migration and invasion by targeting NF κB pathway

Purpose: To investigate the effect of indole-thiazolidinone on metastasis in HK1 nasopharyngeal carcinoma cells.&#x0D; Methods: HK1 cell proliferation was determined colorimetrically using 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide (MTT) assay. Invasion and migration of HK1 cells were assessed using Matrigel™ chamber coated invasion and wound healing assays, respectively.&#x0D; Results: Indole-thiazolidinone suppressed proliferation of HK1 and NPC 039 NPC cell lines at 72 h. The degree of proliferation of HK1 cells on treatment with 0.25, 0.5, 1.0, 1.5, 2.0, 2.5 and 3.0 μM indolethiazolidinone was 99, 87, 71, 64, 49, 38 and 31 %, respectively. In HK1 cell cultures, migration potential was reduced to 58.32, 47.54, 28.91 and 17.65 %, on exposure to 1.5, 2.0, 2.5 and 3.0 μM indole-thiazolidinone, respectively. Incubation with 1.5, 2.0, 2.5 and 3.0 μM indole-thiazolidinone resulted in cell invasion values of 63.41, 49.37, 35.12 and 19.67 %, respectively. There was a marked decrease in the expressions of matrix metalloproteinase 2 and matrix metalloproteinase 9 in HK1 cells on treatment with indole-thiazolidinone (p &lt; 0.05). In addition, indole-thiazolidinone treatment resulted in decrease in p65 and p50 in nuclear fraction. Treatment of HK1 and NPC 039 cells with indolethiazolidinone and henenalin synergistically decreased cell proliferation. Indole-thiazolidinone treatment caused significant decrease in tumor growth in mice (p &lt; 0.05).&#x0D; Conclusion: Indole-thiazolidinone inhibits proliferation and metastasis in nasopharyngeal carcinoma cells. Therefore, it has potential for development as a therapeutic management of nasopharyngeal carcinoma in humans.

Intensity-Modulated Proton Therapy for Nasopharynx Cancer: 2-year Outcomes from a Single Institution.

PurposeAdvances in radiotherapy have improved tumor control and reduced toxicity in the management of nasopharyngeal carcinoma (NPC). Local failure remains a problem for some patients with advanced primary tumors, and toxicities are significant given the large treatment volume and tumor proximity to critical structures, even with modern photon-based radiotherapy. Proton therapy has unique dosimetric advantages, and recent technological advances now allow delivery of intensity-modulated proton therapy (IMPT), which can potentially improve the therapeutic ratio in NPC. We report our 2-year clinical outcomes with IMPT for NPC.Materials and MethodsWe retrospectively reviewed treatment records of patients with NPC treated with IMPT at our center. Demographics, dosimetry, tumor response, local regional control (LRC), distant metastasis, overall survival, and acute and late toxicity outcomes were reviewed. Analyses were performed with descriptive statistics and Kaplan-Meier method. Toxicity was graded per Common Terminology Criteria for Adverse Events (version 4.0).ResultsTwenty-six patients were treated from 2015 to 2020. Median age was 48 years (range, 19–73 years), 62% (n = 16) had T3-T4 disease, 92% (n = 24) were node positive, 92% (n = 24) had stage III-IV disease, and 69% (n = 18) had positive results for Epstein-Barr virus. Dose-painted pencil-beam IMPT was used. Most patients (85%; 22 of 26) were treated with 70 Gy(RBE) in 33 fractions once daily; 4 (15%) underwent hyperfractionated accelerated treatment twice daily. All received concurrent cisplatin chemotherapy; 7 (27%) also received induction chemotherapy. All patients (100%) completed the planned radiotherapy, and no acute or late grade 4 or 5 toxicities were observed. At median follow-up of 25 months (range, 4-60), there were 2 local regional failures (8%) and 3 distant metastases (12%). The Kaplan-Meier 2-year LRC, freedom from distant metastasis, and overall survival were 92%, 87%, and 85% respectively.ConclusionIMPT is feasible in locally advanced NPC with early outcomes demonstrating excellent LRC and favorable toxicity profile. Our data add to the growing body of evidence supporting the clinical use of IMPT for NPC.

Parallel genome-wide RNAi screens identify lymphocyte-specific protein tyrosine kinase (LCK) as a targetable vulnerability of cell proliferation and chemoresistance in nasopharyngeal carcinoma.

Despite recent in advances in the management of nasopharyngeal carcinoma (NPC), development of targeted therapy remains challenging particularly in patients with recurrent or metastatic disease. To search for clinically relevant targets for the treatment of NPC, we carried out parallel genome-wide functional screens to identified essential genes that are required for NPC cells proliferation and cisplatin resistance. We identified lymphocyte-specific protein tyrosine kinase (LCK) as a key vulnerability of both proliferation and cisplatin resistance. Depletion of endogenous LCK or treatment of cells with LCK inhibitor induced tumor-specific cell death and synergized cisplatin sensitivity in EBV-positive C666-1 and EBV-negative SUNE1 cells. Further analyses demonstrated that LCK is regulating the proliferation and cisplatin resistance through activation of signal transducer and activator of transcription 5 (STAT5). Taken together, our study provides a molecular basis for targeting LCK and STAT5 signaling as potential druggable targets for the management of NPC.

CASE REPORT: NASOPHARYNGEAL CARCINOMA IN PREGNANCY

Abstract Introduction: Nasopharyngeal carcinoma in pregnancy is a rare case, a dilemma in its management. This condition has a significant negative effect on pregnancy, given risk of premature birth, fetal defects and abortion. Case Report: 23-year-old woman with 13 weeks gestation age comes with swelling in both necks accompanied by nosebleeds. On nasoendoscopic examination, there was a mass at nasopharynx. Histopathological examination results a nasopharyngeal squamous cell carcinoma. Conclusion: The management of nasopharyngeal carcinoma in pregnancy is very complex, need for extensive multidisciplinary approach with experienced doctors in their respective fields

The Homologous Recombination Repair Pathway is Associated with Resistance to Radiotherapy in Nasopharyngeal Carcinoma.

Radiotherapy plays a major role in the management of nasopharyngeal carcinoma (NPC). However, the radioresistant cells limit its efficiency and drive recurrence inside the irradiated tumor volume leading to poor outcome for patients. To illuminate the signal pathway involved in the radioresistance and evaluate the potential for predicting NPC response to radiotherapy, we established the radioresistant NPC cell line (CNE2-RR) derived from NPC cell line CNE2 by gradually increased the radiation dose (total 60 Gy), and the radioresistance of CNE2-RR cells was evaluated by the colony formation, FCM and comet assays. Furthermore, comparison of established CNE2-RR cell line to parental cell line found the homologous recombination repair (HRR) proteins differences involved in NPC radioresistance. In addition, the differentially expressed proteins were further validated by western blotting, immunofluorescence and IHC in tumor xenografs and radioresistant NPC tissues. Furthermore, the correlation of HRR proteins expression levels with NPC radioresistance were evaluated. The results showed that the upregulation of HRR proteins were significantly correlated with NPC radioresistance. In addition, using the Youden Index cutoff value, a panel of the HRR proteins analyses revealed a sensitivity of 70%, specificity of 72%. Furthermore, silencing NFBD1 enhanced the radiosensitivity of CNE2-RR cells by impairing IR-inducing γ-H2AX and HR proteins foci formation. These results suggest that controlling the HRR signaling pathway may hold promise to overcome NPC radioresistance.

Potential pitfalls in incorporating plasma Epstein-Barr virus DNA in the management of nasopharyngeal carcinoma.

This study identifies potential pitfalls in incorporating plasma Epstein-Barr virus (EBV) DNA into the management of nasopharyngeal carcinoma (NPC). A total of 208 NPC patients without distant metastasis who received radical treatment and had measurements of EBV DNA at baseline, 8 weeks and 26 weeks postradiotherapy were analyzed. Prognostic and predictive values at each time-point were compared. Risk stratification by pretreatment level failed to identify a poor prognostic group. Detectable EBV DNA at 8 weeks and 26 weeks postradiotherapy were both associated with significantly poorer 5-year disease-free survival (HR 0.30, P < .001 and HR 0.03, P < .001, respectively) and overall survival (HR 0.27, P = .009 and HR 0.03, P < .001, respectively). Eighty percentage had detectable EBV DNA at recurrence (53.3% for local only, 100% for regional only, and 100% for distant failure). Posttreatment EBV DNA, particularly at 26 weeks post-radiotherapy, has high prognostic and predictive values. Surveillance endoscopy/imaging are recommended for the detection of local recurrence.

MANAGEMENT OF NASOPHARYNGEAL CANCER IN DR. ZAINOEL ABIDIN GENERAL HOSPITAL BANDA ACEH

Introduction:&#x0D; Most of the patients who are at an advanced or final stage of an illness usually comes from middle to low economic level. Right now, nasopharyngeal carcinoma management in Dr. Zainoel Abidin General Hospital Banda Aceh only has chemotherapy to treat patients. Actually patients need to also undergo radiotherapy treatment which unavailable in our hospital yet, so we will refer it to another hospital located in North Sumatera or Jakarta. Therefore, the Acehnese government is preparing to build an oncology center which includes radiotherapy, so that we can treat our patients here.&#x0D; Objective: &#x0D; The purpose of this research is to report management of NPC in Dr. Zainoel Abidin General Hospital Banda Aceh from January 2016 to October 2018.&#x0D; Method: &#x0D; Data was taken from medical records of patients diagnosed with NPC from January 2016 to October 2018. 73 patients was diagnosed with NPC and underwent chemotherapy.&#x0D; Result: &#x0D; There were 73 patients NPC, 44 (60.3%) patients are male (60.3%) and 29 patients are female (39.7%). The youngest patient is 13 years old and the oldest is 79 years old. Most common average age are between36-65 years old. The highest number is from Banda Aceh 10 patients. WHO histopathology classification reported that 26 (35.6%) patients with type I and type III as well, and 21 (28.8%) patients with type II. While 30 (41,1%) patients underwent chemotherapy for 6 cycles, 43 (58.9%) patients dropped out due to lack of living cost, long distance from hospital, or worsen of general condition.&#x0D; Conclusion: &#x0D; It was reported 73 patients NPC, 44 (60.3%) male and 29 (39.7%) female. The youngest 13 years old and the oldest 79 years old. Most common average age between 36-65 years old. The highest number was from Banda Aceh 10 patients, WHO histopathology classification reported 26 (35.6%) patients with type I and type III as well, and 21 (28.8%) patients with type II. While 30 (41.1%) patients underwent chemotherapy 6 cycles, 43 (58.9%) patients dropped out due to lack of the cost of. This study reported 4 (13.3%) patients who survived after underwent chemotherapy full dose with average range of 19-26 months.

Cetuximab in the management of nasopharyngeal carcinoma - a narrative review.

Concurrent chemotherapy with radiotherapy is the standard treatment for locoregionally advanced nasopharyngeal cancer. Cetuximab can be used in the treatment of head and neck squamous cell carcinoma. However, the randomised studies that led to approval for its use in this setting excluded nasopharyngeal cancer. In the context of limited data for the use of cetuximab in nasopharyngeal cancer in the medical literature, this review aimed to summarise the current evidence for its use in both primary and recurrent or metastatic disease. A literature search was performed using the keywords 'nasopharyngeal neoplasm', 'cetuximab' and 'Erbitux'. Twenty studies were included. There were no randomised phase III trials, but there were nine phase II trials. The use of cetuximab in the treatment of nasopharyngeal carcinoma has been tested in various settings, including in combination with induction chemotherapy and concurrent chemoradiotherapy, and in the palliative setting. There is no evidence of benefit from the addition of cetuximab to standard management protocols, and there is some evidence of increased toxicity. There is more promise for its use in metastatic or locally recurrent settings. This review draws together the existing evidence and could provide a focus for future studies.

Celastrol, a plant-derived triterpene, induces cisplatin-resistance nasopharyngeal carcinoma cancer cell apoptosis though ERK1/2 and p38 MAPK signaling pathway

BackgroundDeveloping resistance to chemotherapeutic drugs has become a major problem in the management of nasopharyngeal carcinoma (NPC). To overcome this issue, use of natural plant products as chemosensitizers is gaining importance at a fast pace. Hypothesis/PurposeThe present study was designed to evaluate the cytotoxic effect and mode of action of a natural pentacyclic triterpenoid, celastrol, on cisplatin-resistant NPC cells. ResultsStudy results revealed that celastrol treatment significantly reduced the viability of NPC cells in dose and time dependent manners, as compared to untreated control cells. The cytotoxic effect of celastrol was mediated by cell cycle arrest at G2/M phase and induction of intrinsic and extrinsic apoptotic pathways. With further analysis, we observed that celastrol-induced activation of caspases was accompanied by increased phosphorylation of MAPK pathway proteins, p38, ERK1/2. ConclusionTaken together, our observation provides a novel insight on use of a natural plant product, celastrol, in the management of chemoresistant NPC.

Recent advances in the management of nasopharyngeal carcinoma.

Over the last few years, certain areas in the management nasopharyngeal carcinoma (NPC) that have an impact on the care of these patients have evolved, particularly with regard to liquid biopsies, minimally invasive surgery, and advances in chemotherapy and immunotherapy. Beyond its proven role in the diagnostics, surveillance, and treatment of NPC, liquid biopsy with plasma Epstein–Barr virus DNA in the screening of high-risk populations for NPC is strongly supported by recent evidence. Surgery of the nasopharynx is reserved for locally recurrent NPC, and in recent years there have been great strides in minimally invasive techniques with survival rates similar to those of open techniques in treating NPC. Induction chemotherapy in a recent pooled analysis was shown to be superior to concurrent chemotherapy alone for locoregionally advanced NPC. Finally, immunotherapy with a PD-1 inhibitor in NPC has been shown to have 1-year overall survival rates comparable to those of other patients with heavily pre-treated metastatic or recurrent NPC. In this commentary, we discuss these recent advances and their potential in the clinical management of patients with NPC.

Concurrent Chemoradiotherapy for Loco-regionally Advanced Nasopharyngeal Carcinoma: Treatment Outcomes and Prognostic Factors

Background:We conducted this study to contribute to resolving some controversial issues on management of nasopharyngeal carcinoma.Methods:Thirty-two patients with stage III-IVB nasopharyngeal carcinoma were included in this retrospective study. All patients received concurrent chemoradiotherapy with either 3D conformal radiotherapy or intensity-modulated radiotherapy. We retrospectively analyzed the survival outcome, prognostic factors for survival, and toxicity outcome.Results:The 2- and 5-year overall survival rates were 89.9% and 82.6%. The 2- and 5-year distant metastasis-free survival rates were 83.2% and 79.4%. The 2- and 5-year loco-regional recurrence-free survival rates were 83.3% and 79.5%. Addition of induction chemotherapy to concurrent chemoradiotherapy did not improve survival outcomes. The survival benefit of intensity-modulated radiotherapy over 3D conformal radiotherapy was not clear. Intensity-modulated radiotherapy significantly decreased the development of late toxicities compared with 3D conformal radiotherapy. Total RT dose was prognostic factor for overall, loco-regional recurrence-free, and distant metastasis-free survival. Temporary RT interruption was prognostic factor for overall survival. Daily RT dose was prognostic factor for distant metastasis-free survival.Conclusions:Concurrent chemoradiotherapy resulted in high survival rates with an acceptable level of toxicities in patients with loco-regionally advanced nasopharyngeal carcinoma. To confirm the results of this study, well-designed randomized prospective trials are warranted.

The prognostic value of pretreatment tumor apparent diffusion coefficient values in nasopharyngeal carcinoma

BackgroundDiffusion-weighted MR imaging (DWI) has increasingly contributed to the management of nasopharyngeal carcinoma (NPC) patients. The objective of this paper was to explore the prognostic significance of apparent diffusion coefficient (ADC) values in 93 NPC patients.MethodsThis retrospective study included 93 newly diagnosed NPC patients. Pretreatment ADC values were determined and compared with patients’ age, gender, alcohol intake, smoking, tumor volume, pathological type, tumor stage, and nodal stage. Using the Kaplan-Meier method, overall survival (OS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were calculated and the values compared between the low and high ADC groups. Multivariate analysis of ADC values and other 9 clinical parameters was performed using a Cox proportional hazards model to test the independent significance for OS, LRFS and DMFS.ResultsThe mean ADC value for the initial nasopharyngeal tumors was 0.72 × 10−3 mm2/s (range: 0.48–0.97 × 10−3 mm2/s). There was no significant difference between pretreatment ADCs and patient’ gender, age, smoking, alcohol intake, or tumor stage. A significant difference in the ADCs for different N stages (P = 0.022) and correlation with initial tumor volume (r = −0.26, P = 0.012) were observed. In comparison, the ADC value for undifferentiated carcinoma was lower than that for other 3 pathological types. With a median follow-up period of 50 months, the 3-year and 5-year OS rates were 88.2% and 83.3%, respectively, 3-year and 5-year LRFS rates were 93.5% and 93.3%, respectively, and 3-year and 5-year DMFS rates were 83.9% and 83.3%, respectively. Patients with tumor ADC values ≥0.72 × 10−3 mm2/s exhibited longer OS and LRFS periods compared with tumor ADC values <0.72 × 10−3 mm2/s, with P values 0.036 and 0.018, respectively. In addition, patients with deaths or recurrences or distant metastasis had significant lower ADC values than those without disease failures. According to a multivariate analysis using the Cox proportional hazard test, ADC values showed a significant correlation with OS (P = 0.0004), LRFS (P = 0.0009), and DMFS (P < 0.0001), respectively.ConclusionsPretreatment tumor ADC values supposed to be a noninvasive important prognostic parameter for NPC.

Concomitant Radiochemotherapy in the Management of Nasopharyngeal Carcinoma

Purpose To develop the results of concomitant radiochemotherapy in management of nasopharyngeal carcinoma (NPC) to the National Institute of Oncology at Rabat. Materials and methods Retrospective study of 81 patients with nasopharyngeal carcinoma and who were treated with concomitant radiochemotherapy to the National Institute of Oncology at Rabat in radiotherapy department, for a period of January to December 2012. Results Median age was 43 years old with male dominance to 78,8 %. According to TNM classification passed by AJCC 2010, 43,2% were classified stage IV, 37 % stage III and 19,8 % stage II. Neoadjuvant chemotherapy was indicated in 20 patients (24,7%) or 95% in N2-N3. The Therapeutic result after the neoadjuvant chemotherapy for lymph node was complete in 31,2 %. The concomitant radiochemotherapy treatment consisted in a conformal therapy treatment with lateral 6 MV photon beams dose of 70 Gy in conventional fractioning, and in two series by excluding spinal cord after dose of 40 Gy. We used electrons treatment in addition to treat the lymph nodes. The concomitant chemotherapy consisted of a weekly cisplatin treatment 40 mg/m2. The mean spread was 57,3 days. During the concomitant chemotherapy treatment 60 % of radiomucitis and 30 % nephrotoxicity were observed in patients receiving neoadjuvant chemotherapy. Late toxicities were dominated by hyposcialie (90,1%) and otological disorders (67,9%). After an average follow-up of 30,6 months, we were able to follow the progress of 69 patients (85,2%). Forty-nine patients (75,3%) were in good locoregional control. We observed 20 relapses (24,7 %) including 14 metastatic relapses. The main prognostic factors of metastasis were lymph node involvement in 92,2% (p = 0,04) and T3-T4 stages in 64,2% (p = 0,013). At three years, overall survival at all stages were to 81,9%, survival without recurrence to 71% and local control to 79,2%. Conclusion The nasopharyngeal carcinoma are radiosensitive and radiocurable tumors. Concomitant radiochemotherapy is the therapeutic standard for locally advanced nasopharyngeal carcinoma, and allow to obtain carcinological good results at toxicity notable disadvantage.