Association of chemotherapy and radiotherapy for T3N0 nasopharyngeal carcinoma in the area of intensity-modulated radiation therapy

Nasopharyngeal carcinoma (NPC) is a highly radiosensitive tumor (especially non-keratinizing carcinoma) and radiotherapy (RT) is the mainstay of treatment for newly diagnosed tumors. For early stage NPC, RT alone is the standard treatment while for locally advanced (LA) NPC concurrent chemoradiotherapy (CRT) with or without sequential chemotherapy [induction chemotherapy (IC) or adjuvant chemotherapy] is the standard treatment modality according to current guidelines, while the benefit of adjuvant or induction chemotherapy alone in addition to RT is limited (1,2). Indeed, the benefit of a combined modality approach has been demonstrated by several randomized trials and individual patient data meta-analysis (3). Moreover, in the Meta-Analysis of Chemotherapy in Nasopharynx Carcinoma (MAC-NPC) that included data on 4,806 patients in nineteen trials, with a median follow-up of 7.7 years, the addition of chemotherapy to RT significantly improved overall survival with an absolute benefit at 5 years of 6.3% (95% CI, 3.5–9.1%).