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Management of Nasopharyngeal Carcinoma

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Head and Neck Cancer

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Abstract

Nasopharyngeal carcinoma 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 radiotherapy (IMRT) 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. Contemporary series using IMRT together with extensive use of chemotherapy reported very encouraging long-term results with locoregional control in excess of 85 % at 5 years; the key remaining problems are advanced T4 disease and distant failure. Further improvement of efficacy by more potent systemic therapy and changing chemotherapy sequence to induction-concurrent is being explored.

The plasma level of Epstein–Barr Viral Deoxyribonucleic Acid is a well-established tool for non-keratinizing 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; and aggressive treatment should be attempted as long survival could be achieved for patients with limited failure. Different salvage methods and reported results are summarized.

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Authors and Affiliations

  1. Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China

    Wai Tong Ng MD, FRCR & Siu Hong Chan FRCR

  2. Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China

    Roger K. C. Ngan FRCR

  3. Department of Clinical Oncology, Queen Mary Hospital, Li Ka Shing, The University of Hong Kong, Hong Kong, China

    Henry Sze MBBS, FRCR, FHKCR, FHKAM, PDip

  4. Department of Surgery, Queen Mary Hospital, Hong Kong, China

    Jimmy Y. W. Chan MS

  5. Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Futian District, Shenzhen, Guangdong Province, 518053, China

    Anne W. M. Lee MD, FRCR

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  1. Wai Tong Ng MD, FRCR
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  2. Roger K. C. Ngan FRCR
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  3. Siu Hong Chan FRCR
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  4. Henry Sze MBBS, FRCR, FHKCR, FHKAM, PDip
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  5. Jimmy Y. W. Chan MS
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  6. Anne W. M. Lee MD, FRCR
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Correspondence to Anne W. M. Lee MD, FRCR .

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  1. Department of Radio-Oncology, Genolier Swiss Medical Network, Genolier, Switzerland

    Jacques Bernier

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Ng, W.T., Ngan, R.K.C., Chan, S.H., Sze, H., Chan, J.Y.W., Lee, A.W.M. (2016). Management of Nasopharyngeal Carcinoma. In: Bernier, J. (eds) Head and Neck Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-27601-4_26

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