Recent developments in diagnosis and treatment of nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is one of the major cancers that Chinese radiotherapists have to treat, because of its high incidence which shows a tendency to increase. Although results of radiotherapy in NPC have improved markedly during the last decade, treatment at an early stage of the disease is the most effective. It is therefore important to make the diagnosis early, and recently serological surveys by IgA/VCA show its efficacy in high risk populations. Histological diagnosis so far has not correlated to prognosis, and new histological classifications have been proposed by many authors. The importance of CT scans in diagnosis and treatment is stressed. Criteria for clinical staging of NPC will have to be reconsidered, especially the T staging, as 80% of cases formerly classified as T1 may already have paranasopharyngeal extension, as shown on CT scans. The technique of radiotherapy has not changed much essentially since the advent of telecobaltherapy. However, various institutions have their own special variations. The most striking advance is the use of high-dose rate afterloading brachytherapy as boost for residual disease or as main treatment for nasopharyngeal recurrences. Finally, the role of chemotherapy in the radiation treatment of NPC is discussed, and the paper concludes with some remarks on the future outlook in the diagnosis and treatment of NPC.