Nasopharyngeal carcinoma. Biology, natural history, and therapeutic implications

Undifferentiated carcinoma of the nasopharyngeal type (UCNT) is a particular head and neck Epstein Barr virus (EBV)-related carcinoma. It has a specific geographic repartition and a short natural history. Radiotherapy allows a high rate of local control, but 80% of patients die with or of metastatic spread. This tumor is also very chemosensitive, but the role of chemotherapy is still controversial. The Gustave Roussy experience (1984-1989) in this field is described. An 80% response rate in metastatic disease, 10% of unmaintained long-term complete responders after chemotherapy, and the achievement of 66% complete response with bleomycin-epirubicin-cisplatin (BEC) regimen in locally advanced disease are the main arguments for a primary role for chemotherapy in this potentially curable disease.