Current management of nasopharyngeal cancer

Management of nasopharyngeal carcinoma is one of the greatest clinical challenges. Appropriate detection is not easy because of its anatomical location; sensitive biomarkers in addition to endoscopic and radiological examinations would be valuable. One useful biomarker (particularly for nonkeratinizing carcinoma) is the plasma level of Epstein-Barr viral deoxyribonucleic acid, and its role as a tool for prognostication and monitoring disease progress is presented. Radiotherapy is the primary treatment modality, and using radiation therapy in combination with chemotherapy is recommended for the treatment of locoregionally advanced tumors. Intensity-modulated radiotherapy techniques with image guidance to ensure setup precision are recommended if resources allow; adaptive replanning should be considered if major deviations from the intended dose distribution occur during the treatment course. Most contemporary series have reported encouraging results, with locoregional control exceeding 90%; the key problem is distant failure. The therapeutic margin is extremely narrow. Although significant reduction of some toxicities (eg, xerostomia) and better quality of life is now achievable especially for early stages, the risk of major late toxicities remains substantial. This review will focus on the primary treatment: the current consensus and controversies in the treatment strategy for different stages, the choice of chemotherapy regimen, and the key factors for improving the therapeutic ratio of radiotherapy will be discussed. Summary of the current achievement and direction for future improvement will be presented.