Radiotherapy for nasopharyngeal cancer: 2025 update

Nasopharyngeal cancers are rare in France but much more common in endemic regions such as Southeast Asia, North Africa, and Alaska. Radiotherapy remains the cornerstone of treatment, combined with chemotherapy for locally advanced cases. The technical aspects of radiotherapy are complex due to the proximity of numerous critical structures. Recent studies have explored the benefits of combining systemic therapies, such as immunotherapy, with radiotherapy, the advantage of de-escalating irradiated lymph node volumes to reduce toxicity while maintaining therapeutic efficacy, and the value of monitoring via Epstein-Barr virus circulating tumour DNA to improve patient follow-up. Here, we present the updated recommendations of the French society of radiation oncology (Société française de radiothérapie oncologique, SFRO) concerning the indications and technical modalities of radiotherapy in nasopharyngeal cancers.