Radiotherapy Planning for Nasopharyngeal Carcinoma After Induction Chemotherapy: A Systematic Review to Inform...

Area of Science:

• Oncology
• Radiation Oncology
• Medical Guidelines

Background:

• Induction chemotherapy (ICT) followed by chemoradiotherapy is standard for locoregionally advanced nasopharyngeal carcinoma (LA-NPC).
• Significant practice variations exist regarding radiotherapy (RT) after ICT.
• There is a need to harmonize RT practices for LA-NPC.

Purpose of the Study:

• To systematically review current literature on RT practices post-ICT for LA-NPC.
• To identify areas of significant practice variation in RT target volumes and prescriptions.
• To inform the development of international consensus guidelines.

Main Methods:

• A scoping review was conducted to identify practice differences.
• A systematic review followed to analyze existing literature.
• Expert committees (Steering Committee and Evidence Review Committee) comprising radiation oncologists were involved.

Main Results:

• Significant practice variations identified in RT timing, imaging modalities, dose prescription, and target volume delineation post-ICT.
• No specific recommendations found for optimal post-ICT RT timing or imaging modalities.
• Evidence suggests potential for volume reduction in RT targets without compromising outcomes, possibly improving quality of life.

Conclusions:

• A lack of evidence and established guidelines exists for post-ICT RT timing and imaging in LA-NPC.
• Divergent guidelines on post-ICT target volumes and dose levels are prevalent, with limited clinical trial data.
• International consensus guidelines are essential to standardize RT practices for LA-NPC.