Concurrent Chemotherapy
Recommendation 3.1
➤ For all NPC patients without contraindications, concurrent cisplatin,
given weekly (40 mg/m²) or triweekly (100 mg/m², or at least
80 mg/m²), should be offered along with radiotherapy. (Strong
Recommendation; EB-B-H)
Recommendation 3.2
➤ For all NPC patients without contraindications, in the concurrent
chemotherapy setting, 3 doses of triweekly or 7 doses of weekly
cisplatin should be attempted to achieve a cumulative dose of at least
200 mg/m². (Moderate Recommendation; IC-B-I)
Recommendation 3.3
➤ For NPC patients with a contraindication to cisplatin, nedaplatin (100
mg/m
2
triweekly) may be offered for concurrent chemoradiotherapy.
Other options that may be offered are carboplatin (Area Under Curve
[AUC] 5–6 triweekly) or oxaliplatin (70 mg/m
2
weekly). (Strong
Recommendation; EB-B-I)
Recommendation 3.4
➤ For NPC patients with a contraindication to platinum-based
chemotherapy, fluoropyrimidines (e.g., capecitabine, 5-fluorouracil,
tegafur) with concurrent radiotherapy may be offered. (Weak
Recommendation; EB-B-L)
Recommendation 2.4
➤ For Stage III–IVA (except T3N0) (AJCC 8th) NPC patients who do not
receive induction chemotherapy plus concurrent chemoradiotherapy,
then concurrent chemoradiotherapy plus adjuvant chemotherapy should
be offered. (Moderate Recommendation; EB-B-I)
Note: There's a lack of head-to-head trials comparing induction chemotherapy plus concurrent
chemoradiotherapy versus concurrent chemoradiotherapy plus adjuvant chemotherapy. Therefore, which
sequence performs better in the contemporary era remains uncertain.
Recommendation 2.5
➤ For T3N0 (AJCC 8th) NPC patients, concurrent chemoradiotherapy
should be offered. Adjuvant or induction chemotherapy may also be
offered. (Moderate Recommendation; EB-B-I)
