Key Points
➤ Nasopharyngeal carcinoma (NPC) is uncommon in many jurisdictions but
remains a significant public health problem in East and Southeast Asia,
which accounted for more than 70% of the approximate 129,000 new
diagnoses worldwide in 2018.
➤ NPC relies almost exclusively on (chemo-)radiotherapy to achieve disease
control in most presentations, particularly in the definitive treatment of
stage II to IVA disease.
Treatment
Radiotherapy: For Patients with Stage II to IVA Nasopharyngeal
Carcinoma
Recommendation 1.1
➤ For all nasopharyngeal carcinoma (NPC) patients, intensity modulated
radiotherapy (IMRT) with daily image guidance should be offered. If IMRT
is unavailable, patients should be transferred to institutions that could
implement IMRT whenever possible. (Strong Recommendation; EB-B-H)
Recommendation 1.2
➤ For all NPC patients, both sequential boost and simultaneous integrated
boost radiotherapy may be offered. (Moderate Recommendation; EB-B-I)
Recommendation 1.3
➤ For all NPC patients, a prescribed dose of 70 Gy in 33–35 fractions
(2.0–2.12 Gy per fraction) delivered over 7 weeks (once daily, 5 fractions
per week) should be offered. Radiation dose may be adjusted according
to tumor volume and its response to (chemo-)radiotherapy. (Strong
Recommendation; EB-B-H)
Recommendation 1.4
➤ For all NPC patients, gross tumor volume should be carefully delineated.
Target delineation should follow consensus guidelines and exploit
technical opportunities including image fusion. MRI image fusion with CT
for target delineation is mandatory, especially to appreciate the potential
tumor extension at the skull base and rule out or confirm the presence
of cranial nerve involvement and/or intracranial extension. (Strong
Recommendation; IC-B-I)
