Progress and Challenges in Chemotherapy for Loco-Regionally Advanced Nasopharyngeal Carcinoma

Incidence rates of nasopharyngeal carcinoma are high in Indonesia, Singapore and South-Eastern China.Chemoradiotherapy has been the standard regimen for locally advanced nasopharyngeal carcinoma accordingto guidelines from the National Comprehensive Cancer Network. Recently, advances in the management ofnasopharyngeal carcinoma have transferred into better treatment outcomes. Most phase III clinical trials supportthe addition of concurrent chemotherapy to radiotherapy for the initial treatment of these patients. Studiesevaluating effects and toxicity of concurrent chemotherapy with different regimens have been reported. However,the status of adding adjuvant chemotherapy or induction chemotherapy remains controversial. Recent studieshave shown that adjuvant chemotherapy with two or three cycles may improve survival for nasopharyngealcarcinoma with stage N2-3 disease or with persistently detectable plasma EBV DNA after radiotherapy. Thisreview examines the pertinent issues and latest studies concerning the management of loco-regionally advancedNPC, regarding concurrent chemotherapy, adjuvant chemotherapy, and induction chemotherapy in decades.