Current management of stage IV nasopharyngeal carcinoma without distant metastasis

Cancer Treat Rev. 2020 Apr:85:101995. doi: 10.1016/j.ctrv.2020.101995. Epub 2020 Feb 21.


Up to one in four patients with nasopharyngeal carcinoma present with non-metastatic stage IV disease (i.e. T4 or N3). Distinct failure patterns exist, despite the routine adoption of contemporary treatment modalities such as intensity modulated radiotherapy and systemic chemotherapy. Concurrent chemoradiotherapy (CCRT) followed by adjuvant chemotherapy or induction chemotherapy followed by CCRT are commonly employed in this setting, with the latter emerging as the preferred option. Additionally, emerging radiation technologies like proton therapy has become available offering new opportunities for prevention of radiation-induced side effects. This article reviews not only the current treatment strategies, but also discusses novel ways to tackle this challenging disease with respect to the patterns of failure.

Keywords: Chemotherapy; Immunotherapy; Nasopharyngeal carcinoma; Prognosis; Radiotherapy; Targeted therapy.

Publication types

  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Biopsy, Needle
  • Cause of Death*
  • Chemoradiotherapy / methods
  • Combined Modality Therapy
  • Disease-Free Survival
  • Female
  • Humans
  • Immunohistochemistry
  • Induction Chemotherapy / methods
  • Male
  • Nasopharyngeal Carcinoma / diagnostic imaging
  • Nasopharyngeal Carcinoma / mortality
  • Nasopharyngeal Carcinoma / pathology*
  • Nasopharyngeal Carcinoma / therapy*
  • Nasopharyngeal Neoplasms / diagnostic imaging
  • Nasopharyngeal Neoplasms / mortality
  • Nasopharyngeal Neoplasms / pathology*
  • Nasopharyngeal Neoplasms / therapy*
  • Neoplasm Invasiveness / pathology
  • Neoplasm Metastasis
  • Neoplasm Staging
  • Positron-Emission Tomography / methods
  • Prognosis
  • Risk Assessment
  • Survival Analysis
  • Treatment Outcome