Management

Nasopharyngeal carcinoma is nearly always managed by radiotherapy with or without chemotherapy.


Early Stage Disease (I, II)

Radiotherapy alone is standard treatment for early stage disease.

Volume Based Treatment

3D conformal or IMRT using volumes is current best practice.

Target Volumes

  • GTV_p = Visible primary tumour on CT/MRI
  • CTV_p = Microscopic spread from GTV_p
  • GTV_n = Visible nodal disease on CT/MRI
  • CTV_n = Microscopic extent around involved nodes
  • CTV_N0 = Remaining nodal volumes

Organs at Risk

The following organs at risk should also be contoured:

  • LENS_L/R = Left and right lens dmax < 6 Gy
  • RETINA_L/R = Left and right retina, dmax < 45 Gy
  • OPTIC_NERVE_L/R = Left and right optic nerve, dmax < 54 Gy
  • OPTIC_CHIASM = Optic Chiasm, dmax < 54 Gy
  • BRAINSTEM = Brainstem, dmax < 54 Gy
  • SPINAL CORD = Spinal cord, dmax < 45 Gy
  • TEMPORAL_LOBE_L/R = Left and right temporal lobes, dmax < 60 Gy
  • MANDIBLE = Mandible, dmax < 70 Gy
  • PAROTID_L/R = Parotid glands, as low as possible (under 25 Gy)
  • COCHLEA_L/R

Locally Advanced Disease (III, IVA, IVB)

Concurrent chemoradiotherapy is the gold standard treatment.

Radiotherapy Volumes

Volumes are the same as for Stage I/II disease (although larger due to larger disease volume)

Establishment of Concurrent Chemoradiotherapy

Radiotherapy alone has a 5 year survival of 40% in the locally advanced setting.
The IG0099 trial (al-Sarraf et al) randomised patients to radiotherapy alone or concurrent chemoradiotherapy with adjuvant radiotherapy. The study was stopped early due to significant difference in local control and overall survival (47% vs 78%). Persisted at 5y follow up (37% vs 67%).
A meta-analysis in 2004 (Langendijk et al) demonstrated that concurrent chemotherapy with radiation provided the greatest benefit (overall survival). Either neoadjuvant or concurrent chemotherapy provides improved local control and disease free survival. Adjuvant chemotherapy is not effective.

Concurrent chemotherapy protocol

Cisplatin 100mg/m2 on days 1, 22 and 43.


Metastatic Disease (IVC)

Platinum based therapes are the mainstay of treatment with response rates of about 80% with carboplatin AUC6 and paclitaxel. Median overall survival is 12 months with treatment.


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