<p>Management of Chemotherapy for Stage II Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era: A Review</p>

Abstract

Nasopharyngeal carcinoma is an endemic disease with a high prevalence in Southeast Asia, Mediterranean countries, and Northern Africa. With substantial advances in screening and diagnosis, increasingly more early-stage (stage I~II) patients are being diagnosed. The undebated treatment modality for stage I patients is radiotherapy alone. However, controversies exist for patients with stage II disease, mostly revolving around the management of chemotherapy. However, the use of intensity-modulated radiotherapy for the treatment of nasopharyngeal carcinoma has increased recently, which has drastically improved survival outcomes. Thus, many oncologists have considered omitting chemotherapy for stage II patients in the intensity-modulated radiotherapy era. Unfortunately, prospective studies comparing concurrent radio-chemotherapy with intensity-modulated radiotherapy alone are limited. Notably, stage II nasopharyngeal carcinoma consists of three subgroups, among which stage T2N1M0 disease is unique and potentially warrants additional treatment including chemotherapy. Additionally, molecular biology techniques are advancing at an incredible speed. Instead of adopting a one-size-fits-all recommendation, exploring potential predictive biomarkers to select patients who are likely to derive benefit from chemotherapy is a better choice. In this review, we summarize the data from studies and reviews regarding chemotherapy for stage II nasopharyngeal carcinoma in the intensitymodulated radiotherapy era and discuss chemotherapy utility. Eventually, we conclude that IMRT alone may be sufficient for stage II nasopharyngeal carcinoma, but this needs to be verified by prospective studies in the near future, the evidence collected thus far suggests that concurrent chemo-radiotherapy without induction or adjuvant chemotherapy is yet to be necessary for patients with stage II disease.

Impact of changes in psychological resilience during treatment with intensity-modulated radiotherapy on nasopharyngeal carcinoma patients: a prospective study

“…In addition, nausea and vomiting are the most common complications of NPC patients after radiotherapy. It is reported that the incidence of nausea and vomiting can be as high as more than 80% (22)(23)(24)(25). However, the symptoms of nausea and vomiting are mostly mild and relatively easy to treat, thus they were not recorded in our study.…”

Long-term outcomes of nasopharyngeal carcinoma patients with T1-2 stage in intensity-modulated radiotherapy era

“…NPC patients in Stage II of different subgroups have heterogeneity and controversies exist around the management of chemotherapy. [24][25][26][27][28] Huang et al [24] conducted a Phase 2 multicenter clinical trial in two groups (IMRT alone or CCRT) with stage II (2010 UICC/AJCC) NPC patients. They found that CCT added to IMRT did not improve survival or disease control.…”

A Systematic Review and Meta-Analysis of Studies Comparing Concurrent Chemoradiotherapy With Radiotherapy Alone in the Treatment of Stage II Nasopharyngeal Carcinoma

“…Ahmed et al (11) reported that CCRT was superior to IMRT alone with significant benefits in OS. A systematic review (12) on treatment patterns for stage II NPC indicated that IMRT alone may be sufficient, but more aggressive treatment interventions may be needed for the T2N1M0 subgroup which has poorer survival outcomes than those in the T1N1M0 or T2N0M0 subgroup. In addition, there are three meta-analyses (13)(14)(15) evaluating the role of chemotherapy adding to RT alone for stage II NPC.…”