Treatment of early and locoregionally advanced nasopharyngeal carcinoma
- Edwin P Hui, MD
Edwin P Hui, MD
- Clinical Associate Professor (Honorary)
- Department of Clinical Oncology
- Prince of Wales Hospital
- The Chinese University of Hong Kong
- Anthony TC Chan, MD
Anthony TC Chan, MD
- Professor of Clinical Oncology
- Prince of Wales Hospital
- The Chinese University of Hong Kong
- Quynh-Thu Le, MD
Quynh-Thu Le, MD
- Professor and Chair
- Stanford University
- Section Editors
- Marshall R Posner, MD
Marshall R Posner, MD
- Section Editor — Cancer of the Head and Neck
- Professor of Gene and Cell Medicine
- The Tisch Cancer Institute
- Icahn School of Medicine at Mount Sinai
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- David M Brizel, MD
David M Brizel, MD
- Section Editor — Radiation Therapy
- Leonard R Prosnitz Professor of Radiation Oncology
- Professor of Otolaryngology Head & Neck Surgery
- Duke University Cancer Institute
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
Nasopharyngeal carcinoma arises from the lining of the nasopharynx, the narrow tubular passage behind the nasal cavity. Worldwide, there are approximately 80,000 incident cases and 50,000 deaths annually, but there is remarkable variation in racial and geographic distribution . (See "Epidemiology, etiology, and diagnosis of nasopharyngeal carcinoma", section on 'Epidemiology'.)
The treatment of locoregional nasopharyngeal cancer is presented here. The treatment of recurrent and metastatic disease is discussed separately. (See "Treatment of recurrent and metastatic nasopharyngeal carcinoma".)
PATHOLOGY AND STAGING
The World Health Organization (WHO) classifies nasopharyngeal carcinoma into three histopathologic types  (see "Epidemiology, etiology, and diagnosis of nasopharyngeal carcinoma", section on 'Histology'):
●Keratinizing squamous cell carcinoma (formerly WHO type I)
●Nonkeratinizing carcinoma, which includes differentiated carcinoma (formerly WHO type II) and undifferentiated carcinoma (formerly WHO type III)
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- PATHOLOGY AND STAGING
- GENERAL TREATMENT PRINCIPLES
- Radiation therapy
- - Intensity modulated RT
- - Radiation dose
- - Alternative RT schedules
- Management of the neck
- Endemic versus nonendemic disease
- EARLY (STAGE I) DISEASE
- INTERMEDIATE (STAGE II) DISEASE
- ADVANCED (STAGE III, IVA, AND IVB) DISEASE
- Concurrent chemoradiotherapy
- Adjuvant chemotherapy
- Sequential chemotherapy
- Chemotherapy regimen
- POSTTREATMENT FOLLOW-UP
- Documentation of remission
- Surveillance for recurrence
- Posttreatment EBV DNA levels
- TREATMENT-RELATED COMPLICATIONS
- SUMMARY AND RECOMMENDATIONS