If concurrent–adjuvant chemoradiotherapy is beneficial for locoregionally advanced nasopharyngeal carcinoma, would changing the sequence to induction–concurrent achieve better outcome?

Abstract

Introduction

Radiotherapy (RT) is the primary treatment modality for nasopharyngeal carcinoma, and concurrent–adjuvant chemoradiotherapy (CA-CRT) is regarded as the standard of care for locally advanced disease after survival benefit was demonstrated by randomized clinical trials. However, there remain concerns about the exact magnitude of the benefit and tolerability by such an approach.

Methods

Through an extensive literature review, this paper provides an update on the available data on induction–concurrent chemoradiotherapy (IC-CRT) and a comparison with CA-CRT.

Results

Studies on IC-CRT show that tolerance and compliance to induction chemotherapy are better than adjuvant chemotherapy while the acute toxicity rates are similar. The reported failure-free rates and survival rates are encouraging for IC-CRT. However, part of the improvement might be attributed to better RT techniques, and the exact magnitude of benefit attributed to the induction phase remains uncertain.

Conclusion

The strategy with IC-CRT is an appealing option to be considered especially for patients with extensive locoregional disease infiltrating/abutting critical structures. Data from ongoing phase III trials will need to be available before the current standard of CA-CRT is at risk of being replaced.