Treatment of Stage IB to III Nasopharyngeal Carcinoma: CSCO-ASCO Guideline Update

PURPOSE To update the 2021 CSCO-ASCO guideline on chemotherapy in combination with radiotherapy for the definitive treatment of non-metastatic nasopharyngeal carcinoma (NPC), incorporating new evidence on radiotherapy techniques and target-volume de-escalation, chemotherapy regimens and their sequencing, adjuvant therapy, and immunotherapy for patients with stage IB-III disease. METHODS A multidisciplinary Expert Panel reviewed evidence published since the prior guideline, including randomized controlled trials, systematic reviews, meta-analyses, and relevant prospective and retrospective studies. Outcomes of interest included overall survival, failure-free or progression-free survival, locoregional and distant disease control, acute and late toxicities, and patient-reported quality of life. Recommendations were developed using the ASCO guideline development process and Expert Panel consensus. RESULTS The updated evidence supports: IMRT with image guidance and MRI-based target delineation as core components of definitive treatment; selected response-adapted target delineation following induction chemotherapy; elective nodal de-escalation in appropriately selected patients; risk-adapted chemotherapy sequencing according to stage and biologic risk; cisplatin-based concurrent chemoradiotherapy; gemcitabine–cisplatin (GP) or docetaxel–cisplatin–fluorouracil (TPF) as preferred induction regimens; and selected adjuvant chemotherapy options, including metronomic capecitabine for patients with higher residual post-chemoradiotherapy risk. Several randomized trials evaluating PD-1 inhibitors have demonstrated improved disease-control outcomes, but overall survival data remain immature. RECOMMENDATIONS This guideline update provides recommendations on radiotherapy technique, dose, imaging, and target delineation; sequencing of additional chemotherapy with radiotherapy; concurrent chemotherapy options; induction chemotherapy regimens and timing; adjuvant chemotherapy options; and the role of immunotherapy. At present, the Panel makes no recommendation for or against routine addition of immunotherapy to induction-concurrent chemoradiotherapy; applicability of the trial evidence, benefits and harms, local approval and access, and patient preferences should guide individualized decisions. Additional information is available at www.ascopubs.org/topics/asco-guidelines/head-neck-cancer .