Purpose A“one-size-fits-all”treatment recommendation is not advisable for nasopharyngeal carcinoma(NPC).This article aims to review the risk-stratified strategies and propose future directions in NPC.Results For low...Purpose A“one-size-fits-all”treatment recommendation is not advisable for nasopharyngeal carcinoma(NPC).This article aims to review the risk-stratified strategies and propose future directions in NPC.Results For low-risk NPC patients,a review of literature shows that de-escalation approaches can be generally categorized into de-escalating systemic therapy and de-escalating radiotherapy.Studies have explored the exemption of concurrent chemotherapy in stage II and T3N0M0 NPC patients,as well as sparing concurrent chemotherapy after induction chemotherapy in selected low-risk patients,changing the cisplatin-based chemotherapy schedules,and doses.De-escalation of radiotherapy involves a reduction in dose and clinical treatment volume(CTV).For high-risk patients,increasing treatment intensity is commonly used,including selecting appropriate patients to receive induction or adjuvant chemotherapy or adding targeted therapy to standard chemo-radiotherapy to improve survival.In many instances,these risk-stratified approaches are guided by the measurement of Epstein-Barr virus DNA levels and various image-based modalities.Immunotherapy has shown initial efficacy in recurrent or metastatic NPC patients.The treatment advances of ICIs monotherapy in Locoregionally advanced NPC have remained scarce,and several phase II and III anti-PD-1/PD-L1 monoclonal antibody clinical trials are currently underway.Conclusions Various strategies for the risk-stratified treatment of NPC have been investigated and remain highly effective in most approaches.Optimization of patient selection is still critical,and both long-term oncological outcomes and late complications remain to be determined.More prospective,multi-institutional researches are needed to elucidate how best to individualize the treatment of NPC.展开更多
基金supported by the Beijing hope run fund(grant number LC2021L06).
文摘Purpose A“one-size-fits-all”treatment recommendation is not advisable for nasopharyngeal carcinoma(NPC).This article aims to review the risk-stratified strategies and propose future directions in NPC.Results For low-risk NPC patients,a review of literature shows that de-escalation approaches can be generally categorized into de-escalating systemic therapy and de-escalating radiotherapy.Studies have explored the exemption of concurrent chemotherapy in stage II and T3N0M0 NPC patients,as well as sparing concurrent chemotherapy after induction chemotherapy in selected low-risk patients,changing the cisplatin-based chemotherapy schedules,and doses.De-escalation of radiotherapy involves a reduction in dose and clinical treatment volume(CTV).For high-risk patients,increasing treatment intensity is commonly used,including selecting appropriate patients to receive induction or adjuvant chemotherapy or adding targeted therapy to standard chemo-radiotherapy to improve survival.In many instances,these risk-stratified approaches are guided by the measurement of Epstein-Barr virus DNA levels and various image-based modalities.Immunotherapy has shown initial efficacy in recurrent or metastatic NPC patients.The treatment advances of ICIs monotherapy in Locoregionally advanced NPC have remained scarce,and several phase II and III anti-PD-1/PD-L1 monoclonal antibody clinical trials are currently underway.Conclusions Various strategies for the risk-stratified treatment of NPC have been investigated and remain highly effective in most approaches.Optimization of patient selection is still critical,and both long-term oncological outcomes and late complications remain to be determined.More prospective,multi-institutional researches are needed to elucidate how best to individualize the treatment of NPC.
