Blanchard P, De Felice F, Chua M L K
Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, INSERM U1018 Oncostat CESP, Villejuif, France.
Radiation Oncology, AOU Policlinico Umberto I, Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy.
ESMO Open. 2025 Apr;10(4):104513. doi: 10.1016/j.esmoop.2025.104513. Epub 2025 Mar 25.
The optimal treatment strategy (radiotherapy with induction, concurrent or adjuvant chemotherapy) for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) remains to be addressed. Identifying biomarkers related to precise prognostic risk stratification and treatment benefits gained have been explored in recent years.
We carried out a systematic review of the published literature covering these topics. Of 3732 references screened, 26 articles were found eligible for inclusion.
Regarding the issue of treatment pathway in LA-NPC, induction chemotherapy is usually preferred over adjuvant chemotherapy. It is paramount to stress patient selection to identify those cases at high risk of relapse requiring systemic intensification. Concerning a role for Epstein-Barr virus (EBV) DNA-based personalized therapy, EBV DNA and its kinetics in plasma potentially represents a robust prognostic marker after (chemo)radiotherapy, but it is necessary to standardize test and cut-off levels.
This systematic review provides an overview of biomarker-guided systemic treatment designed to improve prognosis, including key aspects of current guidelines, biomolecular signature aspects and potential limitations between applicability to cancer treatment in endemic regions versus non-endemic regions.
局部区域晚期鼻咽癌（LA-NPC）患者的最佳治疗策略（诱导、同步或辅助化疗联合放疗）仍有待确定。近年来，人们一直在探索与精确预后风险分层和治疗获益相关的生物标志物。
我们对涵盖这些主题的已发表文献进行了系统综述。在筛选的3732篇参考文献中，发现26篇文章符合纳入标准。
关于LA-NPC的治疗路径问题，诱导化疗通常比辅助化疗更受青睐。强调患者选择以确定那些复发风险高需要全身强化治疗的病例至关重要。关于基于爱泼斯坦-巴尔病毒（EBV）DNA的个性化治疗的作用，血浆中的EBV DNA及其动力学可能是（放）化疗后一个可靠的预后标志物，但有必要规范检测和临界值水平。
本系统综述概述了旨在改善预后的生物标志物指导下的全身治疗，包括当前指南的关键方面、生物分子特征方面以及在流行地区与非流行地区癌症治疗适用性之间的潜在局限性。
