Controversies in the management of locoregionally advanced nasopharyngeal carcinoma.

In patients with locoregionally advanced nasopharyngeal carcinoma the results of treatment with conventional radiotherapy are unsatisfactory, with significant rates of both distant metastases and local recurrences. The use of neoadjuvant and adjuvant chemotherapy has resulted in consistently high response rates, but no randomized trial has yet demonstrated an improvement in overall survival. Altered-fractionation radiation techniques have not been proven to improve survival in locoregionally advanced nasopharyngeal carcinoma, and extreme caution is required to minimize unpredicted neurological toxicities. An interim analysis of a Head and Neck Intergroup study randomly assigning patients to receive concurrent chemotherapy and radiotherapy and adjuvant chemotherapy or radiotherapy alone has demonstrated significant benefit in overall survival favoring the use of concurrent chemotherapy and radiotherapy. Whether this regimen is applicable to all ethnic and histological groups, however, remains to be proven.