Locally advanced nasopharyngeal carcinoma: Current and emerging treatment strategies

Table 1 Standard approach to nasopharyngeal carcinoma

Stage	Denomination	Gold standard therapy
T1-2a N0 M0	Early stage	- IMRT alone - Conventional RT alone
From T2b N0 M0 to T4b N3 M0 also every T N2/3 M0	Locally advanced	- Neoadjuvant platinum-based CT followed by IMRT or CCRT (platinum-based) - Concurrent cDDP and RT
Every T every N M1	Metastatic	- Exclusive CT

RT: Radiotherapy; IMRT: Intensity modulated RT; CCRT: Concurrent chemoradiotherapy; CT: Comptued tomography.

Table 2 Chemo-radiation trials

Trial	Phase	Pts	Study design	Main end-point	Results
Lin JC et al[4]	III	284	Exclusive RT alone vs cDDP-5FU + RT	5-year DFS	Experimental arm better (P < 0.0012)
Chan AT et al[5]	III	350	Exclusive RT alone vs cDDP-5FU + RT	2-year PFS	Experimental arm better (P < 0.016)
Zhang L et al[12]	III(m)	1608	Exclusive RT alone vs cDDP based CT + RT	5-year OS	Experimental arm better (P < 0.001)
Yang AK et al[13]	III(m)	1993	Exclusive RT alone vs cDDP based CT + RT	5-year OS	Experimental arm better (P < 0.05)
Lu H et al[17]	II	22	IMRT + cDDP	1 year OS	96%
Ekenel M et al[34]	II	100	IMRT+ cDDP-Cet	ORR	100%

RT: Radiotherapy; IMRT: Intensity modulated RT; CT: Comptued tomography; ORR: Overall response rate; DFS: Disease-free survival.

Table 3 Adjuvant chemotherapy trials

Trial	Phase	Pts	Study design	Main end-point	Results
Al-Sarraf M et al[18]	III	147	Exclusive RT alone vs CCRT followed by cDDP-5FU	3-year PFS	Experimental arm better (P < 0.01)
Chen Y et al[19]	III	316	Exclusive RT alone vs CCRT followed by cDDP-5FU	2-year OS	Experimental arm better (P < 0.003)
Lee AW et al[20]	III	348	Exclusive RT alone vs CCRT followed by cDDP-5FU	5-year PFS	Experimental arm better (P < 0.035)
Park KH et al[21]	II	43	cDDP-5-FU + RT followed by cDDP-Epi-Ble CT	ORR	100%
Hu W et al[22]	II	54	w Pac + RT followed by cDDP-Pac CT	ORR	100%
Leung TW et al[10]	II	48	HFRT + cDDP based CT followed by cDDP-5FU CT	3-year DFS	71%

RT: Radiotherapy; CT: Comptued tomography; ORR: Overall response rate; CCRT: Concurrent chemoradiotherapy; DFS: Disease-free survival.

Table 4 Neoadjuvant chemotherapy trials

Trial	Phase	Pts	Study design	Main end-point	Results
Al-Amro A et al[23]	II	110	Neo cDDP-Epi and followed by cDDP + RT	ORR	100%
Airoldi M et al[24]	II	30	Neo cbdca-Pac followed by RT + cbdca-Pac	ORR	87%
Ferrari D et al[25]	II	34	Neo cDDP-5FU followed by RT + cDDP	ORR	85.3%
Lu X et al[26]	II	58	Neo cbdca-Tax followed by cbdca + RT (arm A) vs neo cbdca-5FU followed by cbdca + RT (armB)	1-year DFS	no difference between arm A and B
Mosatafa E et al[27]	II	36	Neo cDDP-Pac followed by cDDP-RT	ORR	89%
Hui EP et al[28]	II	65	Neo cDDP-Tax followed by cDDP + RT (arm A) vs cDDP + RT (arm B)	3-year OS	Arm A better than arm B (P < 0.012)
Bossi P et al[29]	II	45	Neo cDDP-Tax-5FU followed by cDDP + RT	ORR	98%
Cho S et al[30]	II	19	Neo cDDP-Tax-5FU followed by cDDP + RT	ORR	93%
Bae WK et al[32]	II	33	Neo cDDP-Tax-5FU followed by cDDP + RT	ORR	99%
Kong L et al[6]	II	52	Neo cDDP-Tax-5FU followed by cDDP + RT	ORR	90.2%
Ekenel M et al[34]	II	59	Neo cDDP-Tax followed by cDDP + RT	ORR	95%
Lin S et al[35]	II	370	Neo cDDP based CT followed by IMRT	3-year OS	90%

RT: Radiotherapy; IMRT: Intensity modulated RT; CT: Comptued tomography; ORR: Overall response rate; DFS: Disease-free survival.