This document discusses treatment options for nasopharyngeal carcinoma. It notes that rates of the cancer vary significantly around the world. Surgical intervention is challenging due to the anatomic location. As a result, radiotherapy alone or combined with chemotherapy are the primary treatments. A previous meta-analysis found that adding chemotherapy to radiotherapy improves overall survival, particularly with concomitant (simultaneous) chemotherapy and radiotherapy. This study aims to update that meta-analysis and separately analyze the benefit of concomitant plus adjuvant chemotherapy. Survival curves are presented comparing radiotherapy alone versus combined with chemotherapy. The analysis confirms benefits of adding chemotherapy to radiotherapy, especially with concomitant administration, but the benefits of adjuvant chemotherapy require further assessment.

1. NPC Treatment and clinical Trials
• Nasopharyngeal carcinoma is an uncommon
cancer in most parts of the world. The age-
adjusted incidence rate (per 100,000 people
per year) among men ranges from 0.6 in the
United States and Japan to 5.4 in Algeria, 5.8
in the Philippines,11.0 in Singapore, 17.2
among Eskimos, Indians, and Aleuts in Alaska
to 17.8 and 26.9 in Hong Kong and Guangdong
Province in Southern China, respectively.

2. • Because of the anatomic location—proximity to
critical structures surgical exposure and tumor
resection with sufficient margins have been very
challenging. Primary surgical intervention was
rare after the 1950s for these reasons, with
surgical interventions employed mainly for biopsy
to gain histologic confirmation and salvage
therapy for persistent or recurrent cancer.
Primary treatment since has typically employed
radiotherapy (RT) alone and, more recently, in
combination with chemotherapy.

48. • A previous individual patient data meta-
analysis by the Meta-Analysis of
Chemotherapy in Nasopharynx Carcinoma
(MAC-NPC) collaborative group to assess the
addition of chemotherapy to radiotherapy
showed that it improves overall survival in
nasopharyngeal carcinoma. This benefit was
restricted to patients receiving concomitant
chemotherapy and radiotherapy

49. • The aim of this study was to update the
meta-analysis, include recent trials, and to
analyse separately the benefit of
concomitant plus adjuvant chemotherapy

50. Survival curves for overall survival in trials
investigating CRT,and CRT Plus ACT

51. Survival curves for PFS in trials
investigating CRT and CRT plus ACT

52. Survival curves for (A) OS and (B) PFS in
CCRT And CCRT And ACT

53. conclusion
• this individual patient data meta-analysis
confirms the benefits associated with the
addition of chemotherapy to radiotherapy in
nasopharyngeal carcinoma; the greatest
benefit was found in the groups with
concomitant administration. The benefits of
the addition of adjuvant chemotherapy in the
context of concomitant chemo-radiation still
need further assessment.

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