Recent advances in the treatment of nasopharyngeal carcinoma.

The outcome of nasopharyngeal carcinoma (NPC) treatment has greatly improved as advances in imaging techniques increase the accuracy of tumor mapping. Radiotherapy remains a common treatment for early disease, while concurrent chemoradiotherapy is being increasingly accepted as the standard treatment for advanced disease. Intensity modulation radiotherapy (IMRT) delivers a more conformal radiation dose to the target area and may spare normal organs such as parotid gland for patients with early stage disease. IMRT in conjunction with concurrent chemotherapy offers excellent tumor control with fewer complications. These benefits suggest it will become the mainstay of radiotherapy treatment for NPC. Prevention of distant metastasis remains a crucial objective. The potential of induction chemotherapy to reduce distant metastasis has gained increased attention. Adjuvant chemotherapy has been unsuccessful due to poor tolerability. For metastatic NPC, cisplatin-based chemotherapy is effective but limited by cumulative toxicities. Newer drugs such gemcitabine and vinorelbine have been shown to be active in salvage therapy when cisplatin-containing combinations have failed. Due to their advantageous toxicity profiles, new drugs may replace cisplatin-based combinations as first-line treatment for metastatic NPC in the near future. Signal transduction manipulation is promising but has not been shown to be an essential therapy. Immunotherapy, such as mini-transplant, may offer the chance for durable control without long-term treatment, but its efficacy remains to be demonstrated.