Treatment of Stage IB to III Nasopharyngeal Carcinoma: CSCO-ASCO Guideline Update

PURPOSE To update the 2021 CSCO-ASCO guideline on chemotherapy in combination with radiotherapy for the definitive treatment of non-metastatic nasopharyngeal carcinoma (NPC), incorporating new evidence on radiotherapy techniques and target-volume de-escalation, chemotherapy regimens and their sequencing, adjuvant therapy, and immunotherapy for patients with stage IB-III disease. METHODS A multidisciplinary Expert Panel reviewed evidence published since the prior guideline, including randomized controlled trials, systematic reviews, meta-analyses, and relevant prospective and retrospective studies. Outcomes of interest included overall survival, failure-free or progression-free survival, locoregional and distant disease control, acute and late toxicities, and patient-reported quality of life. Recommendations were developed using the ASCO guideline development process and Expert Panel consensus. RESULTS The updated evidence supports: IMRT with image guidance and MRI-based target delineation as core components of definitive treatment; selected response-adapted target delineation following induction chemotherapy; elective nodal de-escalation in appropriately selected patients; risk-adapted chemotherapy sequencing according to stage and biologic risk; cisplatin-based concurrent chemoradiotherapy; gemcitabine–cisplatin (GP) or docetaxel–cisplatin–fluorouracil (TPF) as preferred induction regimens; and selected adjuvant chemotherapy options, including metronomic capecitabine for patients with higher residual post-chemoradiotherapy risk. Several randomized trials evaluating PD-1 inhibitors have demonstrated improved disease-control outcomes, but overall survival data remain immature. RECOMMENDATIONS This guideline update provides recommendations on radiotherapy technique, dose, imaging, and target delineation; sequencing of additional chemotherapy with radiotherapy; concurrent chemotherapy options; induction chemotherapy regimens and timing; adjuvant chemotherapy options; and the role of immunotherapy. At present, the Panel makes no recommendation for or against routine addition of immunotherapy to induction-concurrent chemoradiotherapy; applicability of the trial evidence, benefits and harms, local approval and access, and patient preferences should guide individualized decisions. Additional information is available at www.ascopubs.org/topics/asco-guidelines/head-neck-cancer .

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Journal
Journal of Clinical Oncology
Published
2026-11-10
DOI
https://doi.org/10.1200/jco-26-02648
Primary Topic
Head and Neck Cancer Studies
Type
article
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article

Treatment of Stage IB to III Nasopharyngeal Carcinoma: CSCO-ASCO Guideline Update

Quynh‐Thu Le, Anne W.M. Lee, Yu‐Pei Chen, Brian O’Sullivan et al.
Journal of Clinical Oncology
Head and Neck Cancer Studies
article

Treatment of Stage IB to III Nasopharyngeal Carcinoma: CSCO-ASCO Guideline Update

Quynh‐Thu Le, Anne W.M. Lee, Yu‐Pei Chen, Brian O’Sullivan, Jin‐Ching Lin, Junlin Yi, Nancy Y. Lee, Annie W. Chan, Alexander Dimitrios Colevas, Kevin Joseph Harrington, Melvin L.K. Chua, Chaosu Hu, Ying Hao Sun, Robert I. Haddad, Sue Sun Yom, Nofisat Ismaila, Anthony T.�C. Chan, Kunyu Yang, Brigette B.Y. Ma, Qin Lin, Shao Hui Huang, Alexander C. Whitley, Wei Jiang, Shu Wing Jack Lam, Yosephtri Siahaan, Jun Ma
article en

Abstract

PURPOSE To update the 2021 CSCO-ASCO guideline on chemotherapy in combination with radiotherapy for the definitive treatment of non-metastatic nasopharyngeal carcinoma (NPC), incorporating new evidence on radiotherapy techniques and target-volume de-escalation, chemotherapy regimens and their sequencing, adjuvant therapy, and immunotherapy for patients with stage IB-III disease. METHODS A multidisciplinary Expert Panel reviewed evidence published since the prior guideline, including randomized controlled trials, systematic reviews, meta-analyses, and relevant prospective and retrospective studies. Outcomes of interest included overall survival, failure-free or progression-free survival, locoregional and distant disease control, acute and late toxicities, and patient-reported quality of life. Recommendations were developed using the ASCO guideline development process and Expert Panel consensus. RESULTS The updated evidence supports: IMRT with image guidance and MRI-based target delineation as core components of definitive treatment; selected response-adapted target delineation following induction chemotherapy; elective nodal de-escalation in appropriately selected patients; risk-adapted chemotherapy sequencing according to stage and biologic risk; cisplatin-based concurrent chemoradiotherapy; gemcitabine–cisplatin (GP) or docetaxel–cisplatin–fluorouracil (TPF) as preferred induction regimens; and selected adjuvant chemotherapy options, including metronomic capecitabine for patients with higher residual post-chemoradiotherapy risk. Several randomized trials evaluating PD-1 inhibitors have demonstrated improved disease-control outcomes, but overall survival data remain immature. RECOMMENDATIONS This guideline update provides recommendations on radiotherapy technique, dose, imaging, and target delineation; sequencing of additional chemotherapy with radiotherapy; concurrent chemotherapy options; induction chemotherapy regimens and timing; adjuvant chemotherapy options; and the role of immunotherapy. At present, the Panel makes no recommendation for or against routine addition of immunotherapy to induction-concurrent chemoradiotherapy; applicability of the trial evidence, benefits and harms, local approval and access, and patient preferences should guide individualized decisions. Additional information is available at www.ascopubs.org/topics/asco-guidelines/head-neck-cancer .

Journal of Clinical Oncology
American Society of Clinical Oncology (US), Royal Marsden NHS Foundation Trust (GB), Memorial Sloan Kettering Cancer Center (US), Institute of Cancer Research (GB), Sun Yat-sen University (CN), National University of Singapore (SG), Chinese University of Hong Kong (HK), University of California, San Francisco (US), University of Toronto (CA), Chinese Academy of Medical Sciences & Peking Union Medical College (CN), Princess Margaret Cancer Centre (CA), Massachusetts General Hospital (US), Fudan University Shanghai Cancer Center (CN), Dana-Farber Cancer Institute (US), Zhongshan Hospital of Xiamen University (CN), Duke-NUS Medical School (SG), Wuhan Union Hospital (CN), National Cancer Centre Singapore (SG), Stanford Medicine (US), Cancer Hospital of Chinese Academy of Medical Sciences (CN), University of Hong Kong - Shenzhen Hospital (CN), Sun Yat-sen University Cancer Center (CN), Changhua Christian Hospital (TW), Chinese Society of Clinical Oncology (CN), State Key Laboratory of Oncology in South China (CN), Stanford University (US)
Head and Neck Cancer Studies
DOISourceOpenAlex
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