Treatment standard of nasopharyngeal cancer
Nasopharyngeal cancer is one of the common malignant tumors in China, with the highest incidence in southern China. It may be related to EBV infection, genetic factors, eating pickled food and living in a polluted air environment. Although the anatomy of the nasopharyngeal cavity is relatively simple, the structures adjacent to the nasopharynx are more complex and important. The nasopharynx faces the posterior nostril, which is a direct continuation of the nasal cavity and is the widest part of the pharynx. The plane from the posterior nostril to the free edge of the soft palate is the nasopharyngeal cavity, with a transverse diameter of 4 cm, a vertical diameter of 4 cm, and an anterior-posterior diameter of 2 cm. Type I is keratinizing squamous cell carcinoma; Type II is non-keratinizing squamous cell carcinoma; Type III is poorly differentiated or undifferentiated carcinoma. Nasopharyngeal carcinoma most commonly metastasizes in cervical lymph nodes, and distant metastases occur in the order of bone, liver and lung. Shi Xuejun, Department of Medical Oncology, Yongchuan Hospital, Chongqing Medical University
Clinical manifestations
Nasopharyngeal carcinoma can be manifested by neck lumps without any clinical symptoms. Some of them are diagnosed by nasopharyngeal tissue biopsy after suspected nasopharyngeal carcinoma through EBV serology screening during physical examination. The clinical manifestations of nasopharyngeal cancer mainly include nasopharyngeal masses and the parts invaded by the masses to produce different symptoms and signs, as well as cervical masses and cranial nerve involvement to produce corresponding symptoms and signs.
1. Symptoms caused by local lesions of nasopharynx: headache, nasal congestion, epistaxis, runny nose, tinnitus and hearing loss.
2. Neck mass: the rate of cervical lymph node metastasis is as high as 60%~86%, among which the upper cervical lymph node metastasis is the most frequent, and double cervical lymph node metastasis also reaches 30%~50%.
3. Local invasion of nasopharyngeal masses and clinical manifestations.
(1) Oropharyngeal invasion: swallowing is obstructed, breathing is poor, and the swelling or submucosal bulge is visible when the mouth is opened.
(2) Nasal invasion: Invasion of the nasal cavity through the posterior nostril, with nasal congestion, epistaxis, and dyspnea.
(3) Orbital invasion: blindness, diplopia, decreased visual acuity, orbital swelling and pain, and protrusion of the eyeball.
(4) Inferior temporal fossa invasion: spread from the parapharynx to the inferior temporal fossa, which may cause facial numbness, difficulty in opening mouth and temporal bulge.
(5) Local secondary infection of nasopharyngeal tumor: there may be pus and blood snot, foul smell, headache, bleeding fever, etc.
(6) Paranasal sinus, skull base bone and intracranial invasion: mainly headache and nerve palsy in the corresponding parts of 12 pairs of brain nerve involvement as clinical manifestations.
Diagnostic points
1. Symptoms: Some early patients may not have any symptoms and signs. Most of the patients can have blood in the nose, headache, nasal congestion, epistaxis, tinnitus, hearing loss and facial numbness or throat discomfort.
2. Physical symptoms: clinical manifestations of nasopharyngeal swelling, neck mass and cerebral nerve invasion.
3. Auxiliary examination
(1) Nasopharyngeal biopsy: patients with a tendency to nasopharyngeal bleeding and hypertension should be performed with caution.
a. Indirect nasopharyngoscopic biopsy: After the site of the nasopharyngeal mass is directly visualized by indirect nasopharyngoscopy, the mass can be biopsied by direct forceps through the mouth or nasal cavity.
b. Direct nasopharyngeal fiberscope biopsy: If the unit has conditions, direct nasopharyngeal fiberscope biopsy can be used. It is especially convenient for biopsy of patients with difficult mouth opening and sensitive gag reflex. However, the biopsy can obtain less tissue and the positive rate is relatively low.
c. Nasopharyngeal fine needle aspiration: some patients with submucosal tumors can be diagnosed pathologically by this method
(2) EBV serological examination: EBV shell antigen (VCA) titer ³ 1:10; EBV early antigen (EA) titer ³ 1:5; EBV deoxyribonuclease (DNAase) titer ³ 25%, etc. can assist in the diagnosis.
(3) MRI scan: MRI scan examination is preferred and should include the nasopharynx, skull base and neck. The application of T1WI, T2WI and Gd-DTPA enhanced T1WI sequences for transverse, sagittal and coronal scans can be used to diagnose the submucosal infiltration of nasopharyngeal carcinoma, as well as to understand more clearly the degree of invasion of palatal sail lift and tensor muscle, parapharyngeal space, pharyngeal cranial base fascia, skull base bone and intracranial. The MRI signal intensity of nasopharyngeal tumors is uniform. The T1WI signal intensity of the tumor is lower than that of the muscle, and the T2WI shows high signal, and Gd-DTPA enhances significantly after enhancement. T1WI signal intensity of tumor invading bone marrow cavity was significantly reduced.
(4) CT scan: CT examination is performed for patients who cannot do MRI examination. It is superior to clinical examination for understanding the invasion scope of nasopharyngeal cancer and invasion of surrounding structures, especially for parapharyngeal, skull base and intracranial invasion. Enhancement scan is more helpful for the diagnosis of tumor invasion in the carotid sheath area, cavernous sinus invasion and cervical lymph node metastasis. The examination sites should include skull base, nasopharynx and neck.
(5) Other auxiliary examinations include ultrasound examination of liver, spleen and abdominal mass, chest X-ray or chest CT, liver and kidney function, blood count, etc. For N2 or above, chest CT and blood count should be performed. Chest CT and bone ECT should be performed for N2 or above, and PET/CT should not be used as routine examination.
Staging principles】Adopt 2008 staging and UICC 2002 staging
Nasopharyngeal cancer 2008 staging
T1 limited to nasopharynx
T2 Invasion of nasal cavity, oropharynx and parapharyngeal space
T3 Invasion of skull base and internal pterygoid muscle
T4 Invasion of cranial nerves, sinuses, external pterygoid muscle and beyond the masticatory muscle gap, intracranial (cavernous sinus, meninges, etc.)
N0 No evidence of lymph node metastasis on imaging and physical examination
N1
N1a Metastasis to retropharyngeal lymph nodes
N1b Unilateral Ⅰb, Ⅱ, Ⅲ, Va lymph node metastasis with diameter ≤ 3cm
N2 Bilateral Ⅰb, Ⅱ, Ⅲ, Va lymph node metastasis, or diameter > 3cm, or lymph node extraperitoneal invasion
N3 Lymph node metastasis in area Ⅳ, Ⅴb
M0 No distant metastasis
M1 With distant metastasis (including lymph node metastasis below the neck)
Stage I T1N0M0
Stage II T1N1a～1bM0, T2N0～1bM0
Stage III T3N0～2M0,T1～2N2M0
Phase IV
Stage IVa:T4N0~3M0,T1~3N3M0
Stage IVb: any T, any N and M1
2002 UICC staging
T stage
Tis carcinoma in situ
T1 Tumor is confined to the nasopharyngeal cavity
T2 Tumor invades the nasal cavity or oropharynx
T2a Without parapharyngeal space invasion
T2b With parapharyngeal space invasion
T3 Tumor invading skull base bones and/or paranasal sinuses
T4 Tumor invasion of hypopharynx, intracranial or/cranial nerve, infratemporal fossa, orbit, mastoid space
N stage
NX Local lymph nodes cannot be evaluated
N0 No local cervical lymph node metastasis
N1 Unilateral cervical lymph node metastasis, < or 6 cm in diameter
Lymph nodes located above the supraclavicular fossa
N2 Bilateral cervical lymph node metastasis, < or 6 cm in diameter
Lymph nodes located above the supraclavicular fossa
N3 Cervical lymph node metastasis
(a)>6cm in diameter
(b)Metastasis in the supraclavicular fossa
M stage
M0 No distant metastasis
M1 with distant metastasis
Clinical staging
Stage 0 TisN0M0
Stage I T1N0M0
Stage IIA T2aN0M0
Stage IIB T1N1M0 T2aN1M0 T2b N0-1M0
Phase III TlN2M0 T2a-2bN2M0 T3 N 0-2M0
Phase IV A T4N0-2M0
Stage IV B Any T N3 M0
Stage IV C Any T, any N, M1
[Treatment plan and principles].
The aim of nasopharyngeal cancer treatment is to effectively improve the control rate of nasopharyngeal primary foci and cervical lymph node metastases, reduce the local tumor recurrence rate and lower the distant metastasis rate, and improve the survival quality of patients. Around this purpose, the principle of its comprehensive treatment is mainly radiation therapy, supplemented by chemotherapy and surgery. According to different TNM stages of primary or recurrent nasopharyngeal carcinoma, different comprehensive treatment methods can be selected clinically. Radiation therapy should be preferred for nasopharyngeal carcinoma, and generally speaking, the 5-year survival rate of nasopharyngeal carcinoma reaches 50%-70%. Even for recurrent nasopharyngeal carcinoma, the 5-year survival rate can reach 10%-20% after reasonable reprocessing treatment.
(1) Primary nasopharyngeal carcinoma: It refers to the first treatment of nasopharyngeal carcinoma diagnosed for the first time.
(1) Early-stage nasopharyngeal carcinoma (stage I/II) is treated with radiation therapy alone, including external irradiation or external irradiation plus intraluminal after-mount treatment. Combined radiotherapy can be considered for stage IIb patients.
② Combined radiotherapy and chemotherapy, including concurrent radiotherapy, induction chemotherapy or adjuvant chemotherapy, can be used for intermediate and advanced cases.
③ For cases with distant metastasis, chemotherapy should be used as the main treatment supplemented by radiation therapy.
(2) Recurrent nasopharyngeal carcinoma: It refers to the case of recurrence of nasopharyngeal carcinoma after more than half a year after radiation treatment.
(1) For recurrence of nasopharyngeal cancer within 1 year after radiation therapy, conventional external radiation radiotherapy should not be used again as far as possible. Adjuvant chemotherapy, brachytherapy or intensity-modulated radiation therapy can be used.
② For recurrence of cervical lymph nodes after radiotherapy, surgery is recommended, and chemotherapy can be used for those who cannot be operated.
③ For nasopharyngeal recurrence more than 1 year after radiation therapy, a second course of radical radiation therapy can be done, which includes external radiation alone or external radiation + brachytherapy.
④ For recurrence of nasopharyngeal cancer, only the recurrence site should be irradiated, and generally no preventive irradiation of regional lymphatic drainage area should be done.
⑤ For cases with brain and spinal cord radiation damage, conventional external radiation therapy is not recommended and chemotherapy should be used.
Radiotherapy for nasopharyngeal carcinoma
I. Radiation source.
(a) Nasopharyngeal irradiation: linear gas pedal 6-8 MV high-energy X-rays.
(2) Cervical lymph node irradiation: linear gas pedal 6-8MV high-energy X-rays and 6-12Mev electron rays, 180-210KV deep X-rays.
(c) Near-range irradiation: high dose rate of 192 iridium (192Ir), etc.
Second, the irradiation target area and range.
(a) Primary nasopharyngeal focal area: The primary focal area is the area of nasopharyngeal tumor seen by clinical examination and CT/MRI/PET imaging.
(b) Nasopharyngeal subclinical focal area: It refers to the areas where nasopharyngeal cancer may expand and invade, such as skull base, nasal cavity, posterior 1/4-1/3 of maxillary sinus, posterior septal sinus, pterygoid sinus, parapharyngeal space, carotid sheath and oropharynx.
(iii) Cervical lymph node metastasis area: the area where the enlarged lymph nodes in the neck are located as observed by clinical examination and/or imaging.
(iv) Cervical lymphatic drainage area: the area where the enlarged lymph nodes in the neck are not observed by clinical examination and imaging. It is clinically divided into upper and lower cervical lymphatic drainage areas according to the level of the transverse line or cricothyroid membrane of the skin in the middle part of the neck.
III. Dose, timing and segmentation of irradiation.
(a) Primary nasopharyngeal foci: 66-76 Gy/6-7.5 weeks
(b) Cervical lymph node metastases: 60-70 Gy/6-7 weeks
(c) Negative cervical lymph node and preventive irradiation area: 50-56Gy/5-5.5 weeks
(iv) Segmentation irradiation method
1. Conventional segmentation: 1.9~2Gy/time, once a day, five days a week.
2. Unconventional segmentation: There are many types and variations of unconventional segmentation radiation therapy for nasopharyngeal carcinoma, including super-segmentation and accelerated super-segmentation, which can be used according to clinical conditions.
4. Conventional external irradiation methods.
Conventional external irradiation methods for nasopharyngeal cancer are treated with supine isocentric irradiation technique.
(I) Supine isocenter irradiation technique
1. Isocentric positioning: fixing the body position and determining the irradiation target area under the simulator.
2. MLC or low melting point lead is used to make irregular field lead mold block.
3. The body position during radiation treatment should be the same as the body position during isocentric simulation positioning.
4. Irradiation field setting and irradiation method.
(1) In cases with negative cervical lymph nodes, after 36-40 Gy in the first segment of the combined facial and cervical field, the second segment should be changed to preauricular field + auxiliary field + upper half of the anterior cervical field (tangential field) irradiation to the total amount.
(2) In cases with positive cervical lymph nodes, after 36-40 Gy in the first segment of the combined facial and cervical fields, the second segment was changed to the anterior ear field + auxiliary field + full anterior cervical field (tangential field) to the total amount.
(3) For cases with large oropharyngeal invasion, after the first 36-40 Gy of combined facial and cervical fields, the oropharyngeal tumor still has not subsided, the second segment is still irradiated with small combined facial and cervical fields to the total amount, but the posterior border must avoid the spinal cord, and the posterior cervical region is irradiated with electronic lines. The lower cervical region is irradiated with anterior field (tangential field).
(4) For invasion of the nasal cavity, skull base and carotid sheath area, the anterior nasal field, skull base field and posterior auricular field can be used as an adjunct respectively.
5. Commonly used irradiation field design.
(1) Combined face and neck field: it should include the nasopharyngeal primary foci, nasopharyngeal subclinical foci and the upper half of the neck area as described previously.
(2) Preauricular field: It should include the nasopharyngeal primary foci and nasopharyngeal subclinical foci as described above.
(3) Anterior cervical segmentation field: the upper border is articulated with the irregular anterior ear field, and the upper half of the neck is irradiated when the upper half of the neck is irradiated for prophylaxis; the lower border should include the supraclavicular region when the whole neck is irradiated.
(4) Anterior nasal field: the upper border may include the septal sinus, the lower border includes the nasal cavity, and both borders include the parapharyngeal space. When designing the irradiation field, it is important to set up lead blocks to protect the eyes bilaterally.
(5) Postauricular field (parapharyngeal field): the carotid sheath area, carotid canal, apices and slopes should be included. When designing the field, care should be taken to avoid over-irradiation of the brainstem and upper cervical spinal cord.
(6) Skull base field: it may include the parietal wall of nasopharynx, posterior septal sinus, pterygoid sinus, cavernous sinus and slope.
V. Brachytherapy techniques and methods
Due to the inhomogeneity of the spatial dose distribution of brachytherapy (post-mounted therapy), i.e., the large gradient of dose decay, its treatment scope has certain limitations, so it can only treat relatively small and superficial tumors, as a supplementary treatment to external irradiation.
(i) Indications.
1. Early stage nasopharyngeal cavity limited lesions.
2. Residual nasopharyngeal cavity after conventional external radiation radiotherapy.
3. Recurrence in the nasopharyngeal cavity after radiotherapy.
(ii) Treatment techniques and methods.
1. Dose and segmentation method
① 8~10Gy per time, 1 time per week.
② Post-loading radiotherapy with external irradiation, total 15~25Gy.
2. Matching external irradiation with after-loading treatment
① After external irradiation of 55-60 Gy for nasopharyngeal lesions in early stage nasopharyngeal cancer, add 10-20 Gy of after-mount treatment.
② After conventional external irradiation of 66-70 Gy, add 10-15 Gy of after-mount treatment for nasopharyngeal confined residual lesions.
③ In cases of local recurrence of nasopharynx after conventional external irradiation radiotherapy, add 20 Gy of after-mount treatment after another course of external irradiation of 50-54 Gy.
Stereotactic radiation therapy: currently used as adjuvant treatment for residual or recurrent lesions after nasopharyngeal cancer treatment in China and abroad.
Three-dimensional conformal radiotherapy and intensity modulated radiotherapy: this new technology has been used in China and abroad, and intensity modulated radiotherapy can improve the survival rate of nasopharyngeal cancer and reduce the complications of normal tissues. This technique requires high precision, outlines the tumor target area based on the image of CT scan, performs 3D image reconstruction, gives precise forward or reverse planning design, and uses coplanar or non-coplanar multifield irradiation. The split dose and total dose, and total treatment time of this technique in radiotherapy for nasopharyngeal carcinoma remain to be further investigated. The following describes the intensity-modulated radiation therapy specifications for primary nasopharyngeal carcinoma.
IMRT specifications for primary nasopharyngeal carcinoma]
1. Mask fixation
A carbon fiber base frame and a thermoplastic mask are used, with the head in a slightly over-supine or mid-supine position, in order to make the patient comfortable, tolerable and easy to repeat the position daily. The head, neck and shoulder mask is used for those who need irradiation of the whole cervical lymph node area.
2. CT simulation positioning
The scan level reaches the top of the head at the upper boundary and the lower boundary at the lower edge of the clavicle. A thin scan of 3 mm per layer is recommended for the nasopharyngeal primary area and 5 mm for the treatment area.
The localization reference point should be chosen at the level that delineates the combined facial and cervical fields and the supraclavicular field, usually the inferior margin of C4-5.
CT simulator parameters are at the operator’s disposal, and either enhanced scanning or plain + MRI fusion is recommended.
3. Definition and outline of the target area
Primary focal GTV is defined as the lesion seen on clinical examination, endoscopy, and CT/MRI/PET
Primary focal CTV as GTV + nasopharyngeal cavity + exenteration of a certain border (at least 5 mm)
It must also include the following structures.
Anterior border including posterior 1/4 of nasal cavity and posterior wall of maxillary sinus
Bilateral border including palatine muscle, internal pterygoid muscle, part of external pterygoid muscle and pterygoid plate
upwards, including the lower 1/2 of the pterygoid sinus and the posterior group of septal sinuses, (the posterior group of septal sinuses may be excluded in the absence of pterygoid sinus and nasal invasion)
the skull base must include part of the middle cranial fossa, round, foramen ovale and rupture foramen, the tip of the rock bone, the slope of the occipital bone and the carotid artery canal
downward to the upper oropharynx to the middle plane of the C2 cervical vertebrae
The posterior border should include bilateral retropharyngeal lymph nodes
Primary focal PTV is 5 mm from the CTV
(GTV involving adjacent spinal cord/brainstem region, GTV, CTV, PTV posterior wall can be without exenteration, 1mm gap with brainstem/spinal cord is preserved when outlined)
Cervical lymph nodes are divided into upper cervical region and lower cervical + supraclavicular region using the lower border of C5 cervical vertebrae. irradiation of lower cervical + supraclavicular region is not possible for N0 patients, while the same intensity plan is performed for upper cervical region and primary foci for N+ patients. irradiation of lower cervical + supraclavicular region can be included in the same intensity plan or another AP field can be irradiated under the same position. Cervical lymph node GTV was defined as a cervical lesion seen on CT/MRI/PET. Positive lesions were defined as lymph nodes >1 cm in diameter and/or with a central area of necrosis.
N0 cases: CTV of cervical lymph nodes included bilateral posterior group Ib submandibular lymph nodes (anterior border is the posterior border of submandibular gland), bilateral group II, III and V superior lymph nodes.
N+ cases: CTV of cervical lymph nodes with certain boundaries (at least 5 mm) for GTV exenteration, including: bilateral Ib, II, III, IV, V lymph nodes.
4. Important organs outline
This includes the spinal cord, brainstem, temporal lobe of the brain, pituitary gland, parotid gland, inner and middle ear, crystal, eye, optic nerve and optic cross, part of the tongue and tongue root, temporomandibular joint, mandible, trachea, larynx (vocal cords), thyroid.
5. Prescribed dose-volume administration to target areas and vital tissues and organs
Primary foci
GTV66 T1-T2 66Gy/30Fx, T3-T4 70.4Gy/32Fx, 2.2Gy/Fx
CTV60 60Gy/30-32Fx 2Gy/Fx
PTV60 60Gy/30-32Fx 2Gy/Fx
Cervical lymph nodes
N+
GTV66 66Gy/30-32Fx
PTV66 (GTV external release 0.5cm) 66Gy/30-32Fx
CTV60 60Gy/30-32Fx
PTV60 60Gy/30-32Fx
Lower neck and supraclavicular lymph node area for preventive irradiation
CTV54 54Gy/30Fx 1.8Gy/Fx
PTV54 54Gy/30Fx 1.8Gy/Fx
N0
No GTV, prophylactic irradiation for upper neck only
CTV54 54-60Gy/30-32Fx
PTV54 54-60Gy/30-32F
If the lower neck + supraclavicular region is selected for irradiation by conventional methods, the prescribed dose for this region without positive lymph nodes is 54Gy/30Fx irradiated 3cm subcutaneously in the AP field, and for those with positive lymph nodes, the prescribed dose is 54Gy/30Fx irradiated 3cm subcutaneously in the AP field, then the field is reduced to a certain border out of the positive lymph nodes, and the dose is increased to 60-70 Gy.
95% PTV-G66 received ≥66Gy
99% PTV-G66 receiving ≥62.7Gy (95% of prescribed dose)
≤20% PTV-G66 receiving ≥72.6Gy (110% of prescribed dose)
95% PTV60 receiving ≥60Gy
99% PTV60 receiving ≥57Gy
No more than 1% of normal tissue outside PTV receives ≥72.6 Gy
Normal Tissue Dose – Volume Limits
Class I – very important normal tissues that must be protected
Brainstem, optic cross, optic nerve: Dmax 54Gy or 1% volume cannot exceed 60Gy
Spinal cord: Dmax 45Gy or 1% volume not to exceed 50Gy
Brain temporal lobe: Dmax 60Gy or 1% volume cannot exceed 65Gy
Class II – Critical normal tissue, protected as much as possible without compromising GTV, CTV dose coverage
Parotid gland: average dose to at least one parotid gland <26Gy or 50% of the gland to at least one parotid gland <30Gy or at least 20mm3 of the bilateral parotid volume receiving <20Gy
Mandible, temporomandibular joint: Dmax 70Gy or 1cm3 volume cannot exceed 75Gy
Class III – other normal tissue structures, as far as possible while meeting the conditions for protection of Class I and II normal tissue structures and without compromising GTV and CTV dose coverage
Eye: average dose <35Gy
Crystalline lens: the less the better
Inner/middle ear: average dose <50Gy
Tongue: Dmax 55Gy or 1% volume cannot exceed 65Gy
6. Priority of the plan
7. If the dose coverage of the tumor target area and the normal tissue exposure limit cannot be satisfied simultaneously, refer to the following plan priorities
1. Class I normal tissue structure
2. tumor
3. Class II normal tissue structures
4. Class III normal tissue structure
Chemotherapy for nasopharyngeal carcinoma]
Radiotherapy is the basic treatment for nasopharyngeal carcinoma, which is mostly non-keratinizing or undifferentiated carcinoma, poorly differentiated and prone to lymph node and blood channel metastasis. In N2 and N3 patients, the rate of distant metastasis can reach 30-50%. Among the causes of failure of patients with nasopharyngeal cancer, distant metastasis accounts for 50% of all deaths, followed by nasopharyngeal and neck recurrence. Therefore, how to reduce distant metastasis, improve local control rate and enhance the quality of survival is the direction of future research.
Currently, DDP-based chemotherapy regimens occupy an important position in nasopharyngeal cancer chemotherapy. The latest French Meta-analysis showed that the combination of radiotherapy and chemotherapy could increase the 5-year survival rate by 6% in locally advanced nasopharyngeal carcinoma, and the best efficacy was achieved with concurrent radiotherapy and chemotherapy.
In the integrated application of radiotherapy and chemotherapy, it is divided into induction chemotherapy before radiation therapy (i.e. neoadjuvant chemotherapy), concurrent radiotherapy and adjuvant chemotherapy after radiation therapy. The commonly used induction chemotherapy and adjuvant chemotherapy regimens are cisplatin (DDP) with fluorouracil (5-FU), and TPF (docetaxel, DDP and 5-FU), GP (Kinzel and platinum), etc. Single agent platinum is commonly used for concurrent chemotherapy.
And for palliative chemotherapy the applications are.
1. for distant metastases of nasopharyngeal carcinoma including bone metastases and lung metastases, chemotherapy is used as complementary treatment
2. for patients with nasopharyngeal or cervical lymph node recurrence or mediastinal metastasis after radiation therapy for nasopharyngeal cancer that cannot be treated with surgery or radiotherapy, effective chemotherapy can reduce patients’ pain and prolong their lives
3. For patients with distant metastasis before radiation therapy, chemotherapy can be used as palliative treatment.
[Surgical treatment].
The nasopharyngeal area is located in the middle of the skull, hidden, surrounded by important blood vessels and nerves, so the surgical route is complicated, and it is difficult to make whole block resection according to the principles of surgical oncology. treatment method. The efficacy of surgery alone is poor. Nowadays, it is considered that surgical treatment of nasopharyngeal cancer is mainly applicable to cases with residual and recurrence in the nasopharynx and/or neck after radiotherapy, and if applied properly, it is an effective remedy to improve the survival rate.
[Targeted therapy].
Targeted therapy is the direction of tumor treatment. Regarding targeted therapy for nasopharyngeal carcinoma, there are some reports such as EGFR receptor antagonists such as Epiduo, Tamsin, etc.. However, there is a lack of bulk prospective randomized studies.