The prognostic value of the cumulative cisplatin dose (CCD) remains controversial for patients with nasopharyngeal carcinoma (NPC) receiving only concurrent chemoradiotherapy (CCRT). We retrospectively reviewed 549 consecutive patients with non-metastatic, histologically-proven NPC treated using intensity-modulated radiotherapy (IMRT) at Sun Yat-sen university cancer center. Patient survival between different CCD groups were compared. The cut-off value of pre-treatment plasma EBV DNA (pre-DNA) and CCD based on disease-free survival (DFS) were 1460 copies/ml (AUC, 0.691; sensitivity, 0.717; specificity, 0.635) and 240 mg/m² (AUC, 0.506; sensitivity, 0.526; specificity, 0.538), respectively. Of the entire cohort, 92/549 (16.8%) patients received a CCD ≥ 240 mg/m² and 457 (83.2%) patients, <240 mg/m². For CCD ≥ 240 mg/m² vs. < 240 mg/m², the estimated 4-year DFS, overall survival (OS), locoregional-free survival (LRFFS) and distant metastasis-free survival (DMFS) rates were 89.1% vs. 81.3% (P = 0.097), 92.4% vs. 90.0% (P = 0.369), 95.6% vs. 91.2% (P = 0.156), and 91.3% vs. 88.4% (P = 0.375), respectively. For the whole cohort, multivariate analysis identified the CCD was an independent prognostic factor for DFS (HR, 0.515; 95% CI, 0.267–0.995; P = 0.048). However, CCD (≥240 mg/m²) had no prognostic value in subgroup analysis with stratification by the cut-off value of pre-DNA (P > 0.05 for all rates).

• brachial plexus
• comparative study
• dose constraints
• intensity-modulated radiation therapy
• nasopharyngeal carcinoma
• radiation injury

• Adult
• Aged
• Brachial Plexus/radiation effects
• Brachial Plexus Neuropathies/etiology
• Brachial Plexus Neuropathies/prevention & control
• Carcinoma
• Humans
• Middle Aged
• Nasopharyngeal Carcinoma
• Nasopharyngeal Neoplasms/radiotherapy
• Organ Sparing Treatments/methods
• Radiation Injuries/etiology
• Radiation Injuries/prevention & control
• Radiation Protection/methods
• Radiotherapy Dosage
• Radiotherapy Planning, Computer-Assisted/methods
• Radiotherapy, Conformal/adverse effects
• Young Adult

• nasopharyngeal carcinoma
• intensity-modulated radiotherapy
• cone-beam computed tomography
• image-guided radiation therapy
• setup error

• Adult
• Artifacts
• Cone-Beam Computed Tomography/methods
• Dose Fractionation, Radiation
• Female
• Humans
• Male
• Middle Aged
• Nasopharyngeal Neoplasms/diagnostic imaging
• Nasopharyngeal Neoplasms/radiotherapy
• Radiotherapy Dosage
• Radiotherapy, Conformal/methods
• Radiotherapy, Image-Guided/methods
• Reproducibility of Results
• Sensitivity and Specificity
• Treatment Outcome

Although nasopharyngeal carcinoma (NPC) is a widespread malignant tumor, it is particularly frequent in Southeast Asia. Although T1 tumors can be effectively controlled with exclusive radiotherapy, this treatment modality is insufficient for most NPC patients, who present with locally advanced disease at diagnosis. In fact, for stages ranging from T2b N0 to T4 N3, definitive scientific evidence supports the use of concurrent platinum-based chemotherapy with standard external beam radiotherapy. This treatment approach has shown a statistically significant advantage in terms of overall survival, with respect to radiotherapy alone. Several trials have also investigated the use of neoadjuvant and adjuvant chemotherapy in combination with radiotherapy or chemo-radiotherapy. Platinum compounds, anthracyclines and taxanes are among the chemotherapy agents employed. This review focuses on the clinical results obtained in the field of adjuvant/concurrent/neoadjuvant chemotherapy for locally advanced NPC, for which exclusive concurrent chemo-radiotherapy currently represents the standard treatment approach.

• Chemotherapy
• Nasopharyngeal carcinoma
• Radiotherapy
• Treatment