# CSCO and ASCO guideline: chemotherapy in combination with radiotherapy for definitive-intent treatment of stage II to IVA nasopharyngeal carcinoma

Source: https://onco.cc/key-papers/paper-csco-asco-nasopharyngeal-carcinoma-guideline-jco-2021/  
OnCo record `paper-csco-asco-nasopharyngeal-carcinoma-guideline-jco-2021` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The joint Chinese and American guideline on when to add chemotherapy to radiotherapy for nasopharyngeal cancer: concurrent cisplatin for most stage II to IVA disease, induction gemcitabine-cisplatin for higher-risk disease, and how to handle patients who cannot take cisplatin.

## Summary

Evidence-based guideline from the Chinese Society of Clinical Oncology and the American Society of Clinical Oncology based on a systematic review of randomised trials in stage II to IVA nasopharyngeal carcinoma, recommending concurrent cisplatin chemoradiotherapy, induction chemotherapy (gemcitabine-cisplatin preferred) for stage III to IVA disease with high-risk features, adjuvant chemotherapy in selected patients, and alternatives for cisplatin-ineligible patients, with cumulative cisplatin dose targets.

## Fields

- Kind: Key paper
- Last checked: 2026-09-18
- Journal: Journal of Clinical Oncology
- Year: 2021
- DOI: 10.1200/JCO.20.03237
- Authors: Chen YP, Ismaila N, Chua MLK, et al.
- What it means: The standard-of-care rows on the locoregionally advanced nasopharyngeal page follow this guideline.
- Caveats: Predates trials adding PD-1 antibodies to chemoradiotherapy and metronomic capecitabine adjuvant therapy.; Most evidence comes from endemic regions.

## Sources

- J Clin Oncol 2021: https://doi.org/10.1200/JCO.20.03237
- PubMed: https://pubmed.ncbi.nlm.nih.gov/33405943/

## Connected records

- cancers: [Locoregionally advanced nasopharyngeal carcinoma (stage III to IVA)](https://onco.cc/cancers/locoregionally-advanced-nasopharyngeal-carcinoma/)
- drugs: [Cisplatin](https://onco.cc/drugs/cisplatin/), [Gemcitabine + cisplatin](https://onco.cc/drugs/gemcitabine-cisplatin/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)

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