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Living with cancer·Standard of care

Locoregionally advanced nasopharyngeal carcinoma: the decisions you may face

Cancer page →Second-opinion finder →

5 treatment settings, 4 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.

2 options

MRI of the nasopharynx and neck, PET-CT or CT of chest and abdomen with bone scan, plasma EBV DNA, dental and audiological assessment.

Guideline
CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers
The options, in plain words
MRIStandard of care

MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.

  • No ionising radiation
  • Best soft-tissue and brain imaging
  • Functional sequences (diffusion, perfusion)
PET/CTStandard of care

PET and CT in one machine, so hot spots on the PET are pinned to exact locations on the CT.

  • Anatomy plus biology
  • Standard for lymphoma, lung, melanoma, head and neck staging
Also referenced:Plasma EBV DNAEpstein-Barr virus (EBV) in cancer
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
MRI
  • Slow and expensive
  • Motion artefacts
  • Gadolinium concerns in renal impairment
PET/CT
  • CT radiation added to PET dose
Questions to ask about this decision
  1. Between MRI and PET/CT, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. For my situation (staging), which of the standard options do you recommend and why?
    Why: Guideline options include: MRI of the nasopharynx and neck, PET-CT or CT of chest and abdomen with bone scan, plasma EBV DNA, dental and audiological assessment.

Add these to your appointment list, or take the full question set for this cancer.

Locally advanced

Stage III to IVA, standard

4 optionsCompare side by side →

Induction gemcitabine and cisplatin for three cycles followed by intensity-modulated radiotherapy (70 Gy) with concurrent cisplatin; TPF induction as an alternative.

Guideline
CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers
The options, in plain words
Gemcitabine + cisplatinStandard of careCytotoxic regimen

Gemcitabine plus cisplatin has been the chemotherapy backbone for bile duct cancer since 2010 and is now given with immunotherapy.

CisplatinApprovedCytotoxic chemotherapy (platinum)

Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.

IMRT / IGRT (modern external beam)Standard of care

IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.

  • Conformal dose, fewer side effects
  • Hypofractionation saves visits
Proton therapyEstablished

Radiation using protons, which stop inside the tumour instead of passing through, so tissue behind it gets no dose.

  • No exit dose; lower integral dose
  • Reduced second cancers in children
Also referenced:Chemoradiation (chemoradiotherapy, CRT)
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Cisplatinall recorded rates →
  • Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
IMRT / IGRT (modern external beam)
  • Low-dose bath to normal tissue
  • Motion management
Proton therapy
  • Cost
  • Range uncertainty
  • Limited randomised evidence in adults
Questions to ask about this decision
  1. Between Gemcitabine + cisplatin, Cisplatin, IMRT / IGRT (modern external beam) and the other options, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. For my situation (stage iii to iva, standard), which of the standard options do you recommend and why?
    Why: Guideline options include: Induction gemcitabine and cisplatin for three cycles followed by intensity-modulated radiotherapy (70 Gy) with concurrent cisplatin; TPF induction as an alternative.
  6. Am I a candidate for Gemcitabine + cisplatin, Cisplatin, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

After chemoradiotherapy

One path named

Metronomic capecitabine for one year in high-risk patients; EBV DNA-directed adjuvant therapy in trials (NRG-HN001).

Guideline
CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers
The path, in plain words
CapecitabineApprovedOral fluoropyrimidine prodrug (antimetabolite)

Capecitabine (Xeloda) is a tablet form of the chemotherapy fluorouracil. It is a backbone of treatment for bowel cancer and a standard option in advanced breast cancer.

Also referenced:Plasma EBV DNA
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.

Questions to ask about this decision
  1. Is Capecitabine the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
    Why: A single standard does not mean a single choice; timing and trials are decisions too.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. For my situation (after chemoradiotherapy), which of the standard options do you recommend and why?
    Why: Guideline options include: Metronomic capecitabine for one year in high-risk patients; EBV DNA-directed adjuvant therapy in trials (NRG-HN001).
  6. Am I a candidate for Capecitabine, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

Immunotherapy in the curative setting

3 optionsCompare side by side →

PD-1 antibody (sintilimab in CONTINUUM; toripalimab and camrelizumab in trials) added to induction and chemoradiotherapy in high-risk disease, adopted in China.

Guideline
CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers
The options, in plain words
CamrelizumabApprovedMonoclonal antibody (anti-PD-1)

Camrelizumab is Jiangsu Hengrui's humanised PD-1 antibody, approved in China for oesophageal, liver and lung cancer but not in the US, where its liver cancer combination with rivoceranib drew complete response letters in 2024 and 2025 over manufacturing and inspection issues. Its signature side effect is reactive cutaneous capillary endothelial proliferation, a skin reaction seen in most patients.

ToripalimabApprovedMonoclonal antibody (anti-PD-1)

A Chinese-developed PD-1 blocker that became the first immunotherapy approved in the US for nasopharyngeal cancer.

Immune checkpoint inhibitorsStandard of care

Immune checkpoint inhibitors are antibodies against CTLA-4, PD-1 or PD-L1 that release the brakes on T cells so they attack the cancer. They are approved in more than 20 tumour types and produce lasting, sometimes curative responses that chemotherapy rarely does, but most patients do not respond and autoimmune side effects are the cost.

  • Durable, sometimes curative responses
  • Broad applicability
The evidence behind it
The main trade-offs on record
Immune checkpoint inhibitors
  • Most patients do not respond
  • Autoimmune toxicity
  • Biomarkers are imperfect
Questions to ask about this decision
  1. Between Camrelizumab, Toripalimab and Immune checkpoint inhibitors, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. How closely do I match the people in A Study of YL201 in Combination With Toripalimab and With or Without Cisplatin in Nasopharyngeal Carcinoma., and does that change what the results mean for me?
    Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
  4. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  5. Does your recommendation follow the current guideline (CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  6. For my situation (immunotherapy in the curative setting), which of the standard options do you recommend and why?
    Why: Guideline options include: PD-1 antibody (sintilimab in CONTINUUM; toripalimab and camrelizumab in trials) added to induction and chemoradiotherapy in high-risk disease, adopted in China.
  7. Am I a candidate for Camrelizumab, Toripalimab, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  8. How do the results of A Study of YL201 in Combination With Toripalimab and With or Without Cisplatin in Nasopharyngeal Carcinoma. apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

2 options

Plasma EBV DNA, MRI and nasopharyngoscopy; management of xerostomia, hearing loss, hypothyroidism and hypopituitarism.

Guideline
CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers
The options, in plain words
MRIStandard of care

MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.

  • No ionising radiation
  • Best soft-tissue and brain imaging
  • Functional sequences (diffusion, perfusion)
Acupuncture for dry mouth after head and neck radiotherapyEmerging

Radiotherapy to the head and neck can permanently dry the mouth. A randomised trial in the United States and China found that acupuncture given during radiotherapy reduced dry mouth a year later compared with standard care, an effect that needs confirming.

  • Randomised, two-country trial with a sham arm
  • Symptom benefit persisted to one year
  • No meaningful adverse events
Also referenced:Plasma EBV DNA
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
MRI
  • Slow and expensive
  • Motion artefacts
  • Gadolinium concerns in renal impairment
Acupuncture for dry mouth after head and neck radiotherapy
  • Effect differed between centres
  • Objective saliva measures rarely improve
  • Needs replication before guideline adoption
Questions to ask about this decision
  1. Between MRI and Acupuncture for dry mouth after head and neck radiotherapy, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (CSCO/ASCO guideline on nasopharyngeal carcinoma 2021; NCCN Head and Neck Cancers), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. For my situation (follow-up), which of the standard options do you recommend and why?
    Why: Guideline options include: Plasma EBV DNA, MRI and nasopharyngoscopy; management of xerostomia, hearing loss, hypothyroidism and hypopituitarism.

Add these to your appointment list, or take the full question set for this cancer.

How to read this page. Options and results come from OnCo records with their sources; the settings are the standard-of-care rows on the cancer page, and the lines of therapy are on the sequencing grid. Where a setting names one path, the choice is usually about timing, trials and where to be treated: see expert centres. OnCo is orientation, not medical advice.