Study Background and Disease Burden
Nasopharyngeal carcinoma (NPC) is a malignancy originating in the epithelial lining of the nasopharynx, showing a high prevalence in East and Southeast Asia. Locoregionally advanced NPC (LA-NPC), corresponding to stages III and IVA per the American Joint Committee on Cancer (AJCC) staging system, presents significant management challenges due to its aggressive nature and risk of both local recurrence and distant metastasis. The current standard of care involves induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT), a regimen that has improved survival outcomes significantly. However, the CCRT phase is frequently accompanied by substantial acute toxic effects, particularly severe mucositis, which complicates treatment adherence and quality of life.
Given these challenges, there has been clinical interest in exploring alternative therapeutic approaches that maintain efficacy but reduce toxicity. Sequential chemoradiotherapy (SCRT), consisting of IC followed by radiotherapy alone and then adjuvant chemotherapy (AC), may potentially reduce acute toxic effects during radiotherapy by omitting concurrent chemotherapy. Nevertheless, robust data evaluating whether SCRT can safely and effectively replace IC plus CCRT have been lacking.
