It’s great to ablate.

Nasopharyngeal radiation is tough, but so is local nasopharyngeal tumor progression. This phase 3 trial evaluated the benefit of adding standard locoregional radiation in the setting of de novo metastatic nasopharyngeal carcinoma that responds well to initial chemo with cis/5FU x 3 cycles. This was the case for 126 enrollees who were then randomized to an additional 3 cycles of cis/5FU alone versus pretty standard 70 Gy via IMRT concurrent with an additional 3 cycles of cis/5FU. Remarkably, the risk of death was slashed in half (HR 0.42) with the addition of radiation. The primary endpoint of overall survival was 76% with radiation versus 55% without at 2 years. A huge decrease in rate of local recurrence as first recurrence from 70% to 16% is presumed to be the reason. Where do we go from here? Nancy Lee is here to tell us. TBL: The addition of aggressive locoregional radiation is now firmly established in the treatment paradigm for chemo-responsive metastatic nasopharyngeal carcinoma to drastically improve survival. | You, JAMA Oncol 2020