Objective To develop a nomogram for refining prognostication for patients with non-disseminated nasopharyngeal cancer (NPC) staged with the proposed AJCC/UICC 8th edition. Material and methods Consecutive patients investigated by magnetic resonance imaging, staged by the proposed AJCC/UICC 8th edition, and irradiated by intensity- modulated radiotherapy (IMRT) from June 2005 to December 2010 were analyzed. The cohort of 1197 patients treated at Fujian Provincial Cancer Hospital was used as the training set and the results were validated by 412 patients from Pamela Youde Nethersole Eastern Hospital. Cox regression analyses were performed to identify significant prognostic factors for developing a nomogram to predict overall survival (OS). The discriminative ability was assessed with concordance index (C-index). Patients were categorized into three risk groups by performing recursive partitioning algorithm (RPA) on the survival scores of the combined set. Results Multivariable analysis showed that age, gross primary tumor volume (GTV-P) and lactate dehydrogenase (LDH) were independent prognostic factors for OS in addition to stage-group. The OS nomogram based on all these factors had a statistically higher bias-corrected C-index than prognostication based on stage-group alone (0.712 vs 0.622, p<0.01). These results were consistent for both the training and the validation cohorts. Patients with <135 points were categorized as low-risk, ≥135–<160 points as intermediate-risk and ≥160 points as high-risk, respectively. Their 5-year OS rates were 92%, 84% and 58%, respectively. Conclusions The proposed nomogram could improve prognostication when compared with TNM stage-group. This could aid in risk stratification for individual NPC patients.

Adequate tumor dose coverage was important for treating rT3 to rT4 NPC. Although late complications were common, treatment-related mortality was solely vascular in nature. Dose constraints of neurologic structures for reirradiation should be revised with the latest information on late toxicities. © 2016 Wiley Periodicals, Inc. Head Neck 39: 533-540, 2017.

Nasopharyngeal cancers are unique among other head and neck cancers, not only in epidemiology and histological characteristics, but also on treatment strategies as well. Radiotherapy is the primary treatment due to its radiosensitivity. In locally advanced stages, concurrent chemoradiation has been established to be effective to eradicate the disease and improve survival, in favor of radiotherapy alone. While increasing studies have explored the potential benefit of adding more chemotherapy to the concurrent regimen, whether adjuvant or neoadjuvant, it is generally agreed that proper patient selection is needed to stratify high-risk groups to intensify treatment and to optimize the disease outcome. Future studies are ongoing, possibly with the addition of biomarkers such as EBV DNA for risk group stratification. Refinement of patient groups that should be selected for combined modality treatment in stage II disease is also warranted.