Objective:

To summarize the latest evidence on toxicity reduction strategies in nasopharyngeal carcinoma (NPC) during the precision radiotherapy era.

Approach:

• Three-dimensional strategy: The review discusses spatial precision sculpting, temporal sequential optimization, and energy technology escalation as key dimensions for toxicity reduction.

Key Findings:

• 5-year local control rates for locally advanced NPC exceed 90% due to advanced radiotherapy techniques.
• Treatment-related toxicities significantly impact long-term quality of life.
• Response-guided precision in target volume delineation reduces toxicity while maintaining tumor control.
• International guidelines recommend target volume reduction based on tumor response to induction chemotherapy.

Interpretation:

Successful toxicity reduction requires an individualized, integrated decision-making system that incorporates multidimensional biomarkers and standardized patient-reported outcomes.

Limitations:

• Much of the evidence is derived from high-incidence regions, which may limit its generalizability.
• Proton therapy lacks Phase III survival evidence and faces ongoing cost-effectiveness debates.

Conclusion:

The shift in treatment goals from 'cure' to 'quality of survival' necessitates a focus on reducing treatment-related toxicities.

Sources:

• CA: A Cancer Journal for Clinicians