Head & neck: Nasopharyngeal carcinoma — chemoRT
Free question published 15 September 2026
A 41-year-old man of southern Chinese descent presents with a unilateral neck mass and epistaxis. Biopsy of a nasopharyngeal mass confirms non-keratinising (EBV-associated) squamous cell carcinoma. Staging shows a locally advanced (stage III) tumour with bilateral nodal involvement and no distant metastases. Renal function is normal. What is the most appropriate primary treatment?
- AIntensity-modulated radiotherapy with concomitant cisplatin-based chemotherapy
- BRadiotherapy alone, as nasopharyngeal carcinoma is highly radiosensitive and chemotherapy adds nothing
- CPrimary nasopharyngectomy followed by adjuvant radiotherapy
- DCetuximab with radiotherapy, as cisplatin is contraindicated in EBV-associated disease
- EInduction chemotherapy alone, with radiotherapy reserved for relapse
Why A is correct
For locally advanced (stage 2 and above) nasopharyngeal cancer, NICE NG36 recommends intensity-modulated radiation therapy with concomitant chemotherapy. Cisplatin-based concurrent chemoradiotherapy is the established standard for locoregionally advanced nasopharyngeal carcinoma, improving overall survival and locoregional and distant control compared with radiotherapy alone.
And why the others are not
- BWrong — concurrent chemotherapy adds a clear survival and disease-control benefit; radiotherapy alone is reserved for early stage I disease.
- CWrong — nasopharyngeal carcinoma is managed non-surgically with chemoradiotherapy; surgery is not the primary modality.
- DWrong — cisplatin is the standard concurrent agent in nasopharyngeal carcinoma and is not contraindicated by EBV association.
- EWrong — definitive radiotherapy is integral to treatment; induction chemotherapy is given before, not instead of, concurrent chemoradiotherapy.
Source NICE NG36 — Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over — National Institute for Health and Care Excellence (NICE) guideline NG36, 2016 (updated 2018).
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