Session

Overview: Management of carcinoma nasopharynx (NPC) have evolved over the last decade with several of the important developments taking place towards personalizing the management of these patients, tailoring and adapting radiotherapy volumes, effective integration of the systemic treatment including immunotherapy in the treatment armamentarium. In the present session on “Management of Nasopharyngeal Carcinoma in 2024 and beyond” elite speakers would shed light on the contemporary practices and evolving trends in the management of NPC. Dr Joseph Wee from Singapore would set the ball rolling for the present session with a rather interesting topic of “EBV and HPV associated diseases: Two similar facets of different disease”. NPCs are mostly associated with EBV and EBV DNA titers have an important role in treatment selection (like intensification with triplet induction chemotherapy in those with high titers at baseline), monitoring for response and for surveillance after completion of the treatment. A small subset of the NPC patients may have HPV positive disease and the implications of having a co-infection with HPV and EBV are also not completely understood and would be deliberated upon by Dr Wee. Dr Hai-Qiang Mai from China would deliberate on the “Optimal association between radiotherapy and systemic treatments”. Primary failure patterns in NPC treated adequately with concurrent chemoradiotherapy has been distant. Studies have evaluated the role of neo-adjuvant and adjuvant systemic treatments to further improve outcomes and meta-analysis to this effect have shown to improve progression free survival and overall survival as well. However, these comes with added toxicity and stratification of the patients to receive these treatments with baseline EBV DNA titers is evolving and will be discussed at length in the present session. Dr Ann Lee from Hong Kong would highlight on the target volume delineation for the radiotherapeutic management of NPC patients. Intensity modulated radiotherapy along with image guidance is the current standard of practice for NPC. However, with concerns of local recurrences, the target volumes have been mainly a replica of the conventional radiotherapy portals and were large enough to increase long term morbidity. With the data on failure patterns, it is being increasingly realized that it may be safe to decrease the volumes of irradiation enhancing the therapeutic ratio. Dr David Lee Dai from Malaysia would cover management of local recurrence for NPC patients. Local recurrences are difficult to treat scenarios and is best treated with a multimodality approach of surgery, re-irradiation, systemic treatment depending on the volume and site of recurrences, previous treatment parameters and performance status of the patients. Surgical salvage may have limited role in this setting and Dr David would focus mainly on radiation and systemic treatment options for these patients. Overall, this is going to be a very engaging and interactive session.