Alexander Dimitrios Colevas

PURPOSE: To update the 2021 CSCO-ASCO guideline on chemotherapy in combination with radiotherapy for the definitive treatment of non-metastatic nasopharyngeal carcinoma (NPC), incorporating new evidence on radiotherapy techniques and target-volume de-escalation, chemotherapy regimens and their sequencing, adjuvant therapy, and immunotherapy for patients with stage IB-III disease. METHODS: A multidisciplinary Expert Panel reviewed evidence published since the prior guideline, including randomized controlled trials, systematic reviews, meta-analyses, and relevant prospective and retrospective studies. Outcomes of interest included overall survival, failure-free or progression-free survival, locoregional and distant disease control, acute and late toxicities, and patient-reported quality of life. Recommendations were developed using the ASCO guideline development process and Expert Panel consensus. RESULTS: The updated evidence supports: IMRT with image guidance and MRI-based target delineation as core components of definitive treatment; selected response-adapted target delineation following induction chemotherapy; elective nodal de-escalation in appropriately selected patients; risk-adapted chemotherapy sequencing according to stage and biologic risk; cisplatin-based concurrent chemoradiotherapy; gemcitabine–cisplatin (GP) or docetaxel–cisplatin–fluorouracil (TPF) as preferred induction regimens; and selected adjuvant chemotherapy options, including metronomic capecitabine for patients with higher residual post-chemoradiotherapy risk. Several randomized trials evaluating PD-1 inhibitors have demonstrated improved disease-control outcomes, but overall survival data remain immature. RECOMMENDATIONS: This guideline update provides recommendations on radiotherapy technique, dose, imaging, and target delineation; sequencing of additional chemotherapy with radiotherapy; concurrent chemotherapy options; induction chemotherapy regimens and timing; adjuvant chemotherapy options; and the role of immunotherapy. At present, the Panel makes no recommendation for or against routine addition of immunotherapy to induction-concurrent chemoradiotherapy; applicability of the trial evidence, benefits and harms, local approval and access, and patient preferences should guide individualized decisions. Additional information is available at www.ascopubs.org/topics/asco-guidelines/head-neck-cancer .

PURPOSE: To provide evidence-based recommendations on first- and subsequent-line systemic therapy, maintenance therapy, locoregional consolidation, and salvage local therapy for patients with recurrent and/or metastatic nasopharyngeal carcinoma (NPC). METHODS: A multidisciplinary Expert Panel convened by CSCO and ASCO reviewed evidence from randomized trials, meta-analyses, systematic reviews, prospective and retrospective studies, and clinical experience. The guideline was informed by a systematic literature review and consensus-based interpretation of efficacy, safety, feasibility, and patient-centered outcomes across scenarios. Outcomes included overall and progression-free survival, response and disease control rates, toxicity, and quality of life. RESULTS: Evidence supports platinum-based chemotherapy plus a programmed cell death protein 1 (PD-1) inhibitor as preferred first-line therapy for medically fit patients. Evidence also supports maintenance strategies after disease control, while treatment selection depends on prior treatment, disease extent, patient fitness, resource availability, and preferences. Selected responders may receive locoregional consolidation radiotherapy or oral maintenance chemotherapy. For isolated locoregional recurrence amenable to local therapy, options include salvage surgery and re-irradiation. RECOMMENDATIONS: Chemotherapy plus a PD-1 inhibitor, followed by maintenance PD-1 inhibition for up to 2 years, should be offered first-line to appropriate patients with recurrent and/or metastatic NPC. Chemotherapy alone may be offered when immunotherapy is unsuitable or declined. Selected patients responding to first-line chemotherapy may receive oral maintenance chemotherapy or locoregional consolidation intensity-modulated radiotherapy. Salvage surgery or re-irradiation is recommended for appropriately selected patients with isolated locoregional recurrence. Subsequent-line options include chemotherapy, PD-1 inhibitors, and antibody-drug conjugates. Treatment should be individualized according to disease setting, prior therapy, expected toxicities, availability, local drug approvals, and patient preferences. Early supportive and specialist interdisciplinary palliative care, where available, should accompany active anticancer treatment for advanced, incurable disease. Additional information is available at www.ascopubs.org/topics/asco-guidelines/head-neck-cancer .

Effect of body size parameters and age on total cardiac mitochondria biogenesis activity (tCMA) and cardiac mitochondria biogenesis volume (CMBV).

Comparison of SUVmax variability between harmonized and scanner-specific reconstructions for LV and RV across sites.

Representativeness of study participants.

Box plot showing the distribution of TBR across sites and lesions, highlighting the wider variability observed in the measurements.

Comparison of SUVmean variability between harmonized and scanner-specific reconstructions for LV and RV across sites.

Demographics and cardiac [¹8F]F-AraG uptake parameters before and after immune checkpoint inhibitor therapy in patients with NSCLC.

Flow diagram of the human cohort study.