{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T10:31:05Z","timestamp":1788517865605,"version":"build-2803163510"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T00:00:00Z","timestamp":1614124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Nasopharyngeal carcinoma (NPC) is one of the most common malignant tumors of the head and neck, and it originates from the mucous epithelium of the nasopharynx. Because it is \u201chidden\u201d, the symptoms of NPC can easily be missed, and more than 70% of patients present with locally advanced disease at diagnosis. Concurrent radiation therapy with chemotherapy can significantly improve regional control of NPC. At present, distant metastasis is the main cause of treatment failure. At the end of the 20th century, clinical trial No. IG0099 in the United States confirmed the effectiveness of adjuvant chemotherapy (AC) for the first time. However, in the past 20 years, various clinical trials and meta-analyses conducted globally have yielded contradictory results regarding the effect of AC on locally advanced NPC. AC has changed from category 1 to the current category 2A in the National Comprehensive Cancer Network (NCCN) guidelines, and it remains controversial whether AC can significantly improve the survival of NPC patients. Here, we comprehensively analyzed the role of AC in locally advanced NPC by comparing some treatment methods. We conclude the role of AC in treating locally advanced NPC, based on the studies presented, remains undefined but is associated with increased toxicity.<\/jats:p>","DOI":"10.3389\/fonc.2020.585046","type":"journal-article","created":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T06:25:04Z","timestamp":1614147904000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":20,"title":["The Current Role of Adjuvant Chemotherapy in Locally Advanced Nasopharyngeal Carcinoma"],"prefix":"10.3389","volume":"10","author":[{"given":"Lin","family":"Su","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"She","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liangfang","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.5732\/cjc.010.10377","article-title":"The prevalence and prevention of nasopharyngeal carcinoma in China","volume":"30","author":"Cao","year":"2011","journal-title":"Chin J Cancer"},{"key":"B2","doi-asserted-by":"publisher","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray","year":"2018","journal-title":"CA Cancer J Clin"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.31937","article-title":"Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods","volume":"144","author":"Ferlay","year":"2019","journal-title":"Int J Cancer"},{"key":"B4","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/s0140-6736(19)30956-0","article-title":"Nasopharyngeal carcinoma","volume":"394","author":"Chen","year":"2019","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(05)66698-6","article-title":"Nasopharyngeal carcinoma","volume":"365","author":"Wei","year":"2005","journal-title":"Lancet"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2008.07.062","article-title":"Re-evaluation of 6th edition of AJCC staging system for nasopharyngeal carcinoma and proposed improvement based on magnetic resonance imaging","volume":"73","author":"Mao","year":"2009","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B7","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/1471-2407-10-39","article-title":"Sequential chemotherapy and intensity-modulated radiation therapy in the management of locoregionally advanced nasopharyngeal carcinoma: experience of 370 consecutive cases","volume":"10","author":"Lin","year":"2010","journal-title":"BMC Cancer"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.5732\/cjc.010.10547","article-title":"Treatment outcomes for different subgroups of nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy","volume":"30","author":"Su","year":"2011","journal-title":"Chin J Cancer"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.01.084","article-title":"Whole-field simultaneous integrated-boost intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma","volume":"76","author":"Wong","year":"2010","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.semradonc.2012.03.008","article-title":"Current management of nasopharyngeal cancer","volume":"22","author":"Lee","year":"2012","journal-title":"Semin Radiat Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1998.16.4.1310","article-title":"Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099","volume":"16","author":"Al-Sarraf","year":"1998","journal-title":"J Clin Oncol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s11864-002-0038-8","article-title":"Nasopharyngeal carcinoma","volume":"3","author":"Al-Sarraf","year":"2002","journal-title":"Curr Treat Options Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.16.790","article-title":"Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer\/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety","volume":"23","author":"Wee","year":"2005","journal-title":"J Clin Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.00.7542","article-title":"Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 Trial by the Hong Kong Nasopharyngeal Cancer Study Group","volume":"23","author":"Lee","year":"2005","journal-title":"J Clin Oncol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30850","article-title":"A multicenter, phase 3, randomized trial of concurrent chemoradiotherapy plus adjuvant chemotherapy versus radiotherapy alone in patients with regionally advanced nasopharyngeal carcinoma: 10-year outcomes for efficacy and toxicity","volume":"123","author":"Lee","year":"2017","journal-title":"Cancer"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2018.04.069","article-title":"Concurrent-Adjuvant Chemoradiation Therapy for Stage III-IVB Nasopharyngeal Carcinoma-Exploration for Achieving Optimal 10-Year Therapeutic Ratio","volume":"101","author":"Ng","year":"2018","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1000-8179.2008.14.002","article-title":"A Prospective Randomized Trial of Concurrent Chemoradiotherapy plus Adjuvant Chemotherapy in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma","volume":"35","author":"Chen","year":"2008","journal-title":"Chin J Clin Oncol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28049","article-title":"Progress report of a randomized trial comparing long-term survival and late toxicity of concurrent chemoradiotherapy with adjuvant chemotherapy versus radiotherapy alone in patients with stage III to IVB nasopharyngeal carcinoma from endemic regions of China","volume":"119","author":"Chen","year":"2013","journal-title":"Cancer"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.06.158","article-title":"Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival","volume":"21","author":"Lin","year":"2003","journal-title":"J Clin Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/dji084","article-title":"Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma","volume":"97","author":"Chan","year":"2005","journal-title":"J Natl Cancer Inst"},{"key":"B21","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1186\/1471-2407-10-558","article-title":"The role of concurrent chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma among endemic population: a meta-analysis of the phase iii randomized trials","volume":"10","author":"Zhang","year":"2010","journal-title":"BMC Cancer"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.10.074","article-title":"The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature","volume":"22","author":"Langendijk","year":"2004","journal-title":"J Clin Oncol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(15)70126-9","article-title":"Chemotherapy and radiotherapy in nasopharyngeal carcinoma: an update of the MAC-NPC meta-analysis","volume":"16","author":"Blanchard","year":"2015","journal-title":"Lancet Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1988.6.9.1401","article-title":"Adjuvant chemotherapy with vincristine, cyclophosphamide, and doxorubicin after radiotherapy in local-regional nasopharyngeal cancer: results of a 4-year multicenter randomized study","volume":"6","author":"Rossi","year":"1988","journal-title":"J Clin Oncol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/s0360-3016(01)02781-x","article-title":"A phase III study of adjuvant chemotherapy in advanced nasopharyngeal carcinoma patients","volume":"52","author":"Chi","year":"2002","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.05.173","article-title":"Concurrent and adjuvant chemotherapy for nasopharyngeal carcinoma: a factorial study","volume":"22","author":"Kwong","year":"2004","journal-title":"J Clin Oncol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2006.07.1340","article-title":"Five-year Update on a Randomized Factorial Study on Concurrent and Adjuvant Chemotherapy for Advanced Nasopharyngeal Carcinoma","volume":"66","author":"Kwong","year":"2006","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(11)70320-5","article-title":"Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial","volume":"13","author":"Chen","year":"2012","journal-title":"Lancet Oncol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2017.01.002","article-title":"Adjuvant chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: Long-term results of a phase 3 multicentre randomised controlled trial","volume":"75","author":"Chen","year":"2017","journal-title":"Eur J Cancer"},{"key":"B30","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1007\/s00066-016-0970-3","article-title":"Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: a matched-pair multicenter analysis of outcomes","volume":"192","author":"Dong","year":"2016","journal-title":"Strahlenther Onkol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0120019","article-title":"The effect of adjuvant chemotherapy on survival in patients with residual nasopharyngeal carcinoma after undergoing concurrent chemoradiotherapy","volume":"10","author":"Yang","year":"2015","journal-title":"PLoS One"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1007\/s13277-013-0710-6","article-title":"Concurrent chemoradiotherapy with or without adjuvant chemotherapy in intermediate and locoregionally advanced nasopharyngeal carcinoma","volume":"34","author":"Zhang","year":"2013","journal-title":"Tumour Biol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.7314\/apjcp.2012.13.11.5747","article-title":"Comparison of concurrent chemoradiotherapy followed by adjuvant chemotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a meta-analysis of 793 patients from 5 randomized controlled trials","volume":"13","author":"Liang","year":"2012","journal-title":"Asian Pac J Cancer Prev"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdt146","article-title":"Significant efficacies of neoadjuvant and adjuvant chemotherapy for nasopharyngeal carcinoma by meta-analysis of published literature-based randomized, controlled trials","volume":"24","author":"OuYang","year":"2013","journal-title":"Ann Oncol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdu507","article-title":"A Bayesian network meta-analysis comparing concurrent chemoradiotherapy followed by adjuvant chemotherapy, concurrent chemoradiotherapy alone and radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma","volume":"26","author":"Chen","year":"2015","journal-title":"Ann Oncol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1200\/JCO.2016.67.4119","article-title":"What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis","volume":"35","author":"Ribassin-Majed","year":"2017","journal-title":"J Clin Oncol"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29208","article-title":"Preliminary results of trial NPC-0501 evaluating the therapeutic gain by changing from concurrent-adjuvant to induction-concurrent chemoradiotherapy, changing from fluorouracil to capecitabine, and changing from conventional to accelerated radiotherapy fractionation in patients with locoregionally advanced nasopharyngeal carcinoma","volume":"121","author":"Lee","year":"2015","journal-title":"Cancer"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32972","article-title":"NPC-0501 trial on the value of changing chemoradiotherapy sequence, replacing 5-fluorouracil with capecitabine, and altering fractionation for patients with advanced nasopharyngeal carcinoma","volume":"126","author":"Lee","year":"2020","journal-title":"Cancer"},{"key":"B39","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1186\/s13643-019-0984-x","article-title":"Individual patient data network meta-analysis using either restricted mean survival time difference or hazard ratios: is there a difference? A case study on locoregionally advanced nasopharyngeal carcinomas","volume":"8","author":"Petit","year":"2019","journal-title":"Syst Rev"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2020.104686","article-title":"Induction versus adjuvant chemotherapy combined with concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: A propensity score-matched analysis","volume":"105","author":"Tang","year":"2020","journal-title":"Oral Oncol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.11978","article-title":"Comparison of the efficacy between concurrent chemoradiotherapy with or without adjuvant chemotherapy and intensity-modulated radiotherapy alone for stage II nasopharyngeal carcinoma","volume":"7","author":"Chen","year":"2016","journal-title":"Oncotarget"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.14799","article-title":"IMRT combined with concurrent chemotherapy plus adjuvant chemotherapy versus IMRT combined with concurrent chemotherapy alone in patients with nasopharyngeal carcinoma","volume":"8","author":"Zhong","year":"2017","journal-title":"Oncotarget"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.3747\/co.21.1777","article-title":"Concurrent chemoradiotherapy followed by adjuvant chemotherapy compared with concurrent chemoradiotherapy alone for the treatment of locally advanced nasopharyngeal carcinoma: a retrospective controlled study","volume":"21","author":"Liang","year":"2014","journal-title":"Curr Oncol"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2010.07.1097","article-title":"Treatment Outcomes of Different Chemotherapy Sequences in N3 Stage Nasopharyngeal Carcinoma","volume":"78","author":"Xu","year":"2010","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.2147\/cmar.S165804","article-title":"A retrospective study of concurrent chemoradiotherapy plus S-1 adjuvant chemotherapy on curative effect for treatment of patients with N3 stage nasopharyngeal carcinoma","volume":"10","author":"Zhang","year":"2018","journal-title":"Cancer Manage Res"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.7849","article-title":"The role of adjuvant chemotherapy in nasopharyngeal carcinoma with bulky neck lymph nodes in the era of IMRT","volume":"7","author":"Xu","year":"2016","journal-title":"Oncotarget"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1000-8179.2018.10.172.[inChinese","article-title":"Research progress of plasma EBV DNA detection in the diagnosis and treatment of nasopharyngeal carcinoma","volume":"45","author":"Li","year":"2018","journal-title":"Chin J Clin Oncol"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.01.052","article-title":"Metronomic adjuvant chemotherapy improves treatment outcome in nasopharyngeal carcinoma patients with postradiation persistently detectable plasma Epstein-Barr virus deoxyribonucleic acid","volume":"89","author":"Twu","year":"2014","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B49","doi-asserted-by":"publisher","first-page":"JCO2018777847","DOI":"10.1200\/JCO.2018.77.7847","article-title":"Analysis of Plasma Epstein-Barr Virus DNA in Nasopharyngeal Cancer After Chemoradiation to Identify High-Risk Patients for Adjuvant Chemotherapy: A Randomized Controlled Trial","volume":"36","author":"Chan","year":"2018","journal-title":"J Clin Oncol"},{"key":"B50","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.oraloncology.2016.11.008","article-title":"Prognostic impact of adjuvant chemotherapy in high-risk nasopharyngeal carcinoma patients","volume":"64","author":"Liu","year":"2017","journal-title":"Oral Oncol"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1038\/srep41449","article-title":"Significant survival benefit of adjuvant chemotherapy after concurrent chemoradiotherapy in locally advanced high-risk nasopharyngeal carcinoma","volume":"7","author":"Liang","year":"2017","journal-title":"Sci Rep"},{"key":"B52","doi-asserted-by":"publisher","first-page":"399","DOI":"10.3321\/j.issn:1004-4221.2008.05.020","article-title":"Effect of radiotherapy combined with different cycles of chemotherapy on the survival of locally advanced nasopharyngeal carcinoma","volume":"17","author":"Li","year":"2008","journal-title":"Chin J Radiat Oncol"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.2217\/fon.13.100","article-title":"Prognostic analysis of adjuvant chemotherapy in patients with nasopharyngeal carcinoma","volume":"9","author":"Lin","year":"2013","journal-title":"Future Oncol"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2017.08.016","article-title":"Long-term results of a phase II study of gemcitabine and cisplatin chemotherapy combined with intensity-modulated radiotherapy in locoregionally advanced nasopharyngeal carcinoma","volume":"73","author":"Wu","year":"2017","journal-title":"Oral Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2020.585046\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T13:57:48Z","timestamp":1614866268000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2020.585046\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,24]]},"references-count":54,"alternative-id":["10.3389\/fonc.2020.585046"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2020.585046","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,24]]},"article-number":"585046"}}