Locoregional Radiotherapy in Metastatic Nasopharyngeal Cancer

To the Editor We read with interest the important findings of the phase 3 randomized clinical trial by You et al,¹ which represents, to our knowledge, the first level 1 evidence to support the use of sequential locoregional radiotherapy in the management of patients with metastatic nasopharyngeal carcinoma. The study randomized patients with metastatic nasopharyngeal carcinoma who had partial or complete response after 3 cycles of cisplatin and fluorouracil to either 3 further cycles of chemotherapy followed by locoregional radiotherapy alone or to 3 cycles of chemotherapy only. Survival was significantly prolonged in patients who received chemotherapy followed by radiotherapy compared with chemotherapy only (24-month overall survival: 76.4% vs 54.5%; hazard ratio, 0.42; 95% CI, 0.23-0.77; P = .004).