## First-Line Induction Chemotherapy for Nasopharyngeal Carcinoma **Key Point:** Cisplatin combined with 5-fluorouracil (5-FU) is the standard induction chemotherapy regimen for locally advanced nasopharyngeal carcinoma (NPC), particularly in endemic regions like South India where EBV-associated undifferentiated carcinoma predominates. ### Rationale for Cisplatin + 5-FU **High-Yield:** The combination of cisplatin and 5-FU followed by concurrent chemoradiotherapy (CCRT) with cisplatin is the evidence-based standard for T3-4 or N2-3 disease based on multiple randomized trials (NCCN, ESMO, AJCC guidelines). 1. **Superior outcomes:** Induction chemotherapy with cisplatin + 5-FU reduces distant metastasis risk by ~10–15% compared to CCRT alone 2. **EBV-associated tumors:** NPC in endemic areas (South India, Southeast Asia) are almost universally EBV-positive undifferentiated carcinomas, which are highly chemosensitive 3. **Concurrent CCRT:** After induction, patients receive weekly or high-dose cisplatin concurrent with radiation therapy ### Typical Regimen | Component | Details | |-----------|----------| | **Induction** | Cisplatin 100 mg/m² + 5-FU 1000 mg/m²/day × 4 days, every 3 weeks × 2–3 cycles | | **Concurrent CCRT** | Cisplatin 40 mg/m² weekly during 6–7 weeks of radiotherapy | | **Total radiation dose** | 70 Gy in conventional fractionation | **Clinical Pearl:** The addition of induction chemotherapy is most beneficial in N2–N3 disease (as in this case with N2 nodal involvement) and T3–T4 tumors, where the risk of distant metastasis is highest. ### Why Not Other Regimens? - **Cisplatin monotherapy:** Lacks the synergistic benefit of 5-FU; lower response rates - **Carboplatin + paclitaxel:** Used in recurrent/metastatic disease or cisplatin-ineligible patients; not first-line for induction - **Methotrexate + bleomycin:** Older regimen with inferior outcomes; rarely used in modern practice [cite:NCCN Head and Neck Cancers Guidelines 2023; AJCC Cancer Staging Manual 8e]
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.