Nasopharynxkarzinom – ein aktueller Überblick über eine spezielle Tumorentität

Carcinomas of the nasopharynx represent a distinct entity, differing from other head and neck tumors in terms of etiology, tumor biology, diagnostic workup, and treatment. The carcinogenesis is partly understood; alongside environmental factors, a complex interplay of genetic factors and chronic Epstein–Barr virus (EBV) infection appears central. This could account for the high geographic variability. The mainstay of primary curative therapy is radiation therapy, to which platinum-based chemotherapy is added in advanced stages. Depending on the stage, this approach may be framed by induction and/or adjuvant chemotherapy. Typical induction therapy protocols are combinations such as gemcitabine/cisplatin or cisplatin/docetaxel/5-fluorouracil (FU; “TPF regimen”). In adjuvant therapy, capecitabine is another less toxic alternative to the standard cisplatin/5-FU regimen, as based on recent data. In the past years, there has been increasing focus on stratifying treatments for locally advanced tumors using additional predictive markers, including the plasma EBV DNA level or tumor mass (“bulky disease”). For local recurrences, salvage surgery is the preferred treatment, increasingly performed endoscopically. In palliative systemic therapy, alongside the first-line regimen gemcitabine/cisplatin, immunotherapy is playing an increasingly important role.