Concluding Chapter

Abstract EBV-related nasopharyngeal cancer (NPC) is the first head and neck cancer with a variety of unique signatures. These include an unequivocal and consistent link to viral causation; a strong association with genetic/familiar ethnicity; a potential biomarker for screening, early diagnosis, and surveillance; evidence of the substantial influence of precision radiotherapy (e.g., intensity-modulated radiotherapy) and the addition of chemotherapy with radiotherapy (either by concurrent or induction approaches); a potential cure of distant metastasis; better management that has forced a refinement of the TNM classification; and entire reliance on radiotherapy to accomplish a cure in most presentations. The outcome of NPC has improved dramatically over recent decades owing to the aforementioned advances in diagnosis, staging, and treatment. Contemporary management has altered the failure pattern such that locoregional control is no longer an overwhelming challenge for most cases, while distant metastasis has assumed the predominant mode of failure. Ongoing questions persist regarding refinement of risk stratification, optimal management algorithms for radiotherapy volume, and the optimal sequence of chemoradiation combinations. The roles of particle therapy (e.g., protons) and immunotherapy in the management of NPC are currently under investigation. This chapter summarizes clinical aspects of NPC management in terms of diagnosis, staging, treatment, and disease surveillance, as well as future strategies to improve the therapeutic ratio.