Precise Guidance of Adaptive Radiotherapy for Nasopharyngeal Carcinoma

Inclusion criteria

• Any sex; age 18-70 years.
• Histologically confirmed non-keratinizing nasopharyngeal carcinoma (World Health Organization (WHO) type II or III).
• Clinical stage I-IVA (American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) 8th edition) with no evidence of distant metastasis.
• Eastern Cooperative Oncology Group (ECOG) performance status 0-1.
• No prior anti-tumor treatment for nasopharyngeal carcinoma, including radiotherapy, chemotherapy, immunotherapy, or biologic therapy.
• No contraindications to radiotherapy or chemotherapy.
• Adequate major organ function as defined below:

7.1 Hematology: white blood cell (WBC) ≥ 4.0 × 10^9/L, absolute neutrophil count (ANC) ≥ 1.5 × 10^9/L, platelet count ≥ 100 × 10^9/L, hemoglobin ≥ 90 g/L (no blood transfusion or blood products within 14 days and no use of granulocyte colony-stimulating factor (G-CSF) or other hematopoietic growth factors to correct counts);

7.2 Biochemistry: alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 × upper limit of normal (ULN); blood urea nitrogen (BUN) and serum creatinine ≤ 1.5 × ULN, or creatinine clearance ≥ 60 mL/min calculated by the Cockcroft-Gault formula.

• Participant voluntarily agrees to join the study, signs informed consent, has good compliance, and is able to attend follow-up.

Exclusion criteria

• Pathological type of keratinizing squamous cell carcinoma or basaloid squamous cell carcinoma.
• History of or concurrent other active (unresolved) malignant tumors, except for previously cured basal cell carcinoma of the skin, carcinoma in situ of the cervix, or superficial bladder cancer.
• Currently participating in another clinical trial.
• Pregnant or breastfeeding women.
• Uncontrolled cardiovascular disease, including ≥ Grade II myocardial ischemia or myocardial infarction, uncontrolled cardiac arrhythmias (including corrected QT (QTc) interval ≥ 470 ms); heart failure New York Heart Association (NYHA) class III-IV, or left ventricular ejection fraction (LVEF) < 50% on echocardiography; or myocardial infarction within the past year.
• Other severe comorbidities such as uncontrolled hypertension, severe cerebrovascular disease, severe renal disease, uncontrolled diabetes mellitus, or other chronic wasting diseases.
• History of substance or alcohol abuse, psychiatric illness, or lack of full or having limited civil capacity.
• In the investigator's judgment, other familial or social factors that could force premature withdrawal from the study, or other conditions likely to affect participant safety or the collection of trial data.