IMRT Alone for Stage IB Nasopharyngeal Carcinoma Without High-Risk Features

Inclusion criteria

• Histopathologically confirmed, newly diagnosed nasopharyngeal carcinoma 3. Age 18-70 years 4. Stage IB disease (T1-2N1M0) per the 9th edition AJCC/UICC staging system 5. Upper-neck nodal metastasis only: inferior border of every positive node at or above the inferior border of the hyoid bone 6. ECOG performance status 0-2 7. Adequate bone-marrow function

Exclusion criteria

• Age > 70 years or < 18 years
• Matted lymph nodes: two or more contiguous nodes with loss of intervening fat planes and/or extracapsular extension forming a confluent mass
• Largest metastatic lymph-node ≥ 3 cm in the longest dimension
• Lower-neck nodal metastasis: inferior border of any positive node below the inferior border of the hyoid bone
• Prior malignancy except adequately treated basal-cell or squamous-cell carcinoma of the skin or carcinoma in situ of the cervix
• Pregnancy or lactation (serum pregnancy test required for women of child-bearing potential; effective contraception mandatory during treatment)
• Previous radiotherapy to the head-and-neck region
• Prior chemotherapy or surgery for the primary tumour or metastatic nodes (diagnostic procedures excluded)
• Any severe comorbidity that would confer unacceptable risk or compromise protocol adherence, including but not limited to unstable cardiac disease, renal failure, chronic hepatitis, or uncontrolled psychiatric disorder
• History of severe hypersensitivity reactions