The first CSCO nasopharyngeal cancer guidelines were published, which Professor Ma jun interpreted.

Nasopharyngeal carcinoma is one of the most frequent cancers in China, accounting for the highest incidence rate of head and neck cancer, especially incidence rate in southern China.radiotherapy is the main treatment strategy for nasopharyngeal carcinoma, but there is no effective treatment for distant metastasis of nasopharyngeal carcinoma.with the rapid development of targeted therapy and immunotherapy in the field of tumor, the treatment of nasopharyngeal carcinoma also shows new dawn.from July 3 to 4, 2020, the annual seminar on progress in Clinical Oncology (BOC) and best of ASCO 2020 China was successfully held under the keen attention of oncologists in China. At the meeting, the Chinese society of Clinical Oncology (CSCO) guidelines for diagnosis and treatment of nasopharyngeal carcinoma was unveiled! As the first guideline for the diagnosis and treatment of nasopharyngeal carcinoma formulated by CSCO, the development of this guideline will have a profound impact on the clinical practice of nasopharyngeal carcinoma in China.therefore, we specially invite Professor Ma Jun, chairman of CSCO NPC Expert Committee and cancer prevention and treatment center of Sun Yat sen University, to introduce the background and highlights of this guideline, to elaborate the current situation of diagnosis and treatment of nasopharyngeal carcinoma, and to interpret the new progress of immunotherapy in the treatment of nasopharyngeal carcinoma.Introduction to experts Professor Ma Jun, chief physician and executive deputy director of Affiliated Cancer Hospital of Sun Yat sen University Executive vice president, CSCO NPC expert committee chairman, China Anti Cancer Association NPC professional committee, vice convener of special medicine discipline evaluation group of Academic Degree Committee of the State Council What is the background of the compilation and release of this guideline? Prof. Ma Jun: in the past, CSCO did not have specific guidelines for the diagnosis and treatment of nasopharyngeal carcinoma.compared with other head and neck tumors, nasopharyngeal carcinoma has special biological characteristics, which is highly correlated with Epstein Barr virus (EBV), and its geographical distribution is significantly unbalanced.most of the pathological types were undifferentiated non keratinocarcinoma.more importantly, radiotherapy is the foundation of nasopharyngeal carcinoma treatment, combined with chemotherapy and immunotherapy.CSCO NPC expert committee was established in 2019. In order to provide more detailed guidelines for the diagnosis and treatment of nasopharyngeal carcinoma, the special committee organized the NPC guidelines expert committee this year. Based on evidence-based medical evidence, the first CSCO expert guide consensus on the diagnosis and treatment of nasopharyngeal carcinoma was written. It is hoped that the release of the guidelines will further promote the standardization of the diagnosis and treatment of nasopharyngeal carcinoma in China.What are the main points and highlights of this guide? Prof. Ma Jun: on the basis of evidence-based evidence, this edition of guidelines mainly provides standardized and professional advice and guidance in the diagnosis, treatment and follow-up of nasopharyngeal carcinoma.its highlights are: 1. This guideline is the first guideline for nasopharyngeal carcinoma (NPC) of CSCO, which is pioneering. It is the first NPC guideline formulated by CSCO NPC expert committee together with nearly 100 NPC experts from mainland China, Hong Kong and Macao. It includes the opinions of experts in radiotherapy, chemotherapy, surgery, epidemiology and other disciplines, which is a tumor with "Chinese characteristics" Diagnosis and treatment is of great clinical significance.2 the recommendation is based on the published high-level evidence-based medicine, which is authoritative. Our recommendations are based on the published high-level or high-impact evidence-based medicine, and the conference report or abstract and other materials are only included in the notes.it can better avoid the misleading of clinical diagnosis and treatment caused by the inconsistent conclusions between the conference summary and the published papers.3 it pays attention to all aspects of the treatment of nasopharyngeal carcinoma, which has operability. In this edition of the guidelines, we have made detailed recommendations and guidance on the diagnosis, staging, radiotherapy body position fixation, target delineation, planning and design methods, dose, quality assurance, chemotherapy strategy, treatment of side effects, and follow-up, which is very easy to promote and help to standardize clinical diagnosis and treatment.4 emphasizes the application of multi-disciplinary consultation mode, which has human feelings, and should run through the diagnosis and treatment of nasopharyngeal carcinoma patients.before treatment, the expert team composed of multi-disciplinary experts will make a comprehensive evaluation, and formulate a scientific, reasonable and standardized overall treatment strategy according to the current domestic and foreign diagnosis and treatment standards or evidence-based medical evidence, combined with the existing treatment methods.based on the participation of the main treatment related departments, such as radiotherapy department, radiology department, oncology department and surgery department, the multidisciplinary expert team also suggests to increase the relevant departments such as psychological department and nutrition department. In addition to increasing the selectivity of treatment plan and paying attention to the curative effect of tumor, it is also helpful to improve the quality of life of patients, so that patients can not only live longer, but also live better! What is the significance of this guideline for clinical practice of nasopharyngeal carcinoma in China? Prof. Ma Jun: in the past, most of the guidelines for NPC in China were based on expert consensus, but lack of systematic evidence-based medicine.CSCO guidelines have a set of systematic and complete standards based on evidence-based medicine to develop guidelines. Therefore, the release of the guidelines is conducive to promoting the standardization of diagnosis and treatment of nasopharyngeal carcinoma in China from the perspective of evidence-based medicine.at the same time, most clinicians in China could only refer to the national comprehensive cancer network (NCCN) guidelines of the United States or the European Society of Oncology (ESMO) guidelines in the diagnosis and treatment of nasopharyngeal carcinoma, which did not take into account the national characteristics of China.This version of the guidelines combines the national conditions of China and considers the feasibility, which will be more conducive to the actual clinical practice of Chinese doctors.in the new guidelines, immunotherapy is recommended as the first-line treatment for recurrent and metastatic nasopharyngeal carcinoma. This is the first time that immunotherapy is recommended as the first-line treatment. What evidence-based evidence is the recommendation based on? In addition, what are the exploration directions of immunotherapy in the treatment of nasopharyngeal carcinoma? Professor Ma Jun: in 2018, Professor Zhang Li of the cancer prevention and treatment center of Sun Yat sen University reported the results of a phase I trial.this study explored the first-line treatment effect of chemotherapy combined with carrizumab in recurrent and metastatic nasopharyngeal carcinoma. The results showed that the overall effective rate of the combined treatment was 91%, suggesting that the combination of chemotherapy and chemotherapy can be used as the first-line treatment for recurrent and metastatic nasopharyngeal carcinoma.although immunotherapy has shown definite efficacy in recurrent and metastatic nasopharyngeal carcinoma, the current studies are small-scale phase I - II exploratory trials, and there are still many exploration directions in the future.first, a large sample size phase III randomized controlled trial should be conducted to determine the value of different immunotherapies, such as single drug use, combined chemotherapy, combined targeted therapy, etc., in the first-line or multi-line treatment of recurrent and metastatic nasopharyngeal carcinoma.secondly, because immunotherapy has the advantages of low toxicity and complementary with chemotherapy, it is necessary to test whether the combined immunotherapy can bring additional benefits to patients on the basis of radiotherapy and chemotherapy for locally advanced nasopharyngeal carcinoma, and the timing of immunotherapy needs to be further clarified.conclusion: CSCO's First NPC guideline based on evidence-based medicine is both practical and cutting-edge, which will effectively regulate clinical activities in all aspects of NPC diagnosis and treatment, and better serve the majority of NPC patients.