Up to one in four patients with nasopharyngeal carcinoma present with non-metastatic stage IV disease (i.e. T4 or N3). Distinct failure patterns exist, despite the routine adoption of contemporary treatment modalities such as intensity modulated radiotherapy and systemic chemotherapy. Concurrent chemoradiotherapy (CCRT) followed by adjuvant chemotherapy or induction chemotherapy followed by CCRT are commonly employed in this setting, with the latter emerging as the preferred option. Additionally, emerging radiation technologies like proton therapy has become available offering new opportunities for prevention of radiation-induced side effects. This article reviews not only the current treatment strategies, but also discusses novel ways to tackle this challenging disease with respect to the patterns of failure.

中文翻译：

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当前治疗IV期鼻咽癌而无远处转移。

多达四分之一的鼻咽癌患者患有非转移性IV期疾病（即T4或N3）。尽管常规采用了现代疗法，例如调强放疗和全身化疗，但仍存在明显的失败模式。在这种情况下，通常采用并发放化疗（CCRT），然后进行辅助化疗或诱导化疗，然后进行CCRT，其中后者是首选。另外，诸如质子疗法的新兴辐射技术已经可用，为预防辐射引起的副作用提供了新的机会。本文不仅回顾了当前的治疗策略，而且还就失败模式讨论了解决这种具有挑战性的疾病的新颖方法。