PRACTICE GUIDELINES AHNS Series – Do you know your guidelines? Principles of treatment for nasopharyngeal cancer: A review of the National Comprehensive Cancer Network guidelines Zhen Gooi, MBBS, 1 Jeremy Richmon, MD, 2 Nishant Agrawal, MD, 1 Elizabeth Blair, MD, 1 Louis Portugal, MD, 1 Everett Vokes, MD, 3 Tanguy Seiwert, MD, 3 Jonas de Souza, MD, 3 Vassiliki Saloura, MD, 3 Daniel Haraf, MD, 4 David Goldenberg, MD, 5 Jason Chan, MBBS 6 * 1 Section of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, 2 Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, 3 Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois, 4 Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois, 5 Division of Otolaryngology–Head and Neck Surgery, Penn State University College of Medicine and Penn State Health, Hershey, Pennsylvania, 6 Department of Otorhinolaryngology–Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR. Accepted 10 October 2016 Published online 00 Month 2016 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/hed.24635 ABSTRACT: This article is a continuation of the “Do You Know Your Guidelines” series, an initiative of the American Head and Neck Society’s Education Committee to increase awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network guidelines for the management of nasopharyngeal cancer are reviewed here in a systematic fashion. These guidelines outline the workup, treatment and surveillance of patients with nasopharyngeal can- cer. V C 2016 Wiley Periodicals, Inc. Head Neck 00: 000–000, 2016 KEY WORDS: nasopharyngeal cancer, fiber-optic examination, Epstein–Barr virus, National Comprehensive Cancer Network (NCCN) guidelines, fine-needle aspiration INTRODUCTION Nasopharyngeal cancer is a relatively uncommon cancer of the head and neck, with 87,000 new cases being diagnosed worldwide and 51,000 deaths being attributed to this cancer in 2012. 1 There is geographic variation in the incidence of this cancer, with an age standardized incidence rate ranging from <1 per 100,000 person years in most areas of the world, including the United States to >20 per 100,000 person years in Southern China. 1,2 The incidence of nasopharyngeal cancer is 2 to 3 times higher in men compared to women, and, in endemic regions, incidence peaks at age 50 to 59 years. 2 When compared with other head and neck cancers, it shows a higher ten- dency for distant metastasis. 3,4 The World Health Organi- zation classifies this cancer into 3 subtypes, with type I comprising keratinizing squamous cell carcinoma, type II comprising nonkeratinizing squamous cell carcinoma, and type III representing undifferentiated carcinoma. Type III nasopharyngeal carcinoma accounts for over 95% of cancers in high-incidence areas and shows a strong association with the Epstein–Barr virus. 2 The boundaries of the nasopharynx are superiorly, mucosa overlying the posterior body of the sphenoid and basilar portion of the occipital bone; posteriorly, the adenoids, pharyngobasilar fascia, and superior constrictor; and later- ally, the Eustachian tube and the lateral pharyngeal recess, also known as the fossa of Rosenm€ uller. The floor of the nasopharynx is formed by the superior surface of the soft palate. The purpose of this review was to summarize the latest National Comprehensive Cancer Network (NCCN) guidelines version 1.2015 pertaining to the management of nasopharyngeal carcinoma. 5 Treatment recommendations are categorized according to the levels of evidence and con- sensus among NCCN panel members. A category 1 recom- mendation is based on high-level evidence with uniform consensus that the intervention is appropriate. Category 2A and 2B recommendations are based on lower level evi- dence, but still with a significant panel member consensus (category 2A, 85% to <100%; category 2B, >50, <85% consensus). Category 3 recommendations are based upon any level evidence, but with major disagreements among NCCN panel members on the suitability of the treatment recommendation. Throughout this review, treatment recom- mendations are category 2A unless specifically stated. Workup As with any head and neck malignancy, the workup for nasopharyngeal carcinoma includes a complete medical his- tory and physical examination. A thorough fiber-optic *Corresponding author: J. Y. K. Chan, Department of Otorhinolaryngology– Head and Neck Surgery, The Chinese University of Hong Kong Prince of Wales, Hospital Shatin, N. T., Shatin, Hong Kong SAR. E-mail: jasonchan@ent.cuhk. edu.hk This article is a continuation of the “Do You Know Your Guidelines” Series, an initiative of the American Head and Neck Society’s Education Committee to increase awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network guidelines for the management of nasopharyngeal cancer are reviewed here in a systematic fashion. HEAD & NECK—DOI 10.1002/HED MONTH 2016 1