Individualized treatment for non-metastatic nasopharyngeal cancer: current practice and future perspectives

The management of non-metastatic nasopharyngeal carcinoma (NPC) is undergoing a profound paradigm shift from a uniform, stage-based approach to a personalized, risk-adapted strategy. This review synthesizes the current landscape and future directions of individualized treatment. Contemporary management is increasingly guided by refined risk stratification that incorporates biomarkers such as plasma EBV DNA into the fundamental tumor-node-metastasis (TNM) staging, enabling tailored treatment strategies—de-escalation for low-risk and escalation for high-risk patients. Advances in precision radiotherapy, including response-adapted target volumes and genomically guided dosing, further enhance the potential of personalized radiotherapy. Future research will focus on dismantling the immunosuppressive tumor microenvironment and targeting unique oncogenic drivers to overcome therapeutic resistance, as well as treating cancer from an evolutionary ecological standpoint. Targeting not only tumor cells but the adaptive dynamics of the pathological ecosystem, represent a promising frontier in the post-genomic era. All these concerted efforts aim to establish a precision oncology framework for NPC, fundamentally guided by individualized biomarkers to design treatment strategies that maximize tumor control while minimizing treatment-related morbidity.