Radiotherapy is the primary treatment modality for non-metastatic nasopharyngeal carcinoma (NPC) across all TN-stages. Locoregional control rates have been impressive even from the 2D radiotherapy (RT) era, except when the ability to deliver optimal dose coverage to the tumor is compromised. However, short- and long-term complications following head and neck RT are potentially debilitating, and thus, there has been much research investigating technological advances in RT delivery over the past decades, with the primary goal of limiting normal tissue damage. On this note, with a plateau in gains of therapeutic ratio by modern RT techniques, future advances have to be focused on individualization of RT, both in terms of dose prescription and the delineation of target volumes. In this review, we analyzed the guidelines and evidence related to contouring methods, and dose prescription for early and locoregionally advanced (LA-) NPC. Next, with the preference for induction chemotherapy (IC) in patients with LA-NPC, we assessed the evidence concerning radiotherapy adaptations guided by IC response, as well as functional imaging and contour changes during treatment. Finally, we discussed on RT individualization that is guided by EBV DNA assessment, and its importance in the era of combinatorial immune checkpoint blockade therapy with RT.
放疗是各TNM分期非转移性鼻咽癌（NPC）的主要治疗方式。即便在二维放疗时代，局部区域控制率已相当可观，除非肿瘤无法获得最佳剂量覆盖。然而，头颈部放疗后的短期与长期并发症可能严重影响患者生活质量，因此过去数十年间，大量研究致力于推动放疗技术革新，其核心目标在于减少正常组织损伤。值得注意的是，随着现代放疗技术带来的治疗增益比趋于平台期，未来进展需聚焦于放疗个体化，包括剂量处方与靶区勾画两方面。本综述分析了早期及局部晚期鼻咽癌靶区勾画方法与剂量处方相关的指南与证据。其次，针对局部晚期鼻咽癌患者更倾向采用诱导化疗的现状，我们评估了基于诱导化疗反应指导放疗调整的证据，以及治疗过程中功能影像与靶区变化的关联。最后，我们探讨了以EBV DNA检测为导向的放疗个体化策略，及其在放疗联合免疫检查点阻断治疗时代的重要意义。
肿瘤(癌症)患者之家