A patient with EBV-associated nasopharyngeal carcinoma develops diplopia. MRI shows cavernous-sinus extension encasing the internal carotid artery without distant metastasis. Which treatment principle is best?
For non-metastatic locally advanced NPC, definitive chemoradiotherapy—not heroic resection—is the core curative strategy.
A. Primary open skull-base resection: Morbidity is high and definitive chemoradiotherapy is standard for locally advanced disease.
B. Neck dissection as sole treatment: This does not treat the primary or skull-base extension.
C. Radiotherapy to the nasopharynx alone without systemic therapy: Locally advanced disease generally requires concurrent systemic treatment when fit.
D. Palliative steroids only because carotid encasement precludes cure: Carotid/cavernous extension does not automatically make non-metastatic NPC incurable.
E. Definitive intensity-modulated radiotherapy with concurrent systemic therapy in a specialist MDT: NPC is primarily chemoradiosensitive; modern target delineation must cover skull-base and nodal risk while respecting critical structures.
If staging demonstrated widespread metastases, systemic therapy and symptom-directed radiotherapy would replace definitive locoregional treatment alone.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, or a substitute for local policy and specialist clinical judgement.
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