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Stereotactic body radiotherapy and checkpoint inhibitor for locally recurrent unresectable nasopharyngeal carcinoma
  1. Jia-Shing Wu1,
  2. Chung-Wen Jen1,
  3. Hsin-Hsuan Chen2 and
  4. Skye Hung-Chun Cheng1
  1. 1Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
  2. 2Department of Hematology-Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
  1. Correspondence to Dr Jia-Shing Wu; wujs{at}


The treatment of local recurrence of nasopharyngeal carcinoma (NPC) is challenging, and the role of reirradiation is controversial regarding the high risk for severe toxicity. Stereotactic body radiotherapy (SBRT) is a high-precision radiation technique that can spare surrounding normal tissues. Studies have demonstrated the high activity and low toxicity of both SBRT and anti-programmed-cell-death-1 immune checkpoint inhibitors for head and neck cancers. There has been preclinical and clinical evidence suggesting synergy between radiotherapy and checkpoint inhibitors. We report two patients with locally recurrent unresectable rT4 NPC both involving the retro-orbital areas. They received the same treatment with low-dose SBRT (28 Gy in 5 fractions) and pembrolizumab, and showed a remarkable tumour response without untoward radiation toxicity. SBRT plus an immune checkpoint inhibitor may provide a new treatment option for locally recurrent NPC. We propose further investigation with a formal clinical trial.

  • head and neck cancer
  • radiotherapy

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  • Contributors J-SW and C-WJ were involved in manuscript writing. H-HC was responsible for patient care. SH-CC gave the original idea and helped in patient care.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.