Surgery as an alternative to radiotherapy in early-stage nasopharyngeal carcinoma:innovation at the expense of uncertainty

Radiotherapy(RT)has an unassailable track record as the backbone of treatment in nasopharyngeal carcinoma(NPC).Several reasons explain its dominance.Likewise to human papilloma virus-associated oropharyngeal squamous cell carcinoma,Epstein-Barr virus(EBV)-associated NPC is exquisitely sensitive to RT.Thus,huge leaps with technological advances in RT delivery over the past decades have led to substantial improvements in tumor control,while reducing debilitating late RT-induced complications[1,2].Innovations in this space continue to drive the enhancement of the therapeutic ratio of RT,with the goal of enhancing the quality of life(QoL)among long-term survivors[3].Therefore,there has not been any compelling reason to disrupt this timehonored convention of employing RT as the standard of care in NPC.