Per the latest ASCO and ESMO guidelines, which stage II NPC patients would you omit concurrent cisplatin?

ASCO recommendations for stage II NPC are: “For T2N0 (AJCC 8th) NPC patients, chemotherapy is not routinely recommended, but may be offered if there are adverse features, such as bulky tumor volumes or high EBV DNA copy number. For T1-2N1 NPC patients, concurrent chemotherapy may be offered, particularly for T2 N1 patients”

The AJCC8 NPC staging expanded T2 to include parapharyngeal extension, prevertebral and pterygoid muscles involvement. This staging system was devised based on the large numbers of endemic patients from SE Asia who were predominantly EBV+. These are patients with mostly undifferentiated cancer highly responsive to therapy, LR control is high, and high EBV copy number pre-therapy is a poor prognostic factor. A randomized ...