What is your preferred treatment for locally advanced poorly differentiated carcinoma of the nasopharynx with bulky neck nodes that is EBER negative and p16 negative?

I prefer concurrent chemoradiation first if this can be started in a timely fashion and deemed reasonable by my radiation oncology colleagues. Discussion in multidisciplinary tumor board would be of immense value here. I would strongly consider adjuvant chemo based on Intergroup 0099 study in which ...

To date, there is no data as to whether induction chemotherapy followed by chemoradiation vs chemoradiation followed by adjuvant chemotherapy should be administered. Moreover, either option is listed as standard of care treatment by the Head and Neck NCCN guidelines for locally advanced EBV (-), p16...

Cis/XRT then adjuvant cis/5FU.