To the Editor A recent randomized clinical trial¹ reported that after induction chemotherapy (IC), patients with stages III to IVB (American Joint Committee on Cancer Staging Manual, 7th Edition) nasopharyngeal carcinoma (NPC) receiving radiation therapy alone had noninferior oncologic outcomes and fewer acute adverse events, compared with those receiving concurrent chemoradiotherapy (CCRT). We have several comments about this impactful study.

Our first concern about this study is the cisplatin dose in CCRT. In 2 randomized clinical trials forming the evidence supporting IC-CCRT as the standard treatment for locoregionally advanced NPC, the IC regimens were either identical to or more intensive (docetaxel, cisplatin and fluorouracil [TPF]: 60 or 75 mg/m² for cisplatin and docetaxel; 600 or 750 mg/m² for 5-fluorouracil) than those in this study; and the cisplatin doses in CCRT were either triweekly 100 mg/m²,² or weekly 40 mg/m².³ In the IC-CCRT arms of both trials,^2,3 the mean cumulative doses of cisplatin in CCRT were greater than 210 mg/m²; and 85.89% of patients in the IC-CCRT arm received more than 200 mg/m² of cisplatin in CCRT in a trial of these.²