Nasopharyngeal Carcinoma (NPC) is a rare type of epithelial cancer originating from the nasopharynx lining, with distinct epidemiological features. It is most common in Southern China and Southeast Asia, while in India, its prevalence is notably higher in the North-Eastern states.

NPC often affects younger patients and shows high radiosensitivity, making radiotherapy (RT) the primary treatment. Historically, treatment evolved from 2D-RT to 3D-CRT, and now Intensity Modulated Radiation Therapy (IMRT) is the standard due to its precision and reduced toxicity to normal tissues.

Despite the success of IMRT in improving survival and reducing side effects like xerostomia and hearing loss, 30-40% of patients still suffer from moderate to severe late toxicities, which negatively impact long-term quality of life (QoL).

To enhance outcomes and reduce side effects further, chemotherapy has been combined with RT, especially in advanced-stage NPC, as proven by landmark trials like Intergroup 0099, NPC-9901, and NPC-0501. Neoadjuvant chemotherapy (NACT) followed by concurrent chemoradiotherapy (CRT) is now considered the standard for Stage III–IVA NPC.

A promising alternative is Intensity Modulated Proton Therapy (IMPT), an advanced form of Proton Beam Therapy (PBT). Due to the unique physical properties of protons (sharp dose fall-off), IMPT can deliver high tumor doses while sparing surrounding healthy tissues. Early clinical and dosimetric studies show IMPT may significantly reduce toxicities (e.g., xerostomia, hearing loss) and improve QoL compared to IMRT.

However, evidence from randomized trials is lacking, especially in Indian populations. Therefore, a Phase II Randomized Controlled Trial is proposed to compare IMRT vs. IMPT in NPC, aiming to establish stronger evidence on reducing long-term toxicity and improving patient outcomes.