**8. Recurrent/metastatic disease**

NPC failures are mainly metastatic, to bones, lungs and liver and loco-regional relapses became more rare due to the high loco-regional control rate obtained by loco-regional RT (Leung et al,2005; Cvitkovic et al,1993). In metastatic situations, NPC remains chemosensitive to cisplatin, adriamycin, 5Fluorouracil or more recently taxanes, gemcitabine or oral capecitabine(Boussen et al,1991,2010;You et al,2011;Bensouda et al,2011). Prolonged survival after palliative CT and/or RT could be observed in patients with bone metastases in case of bone MTS only and less than 4 sites involved (Fandi et al,2000;Cao et al,2011). In isolated bone metastases, prolonged responses under biphosphonates plus CT have been also reported, with a significant reduction of skeletal events and better (11.5 vs 5.5 months, P < 0.001) progression-free survival and overall survival (23.5 vs. 17.5 months, P < 0.001) of combined vs chemotherapy alone group. (Jin et al,2011). Even in case of lung MTS disease, different prognostic groups could be identified according to size and numbers of metastatic nodules (Cao X et al, 2011).
