Indirect cell death involves altered cellular homeostasis and modified signaling pathways ultimately leading to apoptosis.349 On the other hand, ROS is a critical regulator of IR-resistant pathways.223 The tumor cell stemness, antioxidant enzymes expression and inflammation are the reason that related to the ROS-mediated IR-resistant.236 Presently, some biomarkers have been identified that enhance the radiosensitivity of NPC, and include COX-2, EGFR, Bcl-2, and VEGF. This evidence concerns the gene VEGFA and nasopharyngeal carcinoma.