A Chinese research team applied integrated single-cell and spatial transcriptomic techniques to characterize molecular features of recurrent nasopharyngeal carcinoma (rNPC), uncovering key mechanisms of radiotherapy resistance and immune evasion. They identified increased radioresistant fibroblasts expressing MCAM and suppression of T cell infiltration via upregulated collagen IV pathways. Immune escape involved reduced cytotoxic CD8 T cells, fewer B cells and tertiary lymphoid structures, and enhanced interactions between CD47+ tumor and myeloid cells expressing SIRP-alpha. These findings highlight potential therapeutic avenues to overcome rNPC treatment failure.