CARCINOMA OF THE NASOPHARYNX IN YOUNG-PATIENTS

Purpose: To provide an analysis of eighteen cases of adolescent nasoph aryngeal carcinoma treated between 1971 and 1989. Methods and Material s: Between 1971 and 1989, 48 cases of nasopharyngeal carcinoma were ev aluated at the Medical College of Georgia Hospital and Clinics. Eighte en patients between the ages of 9 and 29 years were treated at the Geo rgia Radiation Therapy Center. All patients presented for treatment wi th (AJCC) Stage IV disease. Fifteen patients with lymphoepithelioma an d three with squamous cell carcinoma histologies received definitive r adiation therapy to a median dose of 64.8 Gy. Males outnumbered female s by more than 2:1 and the majority of patients (67%) were black. Nine patients received multiagent adjuvant chemotherapy. Results: Thirteen patients are alive from 7 to 166 months (median 32 months) including three with disease at 17, 24, and 132 months. Overall and disease-free survival at 5 and 10 years were 63% and 54%, respectively. Five patie nts died from disease; four patients had pulmonary metastases while on e had CNS metastasis. Eighty percent of relapses occurred within the f irst 2 years following treatment. Acute and chronic toxicities were li mited, consisting primarily of mucositis and xerostomia. Radiation dos es of 65 Gy or more (p = 0.049) and age greater than 20 years (p = 0.0 05) were positive prognosticators for survival. Adjuvant chemotherapy, race, and sex were not found to be of prognostic value. Disparities i n the distribution of patients with lymphoepithelioma and squamous cel l histologies and the presentation of advanced regional disease preclu ded analysis for prognostic significance of histology and nodal status in this series. Conclusion: The results of the present series compare favorably with those published from other institutions. High doses of radiation and a high systemic failure rate continue to be the fundame ntal obstacles to effective management and enhanced survival for patie nts with nasopharyngeal carcinoma.