NASOPHARYNGEAL CARCINOMA IN CHILDHOOD AND ADOLESCENCE

Background. This study reviews the authors' experience from 1979 throu gh 1996 in the management and outcome of 56 patients with nasopharynge al carcinoma who were under 20 years of age. Procedure. There were 33 males and 23 females, their ages ranging from 7 to 19 years (median: 1 6 years). Forty patients had World Health Organization type III carcin omas, 16 had T4 tumors, 41 had metastatic cervical lymph nodes, and 50 were at stage III or stage IV. Thirty-two patients were treated with radiation therapy alone and 24 with the addition of chemotherapy. Cumu lative radiation dose to the primary tumor ranged from 18 to 70 Cy (me dian: 66 Cy) and radiation dose to metastatic cervical lymph nodes ran ged from 18 to 70 Gy (median: 66 Gy). Results. Followup ranged from 0. 1 to 16.8 years (mean: 9 years). Locoregional tumoral complete respons e was achieved in 49 patients. Locoregional tumoral failure was observ ed in 12 patients and systemic failure in 11. Overall, locoregional fa ilure-free, metastases-free, and disease-free survival rates at 5 year s were 49%, 62%, 79%, and 47%, respectively, for the entire group of p atients, 42%, 61%, 72%, and 42%, respectively, for patients treated wi th radiation therapy alone, and 58%, 63%, 87%, and 54%, respectively, for patients treated with the addition of chemotherapy. Advanced T-sta ge and lower radiation doses worsened locoregional failure-free surviv al, whereas advanced N-stage and exclusion of chemotherapy worsened me tastases-free survival. Conclusions. In children and adolescents with nasopharyngeal carcinoma, radiation therapy alone results in an improv ed locoregional tumoral response rate and a reduced locoregional tumor al failure rate at higher radiation doses, while the addition of chemo therapy results in a reduced systemic failure rate. (C) 1998 Wiley-Lis s, Inc.