Purpose: Nasopharynx cancer is a rare malignancy in childhood. This study a
ims to determine the role of chemotherapy, the optimal dose of radiation, a
nd the long-term outcome for children with locoregional disease.
Methods and Materials: Thirty-three patients [median age 14 (range: 12-20)
years] were treated for Stage I-IVB nasopharynx cancer. Thirteen patients (
39%) received radiotherapy alone and 20 patients (61%) had chemotherapy and
radiotherapy. The median radiation dose to the primary tumor was 66 Gy (ra
nge: 54-72 Gy). The median follow-up time for surviving patients was 8.4 ye
ars (range: 0.5-23.6 years).
Results: The actuarial 10-year locoregional relapse-free survival, distant
metastases-free survival, and overall survival rates were 77%, 68%, and 58%
, respectively. Locoregional control was improved for patients treated with
radiation doses >60 Gy compared to those receiving less than or equal to 6
0 Gy (93% vs. 60%, p < 0.03). The addition of chemotherapy had no significa
nt effect on locoregional control but did reduce the development of distant
metastases (16% vs. 57%, p = 0.01). Combined modality therapy improved 10-
year disease-free survival (84% vs. 35%, p < 0.01) and survival (78% vs. 33
%, p < 0.05) over radiation alone. The 10-year actuarial rate of severe com
plications was 24%.
Conclusions: Excellent locoregional control is achieved with radiotherapy t
o the nasopharynx and neck when doses >60 Gy are used for gross disease. Th
e addition of chemotherapy decreases the risk of distant metastases and inc
reases survival. (C) 2000 Elsevier Science Inc.