Nasopharyngeal carcinoma in childhood and adolescence - A single-institution experience with combined therapy

BACKGROUND. A high cure rate may be attained for locally advanced, undiffer entiated nasopharpngeal carcinoma (NPC) in children, provided that a combin ed modality of treatment is employed. Both local and systemic therapies are necessary. Results at a single pediatric institution were analyzed. METHODS. From November 1988 to December 1997, 16 consecutive patients were treated with NPC at the Hospital Garrahan in Buenos Aires, Argentina. The a uthors were able to evaluate 11 patients (9 boys and 2 girls); their median age was 12 (range, 8-14) years. Chemotherapy consisted of 3 courses, every 3 weeks, of 5-fluorouracil (500 mg/m(2)) plus bleomycin (15 mg/m(2)) daily for 4 days, with cisplatin (100 mg/m(2)) added the last day. External beam radiotherapy was delivered over a median of 52 (range, 45-63) days, to a m edian cumulative dose to the primary site of 55 (range, 50- 61.2) grays (Gy ). The median dose for the lower neck area was 45 (range, 45-55.8) Gy. All patients received radiotherapy to the primary site and to the initially inv olved lymphoid areas, with daily single doses of 1.8 Gy (5 of 7 days per we ek). RESULTS. The main symptoms at onset were cervical mass (100%), epistaxis (5 4%), cephalalgia (36%), and trismus (36%). All cases were Stage IV (America n Joint Committee on Cancer and International Union Against Cancer TNM syst em). Complete response was achieved in 45% of patients after initial chemot herapy. With a median follow-up of 63 (range, 23-119) months, disease free survival (with standard error [SE]) and overall survival estimates were 61% (16%) and 91% (9%), respectively, at 75 months. Acute toxicity due to ther apy was tolerable. Chronic sinusitis (73%), hypothyroidism (73%), and mild (64%) or moderate (9%) neck fibrosis were detected at follow-up. CONCLUSIONS. Although this series is small, the authors concluded that NPC patients have a good chance of survival in the setting described, in spite of locally advanced disease. Chemotherapy might be useful in preventing the development of systemic metastases. (C) 2000 American Cancer Society.