NASOPHARYNGEAL CARCINOMA IN CHILDHOOD AND ADOLESCENCE - CONCEPT AND PRELIMINARY-RESULTS OF THE COOPERATIVE GPOH STUDY NPC-91

BACKGROUND. The increasing use of chemotherapy has improved the progno sis of patients with nasopharyngeal carcinoma (NPC), and the authors d emonstrated the beneficial effect of adjuvant interferon (IFN)-beta in a previous pilot study of children with advanced stage NPC. The curre nt multi-institutional, cooperative GPOH (Gesellschaft fur Padiatrisch e Onkologie und Hamatologie) study NPC-91 was begun in 1992 to determi ne the efficacy of preradiation chemotherapy, radiotherapy, and adjuva nt IFN-beta in the treatment of advanced stage NPC. METHODS. Of a tota l of 22 patients, 21 had American Joint Committee on Cancer Stage III or TV disease, and 1 had Stage II disease. The median age was 12 years (range, 8-16 years). Twenty of 22 received 3 courses of preradiation chemotherapy consisting of methotrexate 120 mg/m(2) on Day 1, cisplati n 100 mg/m(2) on Day 1, and 5-fluorouracil 1000 mg/m(2) for five days as well as 6 doses of leucovorin 25 mg/m(2) every six hours beginning on Day 2. The Stage II patient received no chemotherapy, and chemother apy was terminated for another during the first course. AU patients ha d radiation therapy, stratified by stage. The cumulative dose to the p rimary sites was 59.4 gray (Gy), with single doses of 1.8 Gy. A total of 45 Gy was delivered to the neck area. Finally, all patients were tr eated with recombinant IFN-beta (10(5) U per kg of body weight) 3 time s a week for 6 months. RESULTS. The response rate was 91%. These patie nts stayed in first remission during a median follow-up of 32 months. With the exception of one reversible cardiotoxicity, moderate chemothe rapy-related toxicity was observed. CONCLUSIONS. In this study, patien ts with advanced stage NPC had a good prognosis with treatment consist ing of neoadjuvant cisplatin and 5-fluorouracil, radiotherapy, and adj uvant IFN-beta. It is particularly noteworthy that distant metastases did not develop. (C) 1997 American Cancer Society.