Analysis of long-term results and late complications after combination therapy for head and neck malignant tumors in childhood.

Abstract

15 patients with epithelial and 19 patients with nonepithelial malignant tumors in the head and neck, aged less than 18 years, had been treated by combination therapy consisting of chemotherapy, surgery and radiation in our Department for 18 years from 1972 to 1990. Pathological diagnosis of nonepithelial tumors were malignant lymphoma in 6 cases and rhabdomyosarcoma in 5 cases. The most common sites of origin were nasopharynx, nose, paranasal sinuses and oral cavity. Epithelial tumors were found in parotid gland in 5 cases and in nasopharynx in 4 cases. Nine out of 10 patients with epithelial tumors and 7 out of 11 patients with nonepithelial tumors in whom more than 5 years had elapsed after termination of the therapy survived more than 5 years. Survival rates were much higher in childhood patients compared to those of adult patients. The most common late complications of the combined therapy were growth inhibition of the facial bone observed in 2 cases, loss of teeth in one case and orbital atrophy with blindness in one case induced by radiation. Development of secondary cancer was observed in one patient 17 years after surgery and chemotherapy (cyclophosphamide) followed by radiation for extensive neuroblastoma of the neck compressing the upper airway in a new-born infancy. Judging from the results of recently developed superhigh-dose chemotherapy with combination of auto-bone marrow transplantation and also the present data on long-term follow-up of our patients, particularly on late complications induced by radiation, it was assumed that foranaplastic and poorly differentiated malignant tumors of the head and neck in childhood, primary modality of the therapy should be chemotherapy. Importance of planned multidiscipllinary approach on head and neck malignant tumors in childhood was emphasized.