Comparing the outcome of nasopharyngeal carcinoma in paediatrics and adolescents treated with neoadjuvant chemotherapy followed by radiotherapy versus concomitant chemoradiotherapy.

Abstract

e17008 Background: The optimal treatment of pediatrics and young adolescents with nasopharyngeal carcinoma (NPC) is not clearly addressed in large clinical trials. Systemic failure remains the problem. Our aim is to analyze the profile and treatment outcome of NPC in this age group in Kuwait, and whether the change of practice from neoadjuvant to concomitant chemoradiotherapy (CRT) has an impact on outcome, particularly distant metastasis. Methods: Between 2002-2010, 7 NPC patients aged </=20 years (mean age 16.7 years, SD 3.5) were treated in our institution with concomitant CRT. They represented 4.5% of all NPC cases seen during that time. We analyzed the profile and treatment outcome of that patient cohort, and compared it to our previous results published in 2002, who were treated with neoadjuvant chemotherapy (CTH) followed by radiotherapy (RT). Results: 6 patients were females, and 1 male. All patients had locoregional advanced disease. The median follow-up was 81 ms (r = 25-125 ms). 6 patients (86%) were treated with upfront CRT. Only 1 patient had neoadjuvant CTH followed by CRT. 4 patients had hyperfractionated radiotherapy (RT). The median dose of RT was 70 Gy (r = 66-75.6 Gy). G 3 acute toxicity were as follows. Hematological and skin 29%, mucositis 71%. 57% of patients >10% weight loss. No G 4 acute toxicity was recorded. All patient developed delayed G 2 hypothyroidism, and most developed significant subcutaneous fibrosis. All patient achieved locoregional CR. The only patient that developed distant metastasis was the one who could not tolerate CTH even as adjuvant due to prolonged neutropenia. All patients were alive at time of analysis. Comparing these results to our previous report which included patients between 1991-2001, the general profile of the patients seems to be the same. However, in the former patient cohort, 50% died within the same follow-up period due to distant metastasis. Conclusions: It seems that adoption of concomitant rather than neoadjuvant CTH, and modern RT techniques rather than conventional methods may have an impact on reducing distant metastasis. However, large patient cohort is needed to validate such finding.