Favorable outcome in treating pediatric and adolescent patients with locally advanced nasopharyngeal cancer.

Abstract

e20004 Background: Nasopharyngeal carcinoma (NPC) is extremely rare in pediatric population. Survival of patient with early lesions is excellent with local control rate of 80%. Prognosis of patients with advanced lesions when treated with Radiotherapy (RT) alone is less favorable. Methods: Objectives: To retrospectively review outcome of all registered children and adolescent (20 year or less) with locally advanced NPC (LANPC) at our institution. January 2002 to December 2008, nine patients with LANPC were identified. Three pediatrics and 6 adolescents. Tumors classified according to the AJCC (TNM) 6th edition staging system. Pediatric patients received Induction Chemotherapy (IC) using cisplatin and 5-fluorouracil (5-FU) for 3 to 6 cycles. Adolescent patients were treated with IC consisting of Docetaxel, cisplatin, and 5-FU for 3 cycles. Seven patients received conventionally fractionated RT (median dose 6,600 cGy in 35 fractions) with concomitant chemotherapy using cisplatin or Carboplatin. The remaining two patients received hyperfractionated RT with concomitant Cisplatin. RT was delivered with 3-D conformal technique in all patients. Results: Median age of the whole group was 16 (range 7-20). Male to female ratio 2:1. All pediatric patients (3) had stage IVA. Adolescent patients, 2 had stage IVA, 2 stage IVB, and 2 had stage III. Eight patients (88%) had Undifferentiated Carcinoma (WHO type III) and one patient (12%) had nonkeratinizing squamous cell carcinoma (WHO type II). Median follow-up of 66 month, overall survival was 100%; event-free survival was 88%. One pediatric patient treated with low dose hyperfractionated RT (6,000 cGy in 50 fractions twice-a-day) for close proximity of optic pathway, developed local recurrence 10 month following RT. For 13 months, he showed favorable response to salvage therapy including gemcitabine and docetaxel. Conclusions: LANPC in children and adolescents has favorable outcome when treated with a combination of chemotherapy and radiotherapy. Future development must focus on reducing acute and late treatment morbidity while maintaining efficacy. Patients with complete response to IC might benefit from reduced doses of Intensity Modulated RT (IMRT).