MANAGEMENT OF JUVENILE NASOPHARYNGEAL CARCINOMA IN TUNISIA OVER TIME

Abstract

AOBJECTIVFS: The aim of our study was to analyze the impact of the new imaging techniques as well as the combination of radiotherapy (RT) and chemotherapy (CT) on the diagnostic and therapeutic management of nasopharyngeal cancer (NPC) through a comparative study of epidemiologic, anatomoclinic, therapeutic and evolutive aspects of 316 juvenile NPC over two different periods. METHODES: We compared the results of two retrospective studies on patients younger than 25 years old treated at Salah Azaiz Institute for NPC over different periods: 1969-1979 and 1995-2005. Pretreatment evaluation included conventional X-ray examinations of the nasopharynx in the first study and CT-scan and/or MRI of the nasopharynx in the second study. In the two series, all patients received conventional 2D RT but using two different techniques. For patients treated between 1969 and 1979, CT was indicated only for metastatic or recurrent disease and for those treated between 1995 and 2005; CT was used also for non-metastatic but locally advanced disease. RESULTS: In the first series, 186 cases were registered against 130 in the second one with a male predominance in the two series. Lymph node involvement was frequent in the 2 series (92%) and supraclavicular lymph node, oropharynx and nasal cavity involvement were more common in the first period (1969-1979). According to the 1986 TNM staging system, the JNPC patients treated during the first period presented with less T3-T4 locally advanced tumors than did the JNPC patients treated during the second period (67.2% vs 96.1%). Initially metastatic forms were comparable in the 2 series (4 and 5%). All patients with no metastatic NPC of the first study have received exclusive RT regardless of the disease’s stage. Among the 125 patients with no metastatic NPC of the second study, 86.4% had neoadjuvant CT, 4% had concomitant RT-CT and 9.6% had an exclusive RT. After a complete curative treatment, patients treated between 1969 and 1979 had greater locoregional relapse and distant metastases rates than those treated between 1995 and 2005 (19 and 45% vs 8.8 and 15.2% respectively). The 5-year overall survival (OS) rate was better in the second series (79% vs 42%). CONCLUSION: This comparative study revealed that advances in imagery and radiology techniques as well as the combination of RT and CT have had a significant impact on the success ratio of JNPC treatment by reducing loco-regional and distant relapses over time.