Nasopharyngeal Carcinoma In Children Research Articles

Nasopharyngeal carcinoma in children: a challenging disease in a middle-income country, Tunisia

Background: This study aimed to assess the epidemiological, clinical, and therapeutic aspects and prognosis of juvenile nasopharyngeal carcinoma in Tunis country.
 Materials and Methods: This study included 68 patients, younger than 18 years of age. All the patients had a clinical and para-clinical tumoral assessment. The study of survival and prognostic factors was done after a descriptive analysis. These prognostic factors were studied through uni and multivariate analysis.
 Results: The median age was 14.7 years and the sex ratio was 2 male to 1 female. The average time to first consultation was 4 months. Rhinological signs were the most frequent symptom for consultation (n= 41). The T3-T4 tumors accounted for 78% of patients and there was a lymph node invasion stage N2-N3 in 63% of cases. Non-metastatic patients had radiotherapy associated with chemotherapy in 97% of cases. Metastatic patients received hypofractionated radiotherapy on bone metastasis, and first-line chemotherapy followed by radiotherapy on the primitive tumor and lymph node areas in case of good response to chemotherapy ( n= 2). The mean follow-up was 94 months; 78% of these patients were alive and in complete remission, 19% were in therapeutic failure, and 16% of them had metachronous metastases. The five-year-overall survival was 95%. Hyposialia and skin dystrophy were the most frequent late complications.
 In univariate analyses, significant prognostic factors were cranial nerve invasion, intracranial invasion, and infra-temporal fossa invasion. In multivariate analysis, the most parsimonious model associated extension to the infratemporal fossa, endo-cranial extension, and initial therapeutic modality (treatment failures were less frequent with neoadjuvant chemotherapy (p= 0.22)). 
 Conclusion: Treatment of nasopharyngeal carcinoma in children consists of chemotherapy and radiotherapy. Synchronous or metachronous metastases are common in this patient population. Modern radiotherapy techniques, including conformal radiotherapy with intensity modulation, are promising and could overcome toxicities in long-term survivors.

Nasopharyngeal Carcinoma in Children, Current Treatment Approach.

Nasopharyngeal carcinoma (NPC) is a rare and locally aggressive form of childhood cancer. Treatment of pediatric NPC includes chemotherapy and radiotherapy. Most studies on the treatment of pediatric NPC are single-arm studies. With current treatment protocols survival rates for patients with nonmetastatic disease exceed 80%, although most children will have long-term treatment-related late effects. Efforts to reduce early and late toxicities include reduced radiotherapy doses in children with good responses to induction chemotherapy. Further studies are needed to evaluate the role of immunotherapy in both the primary setting and in children with progressive or relapsed disease. This review summarizes current clinical approaches to the treatment of pediatric NPC.

Paclitaxel liposome, cisplatin and 5-fluorouracil-based induction chemotherapy followed by de-escalated intensity-modulated radiotherapy with concurrent cisplatin in stage IVA–IVB childhood nasopharyngeal carcinoma in endemic area: a phase II, single-arm trial

Previous studies demonstrated that induction chemotherapy (IC) followed by de-escalated chemoradiotherapy adapted to tumor response was effective in treating childhood nasopharyngeal carcinoma (NPC), but the toxicity profile of this treatment strategy, and whether childhood patients with advanced stages can obtain enough benefits from it requires further investigation. We conducted a single-center phase II trial (NCT03020329). All participants received 3 cycles of paclitaxel liposome, cisplatin and 5-fluorouracil (TPF)-based IC. Patients who showed complete or partial response received de-escalated radiotherapy of 60Gy with 3 cycles of concurrent cisplatin, and those who showed stable or progressive disease received standard-dose radiotherapy of 70Gy with concurrent cisplatin. The primary endpoint was the complete response (CR) rate at the end of concurrent chemoradiotherapy (CCRT). From November 2016 to March 2021, 44 patients were recruited in the cohort. The CR rate was 80% (35/44, 95% CI, 65-90) of the whole cohort. All patients achieved CR 3 months after CCRT. By the last follow-up, the 3-year progression-free survival and overall survival were 91% (95% CI, 82-99) and 100% respectively. Dry mouth was the most common late toxicity, with an incidence of 41% (18/44), followed by skin fibrosis and hearing impairment. No patient suffered from severe late toxicity and growth retardation. Our results proved the efficacy and safety of TPF regimen followed by de-escalated radiotherapy with concurrent cisplatin in treating stage IVa-b childhood NPC patients. A full list of funding bodies that contributed to this study can be found in the Acknowledgements section.

Outcome of nasopharyngeal carcinoma (epithelial undifferentiated NOS) in children and adolescents: SEER database analysis.

e22016 Background: Nasopharyngeal carcinoma (NPC) is a rare malignant epithelial tumor of the nasopharynx and account for less than 1% of childhood tumors. Undifferentiated epithelial tumors are one of the commonest histologies. This study aimed to demonstrate the characteristics and outcome of NPC in children and adolescents. Methods: The Surveillance, Epidemiology and End Results database (SEER Research Data 18 Registries Nov 2020Sub (2000-2018)was analyzed for patients diagnosed with carcinoma undifferentiated NOS, NPC ( ICD-O-WHO-3 code 8020). Patients were excluded if the cause of death was not associated with their cancer according to SEER’s cancer-specific death categorization. Overall Survival were estimated using the Kaplan-Meier method, and variables were compared using the log-rank test. P values < .05 were considered significant. Results: A total of 62 patients aged ≤19 years with undifferentiated nasopharyngeal carcinoma were identified. The cohort included 39 (62.9%) males and 23 (37.1%) females .Among them, 40.3 % were white, 40.3% were black,17.7% were Asians/Pacific Islanders, and 1.6% were American Indian. The age of diagnosis distribution included 2 (3.2%)children with 5-9 year, 17 (27.4%) children with 10-14 years and 43(69.4%) children with 15-19 years. With a median follow up of 7.9 years, 3 year OS of the entire cohort was 84.5%. 3 year OS for children aged ≤14 years was 82.1% and for children aged 15-19 years was 85.5% (p- value = 0.649). When stratified by treatment era, the 3-year OS of all patients treated after 2009 was not statistically significant than those treated before (3-year OS, 85.5% vs 82%, P = .0649). Conclusions: Children and adolescents with undifferentiated epithelial neoplasm NOS, NPC had excellent survival. Age and treatment era has no prognostic impact on outcomes.

Ototoxicity in Cisplatin-treated nasopharyngeal carcinoma in children

Ototoxicity in Cisplatin-treated nasopharyngeal carcinoma in children

Advanced stage nasopharyngeal carcinoma in children

<p class="abstract">Nasopharyngeal carcinoma (NPC) is common in adult and elderly population, however, the incidence among children is still very low worldwide. Due to its rarity and non-specific clinical presentation, the diagnosis in children is often delayed and misinterpreted. The difficulty in reaching the final diagnosis was related to its hidden anatomical location, raising challenges in performing endoscopy and biopsy in children to obtain the precise histopathologic feature. We reported two cases on nasopharyngeal carcinoma in children with two different peculiar complaints. The first patient was 12 years old boy who complained of multiple recurrent unilateral masses on the left neck and history of nosebleeds with an unknown history of the previous histopathology features of the neck masses obtained by complete surgical neck mass removal beforehand. The second patient was 15 years old boy with main complaint of chronic headache, accompanied by doubled vision with apparent family history of malignancy, particularly nasopharyngeal carcinoma. Based on the history of illness, physical examination, imaging, and histopathology, we concluded that both patients were diagnosed with advanced stage nasopharyngeal carcinoma with different types of histopathologic feature.</p>

The feasibility of reduced-dose radiotherapy in childhood nasopharyngeal carcinoma with favorable response to neoadjuvant chemotherapy

BackgroundTo assess the feasibility of adjusting radiation dose (RD) in childhood NPC with favorable tumor response after neoadjuvant chemotherapy (NAC). Patients and methodsUsing an NPC-specific database, children and adolescents (≤18 years) with locoregionally advanced NPC (CA-LANPC) were retrospectively analyzed. Enrolled patients were those who received favorable tumor response after 2–4 cycles of NAC followed by concurrent chemoradiotherapy. Survival outcomes and treatment-related toxicities were compared for the standard RD on primary tumors (PT-RDstandard, 66–72 Gy) and the reduced RD on primary tumors (PT-RDreduced, 60–65.9 Gy). ResultsA total of 132 patients were included, and the median follow-up time was 75.2 months (IQR, 53.2–98.7 months) for the entire cohort. The PT-RDreduced group had a significantly decreased incidence of severe mucositis (51.3 % vs 32.1 %; P = 0.034) when compared to the PT-RDstandard group. The total incidence of severe sequela in the PT-RDstandard group were significantly higher than those in the PT-RDreduced group (31.8 % vs 13.7 %; P = 0.029). In the propensity-matched analysis, the PT-RDreduced group resulted in parallel 5-year survival with the PT-RDstandard group from the matched cohort (disease-free survival, 82.7 % vs 80.3 %, P = 0.841; overall survival, 91.7 % vs 91.3 %, P = 0.582; distant metastasis-free survival, 87.5 % vs 82.8 %, P = 0.573; and locoregional relapse-free survival, 95.6 % vs 97.3 %, P = 0.836). In multivariate analysis, the impact of PT-RDreduced on all survival end points remained insignificant. ConclusionsChemoradiotherapy with RD at levels of 60–65.9 Gy may be a reasonable strategy for CA-LANPC with favorable tumor response after NAC.

Retrospective analysis of clinical features and prognosis of nasopharyngeal carcinoma in children and adolescents.

ObjectivesTo investigate the clinical characteristics and prognosis of nasopharyngeal carcinoma (NPC) in children and adolescents in different age groups.Materials and methodsThe clinical data of 51 patients with NPC aged ≤ 18 years who were treated in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2012 to May 2017 were retrospectively analyzed. The patients were divided into children group (≤12 years old) and adolescent group (12–18 years old) with 12 years old as the boundary. The clinical characteristics, diagnosis, treatment, and prognosis of the children and adolescent groups were compared.ResultsThe symptoms of the first diagnosis in the children group were mainly nasal congestion (P = 0.043) and ear symptoms (P = 0.008). The diagnosis rate of nasopharyngeal biopsy in the children group was lower (P = 0.001), while the rate of diagnosis of cervical mass biopsy was significantly higher than that in the adolescent group (P = 0.009). The proportion of keratinizing squamous cell carcinoma of the children group was higher than that of the adolescent group (P = 0.006). There was no significant difference in TNM stage and risk stratification between the two groups, but the number of cases in the III-IVa children group who received induction chemotherapy + concurrent chemoradiotherapy was less than that in the adolescent group (P = 0.013). The proportion of radiotherapy in the upper and lower cervical lymph node drainage areas was lower than that in the adolescent group (P = 0.001). The percentage of recurrence and metastasis in the children group was higher than that in the adolescent group (P = 0.026).ConclusionThe diagnosis in the children group depended on endoscopic biopsy and neck mass biopsy, and the proportion of keratinizing squamous cell carcinoma was higher. The number of cases of induction chemotherapy and concurrent chemoradiotherapy in the children group was less than that in the adolescent group, and the proportion of radiotherapy in the upper and lower cervical lymph node drainage areas was lower than that in the adolescent group. Clinically, it is necessary to improve the understanding of the clinical characteristics of children with NPC and take appropriate treatment strategies.

Nasopharyngeal carcinoma in children and adolescents: a literature review and our own data

Nasopharyngeal carcinoma (NPC) is one of the few epithelial tumors that regularly occur in the pediatric population. The majority of patients with localized and locally advanced NPC can be cured with current treatment protocols which include platinum-based induction therapy followed by chemoradiation therapy. The prognosis of patients with initially metastatic NPC and recurrent disease after prior curative treatment is, however, still unfavorable. Fortunately, new treatment options such as immune checkpoints inhibitors and supportive treatment with oral fluoropyrimidine give hope for better outcomes in these patients as well. It's important to note that the management of NPC diagnosed in adults and children allows for the adaptation of effective treatment approaches for either of the age groups. An analysis of our own data suggests that current treatment protocols for NPC can be successfully adopted by Russian clinics and can help to achieve treatment outcomes comparable to the results obtained in other countries. The purpose of this article is to overview current therapeutic approaches for NPC and possible ways of their improvement based on our own and literature data. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology.

PD-0166 Nasopharyngeal Carcinoma in Children and Adolescents: Result of Patients Treated with 61,2-63 Gy

PD-0166 Nasopharyngeal Carcinoma in Children and Adolescents: Result of Patients Treated with 61,2-63 Gy

The prognostic value of adding systemic inflammation response index to Epstein–Barr virus DNA in childhood nasopharyngeal carcinoma: A real‐world study

To assess the prognostic value of the systemic inflammation response index (SIRI) combined with plasma load of Epstein-Barr virus (EBV) DNA in children and adolescents with locoregionally advanced nasopharyngeal carcinoma (CALANPC). A total of 205 consecutive patients with CALANPC were enrolled. We used recursive partitioning analysis (RPA) to classify patients into various risk groups, with a primary endpoint of overall survival (OS). Elevated SIRI (≥1.53) and EBV DNA (≥4000 copy/ml) were significantly associated with inferior OS in CALANPC. RPA categorized patients into low- and high-risk groups based on prognostic factors. Survival curves showed excellent discrimination in OS (95.3% vs 77.6%; p < 0.001) between the low- and high-risk groups. A significant improvement was confirmed using the prognostic methods for conventional TNM staging systems (p < 0.05). The combination of SIRI with EBV DNA provided a more detailed understanding of patient risks, and enhanced risk discrimination in CALANPC.

Multimodal Treatment of Nasopharyngeal Carcinoma in Children, Adolescents and Young Adults-Extended Follow-Up of the NPC-2003-GPOH Study Cohort and Patients of the Interim Cohort.

Simple SummaryMultimodal treatment of nasopharyngeal carcinoma (NPC) in children and young adults with induction chemotherapy, followed by radiochemotherapy and interferon-β (IFN-β) maintenance, has been successfully applied in studies NPC-91 and NPC-2003 of the German Society of Pediatric Oncology and Hematology (GPOH). We, here, present updated survival rates of the NPC-2003 study cohort after longer follow-up and include 21 additional patients recruited after closure of the study and treated as per the NPC-2003 study protocol (interim cohort) in our survival analysis. Survival rates remain high after extended follow-up and in the larger cohort with EFS and OS of 94% and 97%, respectively, reinforcing the high antitumor efficacy of this multimodal treatment concept. Seven patients with CR after induction therapy received a reduced radiation dose of 54 Gy, and none of them relapsed. Thus, the reduction of radiation dose seems feasible and has the potential to reduce treatment-related late effects in this vulnerable population.Nasopharyngeal carcinoma (NPC) in children and young adults has been treated within two consecutive prospective trials in Germany, the NPC-91 and the NPC-2003 study of the German Society of Pediatric Oncology and Hematology (GPOH). In these studies, multimodal treatment with induction chemotherapy, followed by radio (chemo)therapy and interferon-beta maintenance, yielded promising survival rates even after adapting total radiation doses to tumor response. The outcome of 45 patients in the NPC-2003 study was reassessed after a median follow-up of 85 months. In addition, we analyzed 21 further patients after closure of the NPC-2003 study, recruited between 2011 and 2017, and treated as per the NPC-2003 study protocol. The EFS and OS of 66 patients with locoregionally advanced NPC were 93.6% and 96.7%, respectively, after a median follow-up of 73 months. Seven patients with CR after induction therapy received a reduced radiation dose of 54 Gy; none relapsed. In young patients with advanced locoregional NPC, excellent long-term survival rates can be achieved by multimodal treatment, including interferon-beta. Radiation doses may be reduced in patients with complete remission after induction chemotherapy and may limit radiogenic late effects.

Familial clustering of nasopharyngeal carcinoma in the family of an adolescent with nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is one of the rare malignant diseases of childhood, of which only 1% occurs in children. In recent years, genetic factors have attracted attention in NPC. A very limited data have been reported about clustering within families. Herein, the familial clustering of nasopharyngeal carcinoma in the family of an adolescent with nasopharyngeal carcinoma is presented. There is familial clustering in nasopharyngeal carcinoma (NPC), but our knowledge on this subject is limited, especially in children or adolescent populations. Therefore, we should be more careful in NPC in childhood, especially in first-degree relatives.

Development of a web-based prognostic model to quantify the survival benefit of cumulative cisplatin dose during concurrent chemoradiotherapy in childhood nasopharyngeal carcinoma

PurposeTo quantify and predict the survival benefits of cumulative cisplatin dose during concurrent chemoradiotherapy (CC-CCD) in children and adolescents with locoregionally advanced nasopharyngeal carcinoma (CA-LANPC). Materials and MethodsPatients with CA-LANPC who received first-line neoadjuvant chemotherapy (NAC) followed by concurrent chemoradiotherapy (CCRT) between September 2007 and April 2018 were evaluated. Recursive partitioning analyses (RPAs) helped identify the ideal thresholds of CC-CCD on disease-free survival (DFS). We then developed a web-based predictive model to quantify the survival benefit of CC-CCD for CA-LANPC. ResultsIn total, 139 patients were eligible for the analysis. The median CC-CCD was 162 mg/m2 (IQR, 138–192 mg/m2). The optimum cut-off point of CC-CCD was 160 mg/m2 for DFS. Hence, we selected 160 mg/m2 as the cut-off to classify CA-LANPC into either high or low CC-CCD groups for survival analysis. The 5-year DFS rates were 91.6% in the high (≥160 mg/m2) CC-CCD group and 77.8% in the low (<160 mg/m2) CC-CCD group (P = 0.011). Multivariate analysis indicated CC-CCD (HR, 0.34; 95%CI, 0.13–0.87; P = 0.024), T stage (HR, 3.72; 95%CI, 1.35–10.22; P = 0.011), and EBV DNA (HR, 3.00; 95%CI, 1.00–8.97; P = 0.049) were independent prognostic factors and were incorporated into the prognostic model. N stage was also included due to its clinical importance. The predictive model was demonstrably accurate (C-index, 0.741) when predicting 5-year DFS rates. ConclusionsWe built a predictive model to quantify the survival benefit of CC-CCD for CA-LANPC treated with NAC plus CCRT. This tool may improve individual treatment consultations and facilitate evidence-based decision-making.

Impact of cumulative cisplatin dose in childhood nasopharyngeal carcinoma based on neoadjuvant chemotherapy response in the intensity-modulated radiotherapy era: a real-world study

BackgroundWe aimed to comprehensively investigate the optimal cumulative cisplatin dose during concurrent chemoradiotherapy (CC-CCD) for locoregionally advanced nasopharyngeal carcinoma (CA-LANPC) with different tumor responses after neoadjuvant chemotherapy (NAC).MethodsPatients with CA-LANPC who underwent NAC followed by cisplatin-based concurrent chemoradiotherapy were retrospectively analyzed. Evaluation of tumor response in patients was conducted by Response Evaluation Criteria for Solid Tumor (RECIST) 1.1 after two to four cycles NAC. Multivariate Cox proportional hazards models were used for prognosis. Recursive partitioning analysis (RPA) was conducted to classify participates and predict disease-free survival (DFS).ResultsOne hundred and thirty-two patients with favorable response after NAC were included. The median CC-CCD was 163 mg/m2 (IQR, 145–194 mg/m2), and 160 mg/m2 was selected as the cutoff point to group patients into low and high CC-CCD groups (< 160 vs. ≥ 160 mg/m2). There was significant improvement in 5-year DFS (91.2% vs. 72.6%; P = 0.003) for patients receiving high CC-CCD compared to those receiving low CC-CCD. Multivariate analysis revealed that CC-CCD, T stage, and Epstein–Barr virus (EBV) DNA were independent prognostic factors for DFS (P < 0.05 for all). Patients were further categorized into two prognostic groups by RPA: the low-risk group (T1-3 disease with regardless of EBV DNA, and T4 disease with EBV DNA < 4000 copy/mL), and the high-risk group (T4 disease with EBV DNA ≥ 4000 copy/mL). Significant 5-year DFS improvement was observed for the high-risk group (P = 0.004) with high CC-CCD. However, DFS improvement was relatively insignificant in the low-risk group (P = 0.073).ConclusionsCC-CCD was a positive prognostic factor for responders after NAC in CA-LANPC. Furthermore, CC-CCD ≥ 160 mg/m2 could significantly improve DFS in the high-risk group with CA-LANPC, but the benefit of high CC-CCD in the low-risk group needs further study.

Nasopharyngeal carcinoma in children: Multimodal treatment and long-term outcome of 92 patients in a single center over a 28-year period.

The aim of the study was to evaluate the long-term outcome and late effects in pediatric patients with nasopharyngeal carcinoma (NPC) treated with neoadjuvant chemotherapy (NACT), followed by radiotherapy (RT). Ninety-two children (65 male, 27 female) diagnosed with NPC between 1989 and 2017 in the Istanbul University, Institute of Oncology were evaluated retrospectively. NACT consisted of three cycles of cisplatin-containing regimen every 3weeks, followed by RT. The median age was 13years (5-18years). Most had locoregionally advanced disease (stage III/IVA/IVB) and five had distant metastases at presentation. At a median follow-up of 108 months (3-332months), 5- and 10-year overall survival rates and event-free survival rates were 87.5%, 79.7% and 82.1%, 78.9%, respectively. Three patients with distant metastasis are long-term survivors. Thirteen patients relapsed at a median of 8months (2-23months). Hypothyroidism (36%) and xerostomia (25%) were the most frequent long-term treatment-related toxicities. Nine second malignancies developed in eight patients, eight in the irradiated field at a median of 14years (range 5-26years), five of whom are long-term survivors after curative surgery. Three courses of cisplatin-containing NACT, followed by RT lead to high survival and locoregional control rate in advanced stage NPC in children. Patients with distant metastasis should also be treated with curative intent by systemic chemotherapy and locoregional radiotherapy. Patients should be followed closely for recurrences and long-term morbidities including second malignancies, which may be treated with curative surgeries if diagnosed early.

Parotid carcinoma as a second neoplasm following radiotherapy for a nasopharyngeal carcinoma in childhood

Parotid carcinoma as a second neoplasm following radiotherapy for a nasopharyngeal carcinoma in childhood

Clinicopathological and prognostic features of nasopharyngeal carcinoma in children and adolescents: A retrospective study of 196 cases in South China.

Nasopharyngeal carcinoma (NPC) occurring in children and adolescence is extremely rare and till present there is a lack of understanding on their clinicopathological and prognostic features of this rare entity. For our study, data of 196 cases children and adolescents with NPC from the past 18 years at a high-volume cancer center from South China were retrospectively analyzed. Half of the evaluated NPC patients (83/166, 50.0%) were staged as Stage IVa disease, whereas 1.2% (2/166), 27.7% (46/166), 16.9% (28/166) and 4.2% (7/166) had Stage II, III, IVb and IVc disease, respectively. Serum EBV EA-IgA ≥1:10 and VCA-IgA ≥1:40 were found in 67.7% (113/167) and 76.6% (128/167) of the evaluated patients, respectively, whereas 56.8% (84/148) of the patients had plasma EBV DNA ≥1000 copies/mL. Histologically, all tumors were classified as nonkeratinizing squamous cell carcinoma (NK-SCC). Immunohistochemistrically, the expression of CK (AE1/AE3), P63, CK5/6 and P40 were observed in 100% (88/88), 93.2% (68/73), 84.1% (58/69) and 63.2% (12/19) of the detected cases, respectively. All cases show similar immunophenotype compared to that occurring in adult patients. All evaluated cases (71/71 100%) harbored EBER. Patients with plasma EBV DNA ≥1000 copies/mL and positive serum EBV antibodies had significantly inferior 3-year OS (88% vs 100%, P = .007) compared to other corresponding groups. The combination of EBV serology and plasma EBV DNA are useful to predict the outcome of patients with NPC in children and adolescents.

Neuroimaging Characteristics of Nasopharyngeal Carcinoma in Children.

Pediatric nasopharyngeal carcinoma (NPC) is a rare epithelial origin tumor associated with undifferentiated histology, Epstein-Barr virus (EBV) infection, and genetic risk factors. Childhood NPC is usually clinically silent, often presenting with advanced locoregional compromise, including skull base invasion and cervical lymphadenopathy, and has a better prognosis than adult NPC. This article describes computed tomography (CT) and magnetic resonance imaging (MRI) features in a cohort of 28 pediatric NPC patients. A retrospective review was performed among children with histopathology proven NPC diagnoses between 1996 and 2019 for this study. The electronic medical records were reviewed to determine demographics, EBV serology, and World Health Organization (WHO) type. Nasopharyngeal CT and/or MRI at presentation for tumor spread as well as density and/or intensity, lymphadenopathy, postcontrast enhancement and diffusion characteristics before treatment were evaluated. Twenty-eight patients (21 males, 7 females) were included. The mean patient age at diagnosis was 13.3 (range 7 to 17) years. EBV was positive in 71.4% of patients. The majority of patients (78.6%) had a WHO type III tumor, unilateral fossa of Rosenmuller involvement (71.4%). Neuroimaging features were CT isodensity, T1-isointensity, T2-hyperintensity, and heterogeneous postcontrast enhancement for all patients (100%) and restricted diffusion (90%). Although uncommon in pediatric patients, NPC should be in the differential diagnosis of adolescents presenting with a nasopharyngeal mass. Recognizing key imaging characteristics is helpful in the diagnosis of NPC.

CHARACTERISTICS OF NASOPHARYNGEAL CARSINOMA IN CHILDREN AND ADOLESCENTS IN DR. ZAINOEL ABIDIN GENERAL HOSPITAL BANDA ACEH

Introduction:&#x0D; Nasopharyngeal Carcinoma (NPC) is a malignant tumor arising from epithelial cells that cover the nasopharynx. NPC is a rare malignancy in children. The incidence of NPC varies by age, geographical and ethnic factors which indicate both genetic and environmental factors contribute to the tumor growth. NPC in children has several features different from adults.&#x0D; Objective:&#x0D; To assess characteristics of nasopharyngeal carcinoma in children and adolescents in dr. Zainoel Abidin general hospital Banda Aceh from 2014-2019.&#x0D; Methods:&#x0D; The study was conducted in dr. Zainoel Abidin general hospital Banda Aceh. This study is a descriptive with cross sectional retrospective design. The data collected from medical records of patients diagnosed with nasopharyngeal carcinoma from January 2014-September 2019. The variable including regional distribution, gender, age (between 0-25 years), histopathologic types, stage and chemotherapy regimen used. The sampling was done by total sampling method.&#x0D; Results: The result showed that there was 17 patients of nasopharyngeal carcinoma in children and adolescents with the highest case came from Bireuen and North Aceh district 3 (17.7%) patients, respectively. South Aceh and West Aceh distric 2 (11.8%) patients, respectively. Nasopharyngeal carcinoma mostly infected 9 (53%) male patients than 8 (47%) female with a sex ratio of 1.1 : 1. The age most affected is at the end of childhood between 17-25 years had 9 (53%) patients and between 12-16 years had 8 (47%) patients with the average age range was 17.2 years (range 13-22 years). Most of histopathologic types had found in the type of undifferentiated carcinoma (WHO type III) as many as 7 (41.1%) patients with stage IV being the most frequent 9 (53%) patients. The most widely used chemotherapy regimen is a combination of Cisplatin and Docetaxel with 10 (62.5%) patients.&#x0D; Conclusion:&#x0D; Nasopharyngeal carcinoma in children generally occur at the end of childhood with the most common type of undifferentiated carcinoma (WHO type III) and stage IV which associated with advanced locoregional disease and higher rates of distant metastasis.