Pediatric Nasopharyngeal Carcinoma Research Articles

Plasma Epstein-Barr Viral Deoxyribonucleic Acid Predicts Worse Outcomes in Pediatric Nonmetastatic Nasopharyngeal Carcinoma Patients: An Observational Study of 89 Cases in an Endemic Area.

To evaluate the clinical significance of pretreatment levels of plasma Epstein-Barr virus DNA (pEBV DNA) on prognoses in pediatric nasopharyngeal carcinoma (NPC) patients. Eighty-nine patients aged 21 years old or younger with nonmetastatic NPC were evaluated to determine the effect of pEBV DNA levels on progression-free survival (PFS), distant metastasis-free survival (DMFS), and overall survival (OS). Survival probabilities in patient groups that were segregated by clinical stage or pEBV DNA load (low or high) were compared. The median pretreatment concentrations of pEBV DNA were 3440 copies/mL in 35 patients with stage III disease and 14,900 copies/mL in 50 patients with stage IV disease (P = 0.059). The median concentration of pEBV DNA was 34,500 copies/mL in 17 patients with relapse, which was higher than the concentration in 72 patients without relapse, who had a median level of 4985 copies/mL (P = 0.057). Further study showed that pretreatment pEBV DNA load was an independent prognostic indicator in pediatric NPC patients. High pEBV DNA was associated with adverse clinical outcomes, including PFS [3-year PFS rate = 80.5% versus 95.8%, hazard ratio (HR) = 5.00, 95% confidence interval (CI) = 1.00-25.00; P = 0.050], DMFS (3-year DMFS rate = 80.5% versus 95.8%, HR = 5.20, 95% CI = 1.04-26.00; P = 0.045), and OS (3-year OS rate = 82.9% versus 95.8%, HR = 5.41, 95% CI = 1.08-27.22; P = 0.040). Pretreatment pEBV DNA load was an independent prognostic indicator for PFS, DMFS, and OS in pediatric patients with NPC. Prospective studies, however, are needed to validate these results.

Treatment results of pediatric nasopharyngeal carcinoma, NCI, Cairo University experience

BackgroundInvestigate treatment outcome, prognostic factors and survival among selected group of Egyptian pediatric nasopharyngeal carcinoma patients. Patients and methodsThirty patients treated from non-metastatic nasopharyngeal carcinoma between 1997 and 2012 were retrospectively evaluated including: TNM staging, chemo-radiotherapy regimens. Survival analysis was done using Kaplan–Meier survival curves. ResultsTwenty-three males and 7 females (M:F 3.2:1) with median age of 14years; 84% with stages III/IV. Neck node enlargement was reported in 90% (27/30). Induction chemotherapy followed by radiotherapy was implemented in 80% of patients. Mucositis (87%) was the commonest treatment related toxicity. Nineteen patients (63%) were in CR with a median FU of 69months (range 24–160). Eleven patients had treatment local and distant failures (2 local, 7 distant and 2 local/distant) at a median FU of 24 and 34months respectively.5-year overall and event-free survival rates were 77% and 63% respectively. Prolonged OAP of RT⩾50days, Hb<11g% and T4 stage affected EFS and OAS on UVA; while on MVA; prolonged OAP of RT⩾50days (p=0.002) and T4 stage (p=0.004) affected EFS and only Hb<11g% (p=0.019) affected OAS. Late toxicity was reported in 70% of irradiated patients. ConclusionRadio-chemotherapy management for pediatric NPC resulted in comparable treatment outcomes with tolerable late effects. Response adapted radio-chemotherapy regimens in addition to the potential use of IMRT should be recommended to decrease treatment related side effects. Prolonged OAP of RT⩾50days and low Hb level were encountered as adverse prognostic factors; findings that need further investigation.

Clinical and prognostic analysis in 32 pediatric nasopharyngeal carcinoma.

To analyze the clinical outcome and prognostic factors of pediatric nasopharyngeal carcinomas, provide the basis for the rational treatment, and improve the cure rate. Thirty-two pediatric nasopharyngeal carcinoma patients with pathologically confirmed diagnosis and aged from 11 to 18 years old were retrospectively analyzed. All patients received intensity-modulated radiation therapy, dose of GTVnx 6400-7425 cGy, PGTVnx 6400-7050 cGy, PTV 15,400-6000 cGy, PTV 25,000-5490 cGy, and GTVnd 6000-6996 cGy were given. Among these patients, 29 received various chemotherapies. The Kaplan-Meier test and log-rank test of SPSS 17.0 statistic software package were used to calculate survival rate, compare and analyze the survival rates of each group. Cox model was used to analyzing the prognosis factors. In this study, the median survival time was 44.5 months, and the median follow-up time is 62.5 months. The 1-, 3-, and 5-year overall survival rates were 100.0%, 93.2%, 85.7%, respectively, in stage III, and 94.8%, 88.3%, and 64.7% in stage IV. All patients 1-, 3-, and 5-year overall survival rates were 97.2%, 90.5%, and 74.2%. Univariate analysis resulted that N stage (P = 0.043), chemotherapy (P = 0.003) and the radiotherapy dose (P = 0.028) were significant factors for survival. On multivariate analysis, only the N stage influence survival. In pediatric nasopharyngeal carcinoma, the more important prognostic factors are N stage, chemotherapy, radiotherapy dose. Patients with N2-3 should be treated with combined chemotherapy and radiotherapy.

Leukemoid reaction associated with pediatric nasopharyngeal carcinoma: An unusual presentation

Nasopharyngeal carcinoma is a tumor originating from the surface epithelial cells of nasopharynx. It is rare in children and adolescents. Most common physical finding is a neck mass. Most children with nasopharyngeal carcinoma present with advanced stage disease. The presentation with hematological abnormalities in patients without systemic metastasis is extremely rare. We reported a 14-year-old boy presenting with a mass at the right side of the pharynx and leukemoid reaction. To our knowledge, this is the first report of leukemoid reaction associated with pediatric nasopharyngeal carcinoma in English literature.

Long-term outcome and late toxicities of simultaneous integrated boost-intensity modulated radiotherapy in pediatric and adolescent nasopharyngeal carcinoma

The application of simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in pediatric and adolescent nasopharyngeal carcinoma (NPC) is underevaluated. This study aimed to evaluate long-term outcome and late toxicities in pediatric and adolescent NPC after SIB-IMRT combined with chemotherapy. Thirty-four patients (aged 8–20 years) with histologically proven, non-disseminated NPC treated with SIB-IMRT were enrolled in this retrospective study. The disease stage distribution was as follows: stage I, 1 (2.9%); stage III, 14 (41.2%); and stage IV, 19 (55.9%). All patients underwent SIB-IMRT and 30 patients also underwent cisplatin-based chemotherapy. The prescribed dose of IMRT was 64–68 Gy in 29–31 fractions to the nasopharyngeal gross target volume. Within the median follow-up of 52 months (range, 9–111 months), 1 patient (2.9%) experienced local recurrence and 4 (11.8%) developed distant metastasis (to the lung in 3 cases and to multiple organs in 1 case). Four patients (11.8%) died due to recurrence or metastasis. The 5-year locoregional relapse–free survival, distant metastasis–free survival, disease-free survival, and overall survival rates were 97.1%, 88.2%, 85.3%, and 88.2%, respectively. The most common acute toxicities were grades 3–4 hematologic toxicities and stomatitis. Of the 24 patients who survived for more than 2 years, 16 (66.7%) and 15 (62.5%) developed grades 1–2 xerostomia and ototoxicity, respectively. Two patients (8.3%) developed grade 3 ototoxicity; no grade 4 toxicities were observed. SIB-IMRT combined with chemotherapy achieves excellent long-term locoregional control in pediatric and adolescent NPC, with mild incidence of late toxicities. Distant metastasis is the predominant mode of failure.

Prognostic factors and long‐term outcomes of nasopharyngeal carcinoma in children and adolescents

Nasopharyngeal carcinoma (NPC) is a rare malignancy in children and adolescents, and the optimal treatment modality in youths has not been established. The aim of this study was to evaluate the long-term treatment outcomes and complications associated with childhood and adolescent NPC. From January 1985 to December 2004, the records of 95 patients with NPC and younger than 20 years of age were reviewed. All of the records were confirmed based on pathology via biopsy. The radiation doses to the primary tumors ranged from 64 to 80 Gy. The radiation doses to the metastatic cervical lymph nodes ranged from 60 to 74 Gy. The fractionated doses ranged from 1.8 to 2.0 Gy at 5 fractions/week. A total of 36 patients received chemotherapy before radiotherapy. The 1-, 3-, 5-, 10-, and 15-year overall survival (OS) rates were 92.6%, 63.2%, 54.7%, 46.8%, and 42.6%, respectively. The 1-, 3-, 5-, 10-, and 15-year disease-free survival (DFS) rates were 73.7%, 51.3%, 49.1%, 44.6%, and 42.6%, respectively. The clinical stage had a significant impact on OS (P = 0.007) and DFS (P = 0.012). Complete responders to therapy had superior OS (P < 0.001) and DFS (P < 0.001). Patients >12 years of age had better OS (P = 0.026) and DFS (P = 0.037). Children and adolescents with advanced NPC had a relatively good rate of long-term survival. However, 28% of the survivors had serious long-term treatment-related morbidities. In addition to clinical stage and complete response or partial response, age was an independent prognostic factor in pediatric and adolescent NPC.

The Rare Cancer Network: Achievements from 1993 to 2012

The Rare Cancer Network (RCN), founded in 1993, performs research involving rare tumors that are not common enough to be the focus of prospective study. Over 55 studies have either been completed or are in progress.The aim of the paper is to present an overview of the 30 studies done through the RCN to date, organized by disease site. Five studies focus on breast pathology, including sarcoma, lymphoma, phyllodes tumor, adenoid cystic carcinoma, and ductal carcinoma in situ in young women. Three studies on prostate cancer address prostatic small cell carcinoma and adenocarcinoma of young and elderly patients. Six studies on head and neck cancers include orbital and intraocular lymphoma, mucosal melanoma, pediatric nasopharyngeal carcinoma, olfactory neuroblastoma, and mucosa-associated lymphoid tissue lymphoma of the salivary glands. There were 4 central nervous system studies on patients with cerebellar glioblastoma multiforme, atypical and malignant meningioma, spinal epidural lymphoma and myxopapillary ependymoma. Outside of these disease sites, there is a wide variety of other studies on tumors ranging from uterine leiomyosarcoma to giant cell tumors of the bone. The studies done by the RCN represent a wide range of rare pathologies that were previously only studied in small series or case reports. With further growth of the RCN and collaboration between members our ability to analyze rare tumors will increase and result in better understanding of their behavior and ultimately help direct research that may improve patient outcomes.

PET/CT for staging and follow-up of pediatric nasopharyngeal carcinoma

While FDG PET/CT for the evaluation of nasopharyngeal carcinoma (NPC) in adult patients has documented advantages and disadvantages compared with conventional imaging, to our knowledge, no studies of FDG PET/CT for the evaluation of NPC in pediatric patients have been performed. In this investigation, we studied the utility of FDG PET/CT in children with NPC. The study group comprised 18 children with biopsy-proven NPC who underwent FDG PET/CT and MRI (total 38 pairs of images). All baseline and follow-up FDG PET/CT and MRI studies were independently reviewed for restaging of disease. The concordance between FDG PET/CT and MRI in T, N, and overall staging was 29%, 64%, and 43%, respectively. Compared with MRI, FDG PET/CT yielded lower T and overall staging and showed less cervical and retropharyngeal lymphadenopathy. The concordance between follow-up FDG PET/CT and MRI was 79% overall and 100% 9 months after therapy. In patients who achieved complete remission, FDG PET/CT showed disease clearance 3-6 months earlier than MRI. There were no false-positive or false-negative FDG PET/CT scans during follow-up. FDG PET/CT may underestimate tumor extent and regional lymphadenopathy compared with MRI at the time of diagnosis, but it helps to detect metastases and clarify ambiguous findings. FDG PET/CT is sensitive and specific for follow-up and enables earlier determination of disease remission. FDG PET/CT is a valuable imaging modality for the evaluation and monitoring of NPC in pediatric patients.

A prospective protocol for nasopharyngeal carcinoma in children and adolescents

Nasopharyngeal carcinoma (NPC) is very rare in childhood. It differs from its adult counterpart in the prevalence of the nonkeratinizing, undifferentiated subtype and by an advanced clinical stage at onset and better chances of survival. The risk of long-term treatment-related toxicity also may be a more important issue in younger individuals. A prospective chemoradiotherapy protocol for pediatric NPC was started in Italy in 2000 within the framework of the Rare Tumors in Pediatric Age (TREP) project. Three courses of cisplatin/5-fluorouracil induction chemotherapy were followed by radiotherapy (doses up to 65 grays) with concomitant cisplatin. Forty-six patients (ages 9-17 years) were considered eligible for the study over a 10-year period. The ratio of observed to expected cases based on epidemiological data was approximately 1 for both children and adolescents. All but 1 patient had lymph node involvement, and 5 patients had distant metastases. The rate of response to primary chemotherapy was 90%. The 5-year overall and progression-free survival rates were 80.9% and 79.3%, respectively (median follow-up, 62 months). The only statistically significant prognostic variable was the presence or absence of distant metastases. A 65% incidence of late sequelae was reported. This study demonstrates the feasibility and efficacy of a prospective protocol even for such rare tumors as pediatric NPC. The use of lower radiotherapy doses than those used in adults did not affect locoregional failure rates. Long-term follow-up will be needed to obtain more information on both survival and treatment sequelae. The next objective will be to establish broader, international prospective cooperation schemes.

A Case of Pediatric Nasopharyngeal Carcinoma Treated by Induction Chemotherapy and IMRT

Nasopharyngeal carcinoma in children is rare, and treatment lies mainly in chemotherapy and radiation due to the complexity of nasopharyngeal anatomy. We report a case of pediatric nasopharyngeal carcinoma treated by induction chemotherapy followed by IMRT and adjuvant chemotherapy. An 11-year-old boy was diagnosed with nasopharyngeal carcinoma. We planned the following treatment; initial induction chemotherapy with CDDP and 5FU to reduce the tumor volume as much as possible, then radiation therapy using IMRT to spare parotid gland function and reduce the adverse effects of radiation therapy. Finally, adjuvant chemotherapy was administered 4 times. There are no signs of recurrence 26 months after completion of therapy and no complaints of thirst.

Nasopharyngeal carcinoma with splenic and cystic liver metastases in a pediatric patient: 18F-FDG PET-CT findings

Pediatric nasopharyngeal carcinoma (NPC) is rare and usually poorly differentiated. We report a 14-year-old boy with NPC with metastases to liver, spleen, lymph nodes and bone marrow. The liver metastases closely resembled benign cystic liver disease on imaging; however, they showed intense uptake similar to other metastatic sites on positron emission tomography (PET) scan. A liver biopsy could not be performed on the boy. The boy responded clinically to platinum-based chemotherapy, and all the baseline PET-positive lesions became negative. This case highlights the rarity of splenic and cystic liver metastases in pediatric NPC and demonstrates the potential use of PET/CT in diagnosis, staging and response assessment in metastatic pediatric NPC.

Le cancer du cavum de l’enfant et l’adulte jeune : aspects anatomocliniques, thérapeutiques et particularités évolutives

Purpose We retrospectively analyzed anatomoclinic, therapeutic and evolutive particularities of 74 young patients (≤ 20 years) with nasopharyngeal carcinoma treated between 1993 and 2005. Patients and methods Initial work-up included a fiberoptic nasofibroscopy with biopsy, tomodensitometry and/or MRI of nasopharynx and neck, chest X-ray, abdominal ultrasonography and bone scan. Patients were treated with either primary chemotherapy (epirubicin and cisplatin) followed by radiotherapy or concomitant radiochemotherapy (five fluorouracil and cisplatin). Radiotherapy was delivered to a total dose of 70 to 75 Gy to nasopharynx and involved cervical lymph nodes and 50 Gy to the remainder cervical areas. Results The median age was 16 years. Sixty-three percent of patients had undifferentiated tumors. Sixty-six percent had locally advanced tumor. With a median follow-up of 107 months, one patient presented a local relapse, 24 patients developed distant metastases with a median delay of 7 months. The 5 years overall survival and disease-free survival were 66 and 65 %. Late complications were dominated by dry mouth and endocrine disorders. Comments Pediatric nasopharyngeal carcinoma is characterized by an early metastatic diffusion. Local control is excellent but with severe late toxicities. New techniques of radiotherapy and new molecules of chemotherapy could improve these results.

Evolution of Combined Chemotherapy and Radiation for Pediatric Nasopharyngeal Carcinoma from Conventional 2-Dimensional Techniques to Intensity Modulated Radiation Therapy (IMRT): A 30-Year Experience from a Single Institution

Evolution of Combined Chemotherapy and Radiation for Pediatric Nasopharyngeal Carcinoma from Conventional 2-Dimensional Techniques to Intensity Modulated Radiation Therapy (IMRT): A 30-Year Experience from a Single Institution

Nasopharyngeal carcinoma in adolescents: a retrospective review of 42 patients

The aim of the present study was to evaluate the characteristics and outcome of adolescent patients with nasopharyngeal carcinoma (NPC) disease. The study concerned 46 pediatric NPC patients treated during the period 1999-2002 at the National Institute of Oncology, Rabat. The median age of the patients was 16 years. The male/female ratio was 2.8/1. Histologically, all patients had undifferentiated carcinoma. A total of 93% presented nodal metastasis. Four (9%) had distant metastasis. All patients received neoadjuvant multiagent chemotherapy containing cisplatin, followed by radiotherapy. Kaplan-Meier curves were used to evaluate prognostic factors. The log-rank test was used to evaluate the differences between the groups. While none of the patients had locoregional failure, nine patients (29%) developed distant metastasis. The disease-free survival and overall survival (OS) rate for the entire group were 73 and 41%, respectively. Responders to chemotherapy had superior OS (P < 0.001). We suggest that combined modality management using multi-agent chemotherapy and RT as an effective treatment of NPC disease which will achieve satisfactory locoregional control and OS of NPC pediatric patients. Response to chemotherapy was an important prognostic factor.

Two Cases of Pediatric Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma (NPC) is one of the infrequently occurring malignant tumors in childhood. It is different from the adult form of the disease by its close association with EpsteinBarr virus infection, lymphoepithelial histology, and the high incidence of locoregional advancement of the disease. However, these tumors are associated with higher cure rates as they are very sensitive to radiation. We report two cases of pediatric nasopharyngeal carcinoma with locoregional advancement. Korean J Otorhinolaryngol-Head Neck Surg 2009;52:845-8 Key WordsZZPediatrics·Nasopharyngeal carcinoma.

若年者上咽頭癌６例の検討

Six cases of nasopharyngeal carcinoma involving patients under 30 years old treated in our department were clinically evaluated. The ages of the cases ranged from 14 to 29 years old (median: 19 years old). Four cases (67%) were male and 2 (33%) were female. Histopathologically, 5 cases (83%) were poorly differentiated squamous cell carcinoma (SCC), and a single case (17%) was adenocarcinoma. Chief complaints were hearing loss in 4 cases (67%), cervical swelling in one case (17%), and nasal obstruction in one (17%). The clinical stage was Stage I in the adenocarcinoma case, Stage IVA in 4 SCC cases, and Stage IVB in the remaining SCC case. SCC cases were treated by concurrent chemoradiotherapy followed by adjuvant chemotherapy. The adenocarcinoma case was treated by transpalatal resection followed by postoperative radiotherapy. Since the most common chief complaints were ear symptoms, observation of the nasopharynx should be performed for otitis media with effusion patients, even when the patient is young. For squamous cell carcinoma of the juvenile nasopharynx, aggressive chemoradiotherapy similar to the treatment strategy for older patients was considered to result in a favorable prognosis. For adenocarcinoma arising in the posterior wall of the nasopharynx, surgical resection followed by postoperative radiotherapy was considered to be an appropriate treatment strategy. In the treatment of pediatric nasopharyngeal carcinoma cases, motivation to perform the complicated treatment in cooperation with the department of pediatrics seemed to be important.

Whole-tumor-antigen-pulsed dendritic cells elicit cytotoxic T-cell response against pediatric nasopharyngeal carcinoma in vitro

Nasopharyngeal carcinoma (NPC) is endemic in Southeast Asia. Although dendritic cell (DC)-based vaccine has emerged as a promising immunotherapy for various malignancies, its use in pediatric nasopharyngeal carcinoma (PNPC) has not been addressed. In this study, DCs isolated from peripheral blood monocytes of three pediatric patients with advanced (stage IV) NPC were incubated with whole-tumor-antigen preparations and differentiated into immature DCs in the presence of granulocyte-macrophage colony-stimulating factor and interleukin-4, and then underwent maturation when exposed to tumor necrosis factor-alpha. Upon maturation, DCs acquired the ability to stimulate T-cell proliferation as examined by [(3)H]-thymidine incorporation and the ability of these T-cells to secrete interferon-gamma as determined by enzyme-linked immunosorbent spot assay. Cytotoxic assay revealed that mature tumor-antigen-pulsed DCs induced cytotoxic activity of the T-cells against both autologous and allogeneic NPC tumor cells (including NPC tumor cells from a different individual or from CNE-2Z, a poorly differentiated human NPC cell line). Blocking HLA class I molecules by W6/32 inhibited T-cell-mediated cytotoxic activity in both autologous and allogeneic settings. Our results indicate that DCs pulsed with whole-tumor-antigen can effectively activate HLA class I-restricted cytotoxic T-cells in vitro, and thus provide experimental basis for their future clinical use in PNPC.

A Single Institution Experience With Pediatric Nasopharyngeal Carcinoma: High Incidence of Toxicity Associated With Platinum-based Chemotherapy Plus IMRT

Chemotherapy and intensity-modulated radiotherapy (IMRT) have decreased treatment-related complications in adult patients with nasopharyngeal carcinoma (NPC). Our aim was to evaluate the toxicity profile of IMRT plus chemotherapy in pediatric NPC patients. Five patients were treated with chemotherapy and IMRT. All patients experienced grade 3-4 acute toxicities. With a median follow-up of 6.3 years, all patients experienced >or=3 long-term toxicities. The most common toxicities were hypothyroidism, xerostomia, hearing loss, and dental disease. We did not observe a significant decrease in long-term toxicities with IMRT plus chemotherapy in our small cohort of pediatric NPC patients.

Immunohistochemical expression of epidermal growth factor receptor and cyclooxygenase-2 in pediatric nasopharyngeal carcinomas: No significant correlations with clinicopathological variables and treatment outcomes

Epidermal growth factor receptor (EGFR) and cyclooxygenase-2 (COX-2) were separately found associated with prognosis in adult patients with nasopharyngeal carcinoma (NPC). To date, their expression patterns and prognostic utility have never been specifically addressed in children and adolescents. Thirty consecutive NPC patients aged<or==20 years and treated by radiotherapy (RT) with (n=14) or without (n=16) systemic chemotherapy (CT) were accrued between 1988 and 2001 in a single institute. The clinical outcomes were correlated with clinicopathological features in 30 patients and with immunostains of EGFR and COX-2 in 20 patients with available blocks. The 5-year rates of overall survival (OS) and disease-free survival (DFS) were both 76.4%. Overexpression of EGFR and COX-2 was identified in 13 (65%) and 14 (70%) cases, respectively. The expression levels of these two oncoproteins did not significantly correlate with each other, DFS, OS, and any of clinicopathological factors, including histological subtype, AJCC stage, T stage, and N stage. The only significant prognosticator predictive of adverse outcomes was AJCC stage IV at presentation, which, compared with lower-staged diseases, decreased the rates from 85.2% to 55.6% at 5 years for both DFS (p=0.05) and OS (p=0.05). Despite lacking significant prognostic values, EGFR and COX-2 were overexpressed in approximately two-thirds of pediatric NPC. Such high frequencies provide the basis of combined targeted therapy by specific pharmacological inhibitors to enhance the effects of RT and CT. However, it requires further investigation on the difference between pediatric and adult NPC patients in clinical and biological implications of EGFR and COX-2.

Treatment results of 165 pediatric patients with non-metastatic nasopharyngeal carcinoma: A Rare Cancer Network study

Purpose This Rare Cancer Network (RCN) study was performed in pediatric nasopharyngeal carcinoma (PNPC) patients to evaluate the optimal dose of radiotherapy and to determine prognostic factors. Patients and Methods The study included 165 patients with the diagnosis of PNPC treated between 1978 and 2003. The median age was 14 years. There were 3 (1.8%) patients with stage I, 1 (0.6%) with IIA, 10 (6.1%) with IIB, 60 (36.4%) with III, 44 (26.7%) with IVA, and 47 (29%) with IVB disease. While 21 (12.7%) patients were treated with radiotherapy (RT) alone, 144 (87.3%) received chemotherapy and RT. The median follow-up time was 48 months. Results The actuarial 5-year overall survival (OS) was 77.4% (95% CI: 70.06–84.72), whereas the actuarial 5-year disease-free survival (DFS) rate was 68.8% (95% CI: 61.33–76.31). In multivariate analysis, unfavorable factors were age >14 years for LRC ( p = 0.04); male gender for DMFS ( p = 0.03); T3/T4 disease for LRFS ( p = 0.01); and N3 disease for DFS ( p = 0.002) and OS ( p = 0.002); EBRT dose of less than 66 Gy for LRFS ( p = 0.02) and LRRFS ( p = 0.0028); and patients treated with RT alone for LRFS ( p = 0.0001), LRRFS ( p = 0.007) and DFS ( p = 0.02). Conclusion Our results support the current practice of using combined radiation and chemotherapy for optimal treatment of NPC. However, research should be encouraged in an attempt to reduce the potential for long-term sequelae in pediatric patients given their relatively favorable prognosis and potential for longevity.