Nasopharyngeal carcinoma in the pediatric age group: the northern Israel (Rambam) medical center experience, 1989-2004

• Published in: Journal of pediatric hematology/oncology Vol. 27; no. 10; p. 510
• Main Authors: Haimi, Motti, Arush, Myriam Weyl Ben, Bar-Sela, Gil, Gez, Eliahu, Bernstein, Zvi, Postovsky, Sergey, Barak, Ayelet Ben, Kuten, Abraham
• Format: Journal Article
• Language: English
• Published: United States 01.10.2005
• Subjects: Adolescent; Age Distribution; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma - epidemiology; Carcinoma - therapy; Carcinoma, Squamous Cell - epidemiology; Carcinoma, Squamous Cell - therapy; Chemotherapy, Adjuvant; Child; Child, Preschool; Combined Modality Therapy; Cyclophosphamide - administration & dosage; Doxorubicin - administration & dosage; Female; Fluorouracil - administration & dosage; Humans; Infant; Israel - epidemiology; Male; Nasopharyngeal Neoplasms - epidemiology; Nasopharyngeal Neoplasms - therapy; Neoadjuvant Therapy; Prognosis; Radiotherapy Dosage; Retrospective Studies; Survival Rate; Vinblastine - administration & dosage; Israel
• ISSN: 1077-4114
• DOI: 10.1097/01.mph.0000183271.22947.64

Nasopharyngeal carcinoma (NPC) is rare in children, accounting for less than 1% of all malignancies. Radiation therapy has been the mainstay of treatment of many years, but to improve survival, the use of chemotherapy has been advocated. This is a retrospective analysis of 13 patients less than 20 years of age treated for NPC the Rambam Medical Center during 1989 to 2004. Eight boys and five girls with a median age of 14.5 years (range 10-19) were included. Median follow up (including patients who died) was 6.15 years (range 1-15 years). Duration of symptoms was 1 to 24 months (median 5 months). Of the 13 patients, one patient had stage I, 6 had stage III, 5 had stage IV-A, and 1 had stage IV-B disease. Ten patients (77%) had undifferentiated carcinoma (WHO type III) and three patients (23%) had nonkeratinizing carcinoma (WHO type II). Most of the children received two or three courses of neoadjuvant multiagent chemotherapy consisting of cisplatin and 5-FU, followed by radiotherapy with doses in excess of 60 Gy. One child received concomitant chemoradiation. Ten of the 13 patients (77%) are alive without disease 6 years after diagnosis (range 1-15 years). One patient developed local and distant metastases 1 year after diagnosis and is currently receiving combined radiochemotherapy. Two patients died. Overall survival was 84%; event-free survival was 77%. Nine patients (69%) developed moderate to severe long-term complications. Pediatric NPC is curable by combined radiation and chemotherapy, with doses of radiation in excess of 60 Gy. Long-term follow-up is important for early detection of second malignancies as well as for radiation-induced endocrinologic deficiencies and other normal tissue complications.