title: Nasopharyngeal carcinoma in children: ten years' experience at the Tata Memorial Hospital, Mumbai.
abstract: OBJECTIVE
  To evaluate the disease characteristics and outcome of children with nasopharyngeal carcinoma treated at the Tata Memorial Hospital, Mumbai.
  
  
  METHODS
  Between 1990 and 2000, 81 pediatric patients with a diagnosis of nasopharyngeal carcinoma were treated at the Tata Memorial Hospital. The median age was 14 years. The male/female ratio was 2.8:1. Of the 81 patients, 32 (39%), 21 (26%), and 28 (35%) had T1-T2, T3, and T4 (TNM International Union Against Cancer staging system, 1997), respectively. Ninety-one percent presented with nodal metastasis. Thirty patients (37%) had lymph nodes >6 cm, and 45 (56%) had bilateral nodes at presentation. Histologically, 77 patients (95%) had undifferentiated carcinoma. Eighty-five percent received neoadjuvant multiagent chemotherapy containing bleomycin, methotrexate, and cisplatin, followed by radiotherapy (RT).
  
  
  RESULTS
  After a median follow-up of 50 months, the disease-free survival (DFS) and overall survival (OS) rate for the entire group was 45% and 54%, respectively. Kaplan-Meier curves were used for evaluation of prognostic factors and were compared using the log-rank test. Nodal status had a significant impact on DFS (p = 0.021) and OS (p = 0.006). Complete responders to chemotherapy had superior DFS (p = 0.000) and OS (p = 0.000). RT doses >60 Gy resulted in better DFS (p = 0.020) and OS (p = 0.012). Combined chemotherapy plus RT resulted in improved DFS (p = 0.457) and OS (p = 0.296), although the difference was not statistically significant.
  
  
  CONCLUSIONS
  Combined modality management using chemotherapy and RT resulted in satisfactory locoregional control and OS in pediatric patients with nasopharyngeal carcinoma. Nodal involvement, response to chemotherapy, and RT dose were important prognostic factors.
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India. laskars2000@yahoo.com
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Laskar
authors.forename: Vimal
authors.initials: V
authors.lastname: Sanghavi
authors.forename: Marry Ann
authors.initials: MA
authors.lastname: Muckaden
authors.forename: Sarbani
authors.initials: S
authors.lastname: Ghosh
authors.forename: Vishal
authors.initials: V
authors.lastname: Bhalla
authors.forename: Shripad
authors.initials: S
authors.lastname: Banavali
authors.forename: Purna
authors.initials: P
authors.lastname: Kurkure
authors.forename: Chandrika
authors.initials: C
authors.lastname: Nair
authors.forename: Ketayun A
authors.initials: KA
authors.lastname: Dinshaw
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D002277:Carcinoma / Q000188:drug therapy* / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*
chemical_list: D001761:Bleomycin; D002945:Cisplatin; D008727:Methotrexate