Treatment results of 59 young patients with nasopharyngeal carcinoma.
OBJECTIVE
To evaluate the outcome of patients </=30 years old with non-metastatic nasopharyngeal carcinoma and discover adverse prognostic factors.


METHODS
We performed a database search maintained by the Department of Radiation Oncology of Hacettepe University School of Medicine for patients with nasopharyngeal cancer who were </=30 years old at presentation. This search identified 59 (23.7%) patients among 248 patients treated between 1994 and 2001 that met the inclusion criteria for this retrospective study. Patients were staged according to AJCC 1997 classification. There were 1 (2%) patient with stage I, 7 (12%) with stage IIb, 25 (42%) with stage III, 9 (15%) with stage IVA, and 17 (29%) with stage IVB. Thirteen (22%) patients were stage T1, 16 (27%) were T2, 21 (36%) were T3, and 9 (15%) were T4. Nodal staging at presentation was as follows; 7 (12%) N0, 22 (37%) N1, 13 (22%) N2, 13 (22%) N3a, and 4 (7%) N3b. All patients were treated with fractionated external beam radiotherapy (EBRT) to a median dose of 65Gy. While 12 (20.3%) patients were treated with EBRT alone, 47 (79.7%) received chemotherapy beside EBRT. Twenty-five (42.3%) patients older than 17 years of age received brachytherapy boost in addition to EBRT.


RESULTS
The median follow-up time for all patients was 46 months (range, 1-111 months). While only 3 patients (5%) developed local recurrence (1/21 T3 and 2/9 T4 patients), 13 patients (22%) developed distant metastases (6/35 N1 and 2 and 7/17 N3 patients). None of the patients had regional failure. Four patients (6.7%) died due to the treatment related toxicity. The actuarial 5-year local control (LC), regional control (RC), distant metastasis-free survival (DMFS) and disease-free survival (DFS) rates were 96%, 100%, 76.5%, and 74.5%, respectively. The actuarial 5-year disease-specific survival (DSS) was 70.6%. DFS at 5 years is significantly longer in patients aged <16 years than ones >17 (90.5% versus 64.7%; p=0.02). Patients aged <16 years had longer 5 year DMFS (90.5% versus 67.7%; p=0.05) with a borderline significance. DMFS is significantly shorter in patients initially presented with N3 disease compared to N0-2 disease (58.8% versus 84.4%; p=0.04).


CONCLUSIONS
We suggest that RT combined with multiagent chemotherapy is effective in achieving satisfactory DFS and comparable OS in young patients with NPC. Results of both previous series and ours are evoking the necessity of early administration of efficient chemotherapeutic agents in addition to radiotherapy, but indistinct is the precise regimen and the intensity along the radiotherapy. All efforts towards decreasing late side effects of treatment should be encouraged in this long life expected group.
Selek
Ugur
U
Department of Radiation Oncology, Hacettepe University School of Medicine, 06100 Sihhiye, Ankara, Turkey.
Ozyar
Enis
E
Ozyigit
Gokhan
G
Varan
Ali
A
Buyukpamukcu
Munevver
M
Atahan
I Lale
IL
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002945:Cisplatin / Q000627:therapeutic use; D019992:Databases as Topic; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D012189:Retrospective Studies; D015996:Survival Rate; D014421:Turkey / Q000453:epidemiology
D000970:Antineoplastic Agents; D002945:Cisplatin