title: Nasopharyngeal carcinoma in the pediatric age group: the northern Israel (Rambam) medical center experience, 1989-2004.
abstract: 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.
authors.affiliation: Pediatric Hemato-Oncology Department, Meyer Children's Hospital, Rambam Medical Center, Haifa, Israel. ilh_motti@rambam.health.gov.il
authors.forename: Motti
authors.initials: M
authors.lastname: Haimi
authors.forename: Myriam Weyl Ben
authors.initials: MW
authors.lastname: Arush
authors.forename: Gil
authors.initials: G
authors.lastname: Bar-Sela
authors.forename: Eliahu
authors.initials: E
authors.lastname: Gez
authors.forename: Zvi
authors.initials: Z
authors.lastname: Bernstein
authors.forename: Sergey
authors.initials: S
authors.lastname: Postovsky
authors.forename: Ayelet Ben
authors.initials: AB
authors.lastname: Barak
authors.forename: Abraham
authors.initials: A
authors.lastname: Kuten
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000453:epidemiology / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000453:epidemiology / Q000628:therapy*; D020360:Neoadjuvant Therapy; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D014747:Vinblastine; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil