title: Radiation and chemotherapy combination for nasopharyngeal carcinoma in children: Radiotherapy dose adaptation after chemotherapy response to minimize late effects.
abstract: OBJECTIVE
  To retrospectively report the clinical and therapeutic features of children with nasopharyngeal carcinoma (NPC) treated by chemotherapy and doses adapted of radiotherapy.
  
  
  METHODS
  From 1978 to 2005, 34 children were treated for NPC. All histologic and/or cytologic samples and CT scans were reviewed. Cervical nodal irradiation was reduced (<50 Gy) in the case of a good response to chemotherapy (>/=90% of initial tumor volume).
  
  
  RESULTS
  Thirty-two children had metastatic cervical nodes and one child had systemic metastases at diagnosis. All children had AJJC-TNM Stage IV. Thirty-one children received neoadjuvant chemotherapy with various regimens. The overall chemotherapy response rate was 78%. Fifteen patients had cervical nodal irradiation dose reduced: Median 47 Gy (range: 45-50). Nasopharyngeal radiotherapy was delivered at a dose of 59.4 Gy (range: 45-66). Local and distant failure rates were 10% and 18%, respectively. The 5-year overall survival was 73 +/- 8% and the event-free survival (EFS) was 75 +/- 8%.
  
  
  CONCLUSIONS
  The overall prognosis was not influenced by TNM status, dose of local radiotherapy delivered or response to initial chemotherapy, but EFS was better in patients with a good response to chemotherapy. The cervical local failure rate was low despite radiotherapy dose reduction in the case of a good response to neoadjuvant chemotherapy. We also propose a reduction of nasopharyngeal radiation (</=50 Gy) in the case of good response to initial chemotherapy.
authors.affiliation: Pediatric Oncology Department, Institut Curie, Paris, France. daniel.orbach@curie.net
authors.forename: Daniel
authors.initials: D
authors.lastname: Orbach
authors.forename: Hervé
authors.initials: H
authors.lastname: Brisse
authors.forename: Sylvie
authors.initials: S
authors.lastname: Helfre
authors.forename: Jerzy
authors.initials: J
authors.lastname: Klijanienko
authors.forename: Danielle
authors.initials: D
authors.lastname: Bours
authors.forename: Véronique
authors.initials: V
authors.lastname: Mosseri
authors.forename: José
authors.initials: J
authors.lastname: Rodriguez
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000628:therapy*; D002648:Child; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy / Q000379:methods*; D016896:Treatment Outcome