title: Long-term outcome and late toxicities of simultaneous integrated boost-intensity modulated radiotherapy in pediatric and adolescent nasopharyngeal carcinoma.
abstract: The application of simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in pediatric and adolescent nasopharyngeal carcinoma (NPC) is underevaluated. This study aimed to evaluate long-term outcome and late toxicities in pediatric and adolescent NPC after SIB-IMRT combined with chemotherapy. Thirty-four patients (aged 8-20 years) with histologically proven, non-disseminated NPC treated with SIB-IMRT were enrolled in this retrospective study. The disease stage distribution was as follows: stage I, 1 (2.9%); stage III, 14 (41.2%); and stage IV, 19 (55.9%). All patients underwent SIB-IMRT and 30 patients also underwent cisplatin-based chemotherapy. The prescribed dose of IMRT was 64-68 Gy in 29-31 fractions to the nasopharyngeal gross target volume. Within the median follow-up of 52 months (range, 9-111 months), 1 patient (2.9%) experienced local recurrence and 4 (11.8%) developed distant metastasis (to the lung in 3 cases and to multiple organs in 1 case). Four patients (11.8%) died due to recurrence or metastasis. The 5-year locoregional relapse-free survival, distant metastasis-free survival, disease-free survival, and overall survival rates were 97.1%, 88.2%, 85.3%, and 88.2%, respectively. The most common acute toxicities were grades 3-4 hematologic toxicities and stomatitis. Of the 24 patients who survived for more than 2 years, 16 (66.7%) and 15 (62.5%) developed grades 1-2 xerostomia and ototoxicity, respectively. Two patients (8.3%) developed grade 3 ototoxicity; no grade 4 toxicities were observed. SIB-IMRT combined with chemotherapy achieves excellent long-term locoregional control in pediatric and adolescent NPC, with mild incidence of late toxicities. Distant metastasis is the predominant mode of failure.
authors.affiliation: State Key Laboratory of Oncology in South China; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China. drjunma@hotmail.com, sunying@sysucc.org.cn.
authors.forename: Chang-Juan
authors.initials: CJ
authors.lastname: Tao
authors.forename: Xu
authors.initials: X
authors.lastname: Liu
authors.forename: Ling-Long
authors.initials: LL
authors.lastname: Tang
authors.forename: Yan-Ping
authors.initials: YP
authors.lastname: Mao
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.forename: Wen-Fei
authors.initials: WF
authors.lastname: Li
authors.forename: Xiao-Li
authors.initials: XL
authors.lastname: Yu
authors.forename: Li-Zhi
authors.initials: LZ
authors.lastname: Liu
authors.forename: Rong
authors.initials: R
authors.lastname: Zhang
authors.forename: Ai-Hua
authors.initials: AH
authors.lastname: Lin
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
authors.forename: Ying
authors.initials: Y
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007970:Leukopenia / Q000209:etiology; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009503:Neutropenia / Q000209:etiology; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013280:Stomatitis / Q000209:etiology; D015996:Survival Rate; D014987:Xerostomia / Q000209:etiology; D055815:Young Adult
chemical_list: D002945:Cisplatin
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