Treatment of nasopharyngeal carcinoma in children and adolescents

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Abstract
BACKGROUND: Preliminary results of combined neoadjuvant chemotherapy, radiotherapy, and postradiation interferon beta (IFN‐β) in children and adolescents with nasopharyngeal carcinoma, especially in high‐risk patients, have been promising.METHODS: From 1992 to 2003, 59 patients (58 high‐risk patients and 1 low‐risk patient, median age 13 yrs; range, 8–25 yrs) were treated in the GPOH‐NPC‐91 study. The Stage II patient received irradiation as initial therapy. Fifty‐eight patients received preradiation chemotherapy with methotrexate, cisplatin, and 5‐fluorouracil. The cumulative radiation dose to primary sites was 59.4 Gy, a total dose of 45 Gy was delivered to the neck area. After irradiation, all patients were treated with 105 U recombinant IFN‐β/kg body weight 3 times a week for 6 months.RESULTS: After combination therapy, complete response was accomplished in 58 patients. In one patient, there was tumor progression during chemotherapy. In 3 patients, distant metastases were observed 14, 15, and 18 months after diagnosis, respectively. One patient had a local relapse 12 months after diagnosis. Fifty‐four patients are still in first remission with a median follow‐up of 48 months (range, 10–110 mos). Chemotherapy‐related toxicity was mucositis Grade II, III, or IV in all patients and acute cardiotoxicity in 2 (3.5%) of the patients. Nephrotoxicity Grade I–II occurred in 8.8% of patients.CONCLUSIONS: The combination of initial chemotherapy, radiotherapy, and IFN‐β results in an excellent outcome. These results strongly support the development of a future treatment strategy along this line. Cancer 2005. © 2005 American Cancer Society.