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Lei S, Chen L, Ji P, Li K, Li Q, Huang C, Wang G, Ma J, Guo R, Tang L. Global burdens of nasopharyngeal carcinoma in children and young adults and predictions to 2040. Oral Oncol 2024; 155:106891. [PMID: 38878356 DOI: 10.1016/j.oraloncology.2024.106891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/27/2024] [Accepted: 06/06/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES To investigate the epidemiological trend for nasopharyngeal carcinoma among children and young adults and the disease burden they caused. MATERIALS AND METHODS Data were collected from the Global Burden of Disease (GBD) study 2019. A comprehensive analysis was performed, with age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), disability-adjusted life-years (DALYs) and estimated annual percentage changes (EAPC). And decomposition and frontier analyses were done. Future trends were predicted using Bayesian age-period-cohort model. RESULTS Globally, there were decreases in the ASIR (EAPC -0.175, 95 % confidence interval [CI]: -0.352 to 0.002), ASMR (EAPC -2.681, 95 % CI: -2.937 to -2.424), and age-standardized DALYs rates (EAPC -2.643, 95 % CI: -2.895 to -2.391). However, the ASIR for males in global (EAPC 0.454, 95 % CI: 0.302 to 0.606), Asia (EAPC 0.782, 95 % CI: 0.610 to 0.954) and America (EAPC 0.448, 95 % CI: 0.379 to 0.517), as well as females in European (EAPC 0.595, 95 % CI: 0.479 to 0.712) and American (EAPC 0.369, 95 % CI: 0.324 to 0.415), showed an increasing trend. The future ASIR per 100,000 will likely show a slight upward trend in 2020 to 2040 (increased from 0.254 to 0.284), particularly among females (increased from 0.177 to 0.206), and a continued decline in ASMR for both sexes (decreased from 0.070 to 0.061). CONCLUSIONS Globally, NPC in children and young adults remains a major public health issue, with the global distribution and magnitude of the burden varies markedly, highlighting the need to formulate regional and population-based policies for primary prevention.
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Affiliation(s)
- Sen Lei
- Department of Pancreatobiliary Surgery, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Lin Chen
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Pengjie Ji
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Kunpeng Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Qingjie Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China; Department of Experimental Research, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Chenglong Huang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Gaoyuan Wang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Jun Ma
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
| | - Rui Guo
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
| | - Linglong Tang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
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El-Hennawy G, ElMenawi S, Nasr Said E, Zekri W, Zaghloul M, Elsalam AMA, El-Fendy H, Elantably I. Predictive significance of pretreatment 18F-FDG PET volumetric parameters on survival outcomes in pediatric patients with locally advanced undifferentiated nasopharyngeal carcinoma. Pediatr Blood Cancer 2024; 71:e30998. [PMID: 38650170 DOI: 10.1002/pbc.30998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/20/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) is a rare pediatric cancer. Most children are first diagnosed with advanced locoregional disease. Identification of patients at higher risk of treatment failure is crucial as they may benefit from more aggressive initial treatment approaches. 18Fluorine-labeled fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET) has shown promise as a prognostic tool for predicting outcomes. METHODS Retrospective study of pediatric patients with locally advanced undifferentiated NPC who underwent 18F-FDG PET/CT prior to intial treatment. Predictive significance of metabolic PET parameters on survival outcomes were estimated. RESULTS Thirty-two children were included, age range was 7.1-18 years at the time of diagnosis. The median follow-up duration was 46.1 months. Three patients (9.4%) were classified as AJCC stage IIb, 13 patients (40.6%) as stage IIIa, eight patients (25%) as stage IIIb, and eight patients (25%) as stage IVa. Our findings revealed that high whole-body metabolic tumor volume at the threshold of hepatic reference SUVmean (WB-MTV-HR) (>135 mL) was associated with significantly lower event-free survival (EFS) compared to the low WB-MTV-HR group (≤135 mL) (3-year EFS: 50% ± 18% vs. 82% ± 8%; p = .015). Additionally, the 3-year overall survival (OS) rates differed significantly between the high whole-body metabolic tumor volume at the threshold of an SUV of 2.5 isocontour (WB-MTV-2.5) group (MTV >74 mL) and the low WB-MTV-2.5 group (MTV ≤74 mL) (63% ± 18% vs. 100%; p = .021). CONCLUSION Our study suggests that WB-MTV parameters could serve as significant prognostic factors for disease progression in pediatric patients with locally advanced undifferentiated NPC. However, further prospective studies with larger sample sizes are needed to validate these findings.
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Affiliation(s)
- Gihan El-Hennawy
- Department of Nuclear Medicine and Radiation Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
- Department of Nuclear Medicine, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Salma ElMenawi
- Department of Clinical Research, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Eman Nasr Said
- Department of Diagnostic & Interventional Radiology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
- Department of Radiodiagnosis, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Wael Zekri
- Department of Pediatric Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
- Department of Pediatric Oncology, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Mohamed Zaghloul
- Department of Nuclear Medicine and Radiation Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
- Department of Radiotherapy, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Ahmed Mustafa Abd Elsalam
- Department of Pediatric Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
- Department of Pediatric Oncology, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Habiba El-Fendy
- Department of Pathology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Ismail Elantably
- Department of Nuclear Medicine and Radiation Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
- Department of Nuclear Medicine, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
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Aldakheel A, Aldehaim M, Alwhaid MS, Alhabib R, Anwar MS, Alzayed B, Shehzad K, Ghebeh H, Al-Rajhi N. Locally advanced nasopharyngeal carcinoma in adolescents treated with tomotherapy: Experience at King Faisal Specialist Hospital and Research Centre. Ann Saudi Med 2024; 44:153-160. [PMID: 38853474 DOI: 10.5144/0256-4947.2024.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) is a rare disease worldwide; To the best of our knowledge, there is no established standard of care specifically tailored for the adolescent population. The majority of existing research relies on retrospective data analysis. OBJECTIVE Evaluate clinical features, treatment results, prognostic factors and late toxicities of locally advanced NPC patients treated with tomotherapy. DESIGN Retrospective. SETTINGS Tertiary care hospital. PATIENTS AND METHODS Between January 2007 and January 2020, we treated patients with NPC, aged between 14 and 21 years, with concomitant chemoradiotherapy using tomotherapy at our institution. We prospectively collected details of clinical characteristics, treatment modalities, outcomes and prognostic factors of these patients and then analysed them retrospectively. MAIN OUTCOME MEASURES 3-5 years overall survival (OS), 3-5 years locoregional control rate, 3-5 years disease-free survival (DFS), prognostic factors. SAMPLE SIZE 51 patients. RESULTS There were 26 male and 25 female patients included in our study. The mean age was 16.5 years, 5 (9.8%) patients with stage III, and 46 (90.2%) with stage IVa according to the American Joint Committee on Cancer, 8th edition staging system. Most patients (98%) received two or more cycles of induction chemotherapy. All patients received concomitant chemoradiotherapy. The median total dose of radiotherapy delivered was 6600 cGy (range 4800-7000). With a median follow-up of 73 months (range 9-168 months), a 5-year locoregional control rate, 5-year OS and 5-year DFS rates were 100%, 86.8% and 71.7%, respectively. Five years later, disease control was 71.7%. Ten (19.6%) patients had disease recurrence in the form of distant metastases during the follow up. CONCLUSIONS Helical tomotherapy has an excellent late toxicity profile without compromising clinical outcome for patients with NPC. Radiotherapy remains the mainstay of treatment of nasopharyngeal carcinoma to achieve remarkable local control rates. LIMITATIONS Single institution experience, small number of patients, and retrospective design.
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Affiliation(s)
- Abdulrahman Aldakheel
- From the Department of Radiation Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Aldehaim
- From the Department of Radiation Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Saleh Alwhaid
- From the Department of Radiation Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Renda Alhabib
- From the Department of Radiation Oncology, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Muhammad Suhail Anwar
- From the Department of Radiation Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Balqees Alzayed
- From the Department of Radiation Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khurram Shehzad
- From the Department of Radiation Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hazem Ghebeh
- From the Department of Stem Cell and Tissue Re-engineering, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Nasser Al-Rajhi
- From the Department of Radiation Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Ben-Ami T. Nasopharyngeal Carcinoma in Children, Current Treatment Approach. J Pediatr Hematol Oncol 2024; 46:117-124. [PMID: 38447121 PMCID: PMC10956687 DOI: 10.1097/mph.0000000000002848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 02/04/2024] [Indexed: 03/08/2024]
Abstract
Nasopharyngeal carcinoma (NPC) is a rare and locally aggressive form of childhood cancer. Treatment of pediatric NPC includes chemotherapy and radiotherapy. Most studies on the treatment of pediatric NPC are single-arm studies. With current treatment protocols survival rates for patients with nonmetastatic disease exceed 80%, although most children will have long-term treatment-related late effects. Efforts to reduce early and late toxicities include reduced radiotherapy doses in children with good responses to induction chemotherapy. Further studies are needed to evaluate the role of immunotherapy in both the primary setting and in children with progressive or relapsed disease. This review summarizes current clinical approaches to the treatment of pediatric NPC.
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Liu Q, Bode AM, Chen X, Luo X. Metabolic reprogramming in nasopharyngeal carcinoma: Mechanisms and therapeutic opportunities. Biochim Biophys Acta Rev Cancer 2023; 1878:189023. [PMID: 37979733 DOI: 10.1016/j.bbcan.2023.189023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023]
Abstract
The high prevalence of metabolic reprogramming in nasopharyngeal carcinoma (NPC) offers an abundance of potential therapeutic targets. This review delves into the distinct mechanisms underlying metabolic reprogramming in NPC, including enhanced glycolysis, nucleotide synthesis, and lipid metabolism. All of these changes are modulated by Epstein-Barr virus (EBV) infection, hypoxia, and tumor microenvironment. We highlight the role of metabolic reprogramming in the development of NPC resistance to standard therapies, which represents a challenging barrier in treating this malignancy. Furthermore, we dissect the state of the art in therapeutic strategies that target these metabolic changes, evaluating the successes and failures of clinical trials and the strategies to tackle resistance mechanisms. By providing a comprehensive overview of the current knowledge and future directions in this field, this review sets the stage for new therapeutic avenues in NPC.
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Affiliation(s)
- Qian Liu
- NHC Key Laboratory of Carcinogenesis and Hunan Key Laboratory of Oncotarget Gene, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, PR China; Key Laboratory of Carcinogenesis and Invasion, Chinese Ministry of Education, Cancer Research Institute, School of Basic Medicine, Central South University, Changsha, Hunan 410078, PR China
| | - Ann M Bode
- The Hormel Institute, University of Minnesota, Austin, MN 55912, USA
| | - Xue Chen
- Early Clinical Trial Center, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, PR China.
| | - Xiangjian Luo
- NHC Key Laboratory of Carcinogenesis and Hunan Key Laboratory of Oncotarget Gene, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, PR China; Key Laboratory of Carcinogenesis and Invasion, Chinese Ministry of Education, Cancer Research Institute, School of Basic Medicine, Central South University, Changsha, Hunan 410078, PR China; Key Laboratory of Biological Nanotechnology of National Health Commission, Central South University, Changsha, Hunan 410078, China.
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Sharma K, Goswami A. Childhood Malignancies-Clinico-demographic Profile of Patients Attending the Department of Otorhinolaryngology at a Tertiary Care Centre in North-East India. Indian J Otolaryngol Head Neck Surg 2023; 75:2006-2016. [PMID: 37636808 PMCID: PMC10447731 DOI: 10.1007/s12070-023-03779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/04/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Malignancies in children are different from those found in adults and are a significant cause of childhood mortality.They have varied clinical presentation depending on site and type of disease.It is essential to recognize the early signs and symptoms of malignancies in childhood, especially those involving head and neck region, so as to reduce childhood mortality and morbidity. MATERIALS A total of 2384 children were admitted over a period of 7 years. Out of these, 1004 fulfilled the inclusion criteria and were chosen for further evaluation.They were thoroughly evaluated by undertaking a detailed history and clinical examination.Whenever required, additional investigations were performed.After carrying out the necessary investigations, the cases were accordingly managed. Data was evaluated using proper statistical tools. RESULTS Out of 1004 cases fulfilling the inclusion criteria, 42 turned out to be malignant, with a male-to-female ratio of 1:1.2. Malignancies in children were more common in the age group of 11-18 years, followed by 1-5 years,6-10 years and 0-1 years,with rates of 59.5%, 21.4%, 16.7% and 2.4% respectively. A wide variety of tumour types were recorded,e.g.,Hodgkin's lymphoma,non-Hodgkin's lymphoma,acute leukemia,papillary carcinoma thyroid, nasopharyngeal carcinoma,Langerhans cell histiocytosis,rhabdomyosarcoma, olfactory neuroblastoma and salivary gland neoplasm. CONCLUSION Incidence of head and neck tumors in pediatric age group was found to be 1.76% with lymphoma being the most frequent.Commonest age of presentation was above 10 years. There was an overall female predominance with a male:female ratio of 1:1.2. Awareness of a potential malignancy and careful follow-up of children with suspicious head and neck cancers is mandatory for early diagnosis and prompt treatment.
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Affiliation(s)
- Kalpana Sharma
- Dept. of Otorhinolaryngology, Gauhati Medical College, Guwahati, Assam 781032 India
| | - Abhilasha Goswami
- Dept. of Otorhinolaryngology, Gauhati Medical College, Guwahati, Assam 781032 India
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Schultz KAP, Chintagumpala M, Piao J, Chen KS, Gartrell R, Christison-Lagay E, Berry JL, Shah R, Laetsch TW. Children's Oncology Group's 2023 blueprint for research: Rare tumors. Pediatr Blood Cancer 2023; 70 Suppl 6:e30574. [PMID: 37458616 PMCID: PMC10529839 DOI: 10.1002/pbc.30574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Abstract
The Children's Oncology Group (COG) Rare Tumor Committee includes the Infrequent Tumor and Retinoblastoma subcommittees, encompassing a wide range of extracranial solid tumors that do not fall within another COG disease committee. Current therapeutic trial development focuses on nasopharyngeal carcinoma, adrenocortical carcinoma, pleuropulmonary blastoma, colorectal carcinoma, melanoma, and thyroid carcinoma. Given the rarity of these tumors, novel strategies and international collaborative efforts are necessary to advance research and improve outcomes.
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Affiliation(s)
| | - Murali Chintagumpala
- Division of Hematology-Oncology, Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX
| | - Jin Piao
- University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Kenneth S. Chen
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Robyn Gartrell
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Emily Christison-Lagay
- Division of Pediatric Surgery, Yale School of Medicine, Yale New-Haven Children’s Hospital, New Haven, CT
| | - Jesse L. Berry
- The Vision Center, Children's Hospital Los Angeles, The Saban Research Institute, Children's Hospital Los Angeles, USC Roski Eye Institute, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Rachana Shah
- Division of Hematology-Oncology, Department of Pediatrics, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Theodore W. Laetsch
- Division of Oncology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
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Wu B, Shen L, Peng G, Li Y, Zhou Z, Li J, Huang X, Zhou Q, Jiang H, Huang J, Ding Q, Zhang Z, Qin Y, Hong X, Shi L, Zou Z, Yao J, Zhang J, Liu D, Wan C, Wu G, Song L, Chen S, Yi J, Yang K. Molecular characteristics of pediatric nasopharyngeal carcinoma using whole-exome sequencing. Oral Oncol 2022; 135:106218. [DOI: 10.1016/j.oraloncology.2022.106218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/08/2022] [Accepted: 10/14/2022] [Indexed: 11/08/2022]
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Ayyoub S, Sultan I. Long-term survival in a patient with recurrent nasopharyngeal carcinoma treated with capecitabine. Pediatr Blood Cancer 2022; 69:e29605. [PMID: 35187809 DOI: 10.1002/pbc.29605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Sanaa Ayyoub
- Endocrinology Department, Dartmouth Hitchcock Medical Center, Manchester, New Hampshire, USA
| | - Iyad Sultan
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
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Steffen C, Piwonski I, Heiland M, Stromberger C, Kofla G, Doll C, Coordes A, Beck-Broichsitter B. Influence of Tumor Site on Survival in Young Patients with Head and Neck Squamous Cell Carcinoma. Curr Oncol 2022; 29:969-980. [PMID: 35200581 PMCID: PMC8870694 DOI: 10.3390/curroncol29020082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
The number of patients under the age of 45 diagnosed with head and neck squamous cell carcinomas (HNSCC) is increasing, probably due to the incidence of oropharyngeal cancers. Comparisons of HNSCC in young and old patients regarding tumor site and survival in sample sizes of relevance are rarely published. The aim of the study was to analyze the differences in survival between age groups dependent on tumor site and the influence of oropharyngeal cancers on the rising rates of HNSCC in the young. The records of 4466 patients diagnosed with HNSCC were reviewed retrospectively. Patients younger than 45 years were divided further into four subgroups for specific age differences in the young. The influences of patient and clinicopathological characteristics on survival were assessed using Kaplan–Meier analyses. Among the patient cohort, 4.8% were younger than 45 years. Overall survival (OS) in these patients was better, with a 5-year OS of 66.1% (vs. 46.4%), while relapse-free survival (RFS) was better in the older patient population, with a 5-year RFS of 74.9% (vs. 68.1%). Decreased RFS in the young was found for advanced tumor stages and tumor sited at the larynx. Hypopharynx and advanced stages were independent risk factors for OS under 45 years. Overall, 44.4% of all HNSCC in patients under 30 years were nasopharyngeal cancers, and incidence decreased with age. The incidence of oropharyngeal cancers increased significantly with age. Better OS in the young may be explained by lower tumor and disease stages, whereas oropharyngeal tumors and HPV were not found to cause rising rates of HNSCC. Laryngeal malignancies in young patients might be related to an increased malignant potential and should, consequently, be treated as such.
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Affiliation(s)
- Claudius Steffen
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany; (M.H.); (C.D.); (B.B.-B.)
- Correspondence: ; Tel.: +49-30-450-655083; Fax: +49-30-450-555901
| | - Iris Piwonski
- Department of Pathology, Campus Mitte, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany;
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany; (M.H.); (C.D.); (B.B.-B.)
| | - Carmen Stromberger
- Department of Radiooncology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany;
| | - Grzegorz Kofla
- Department of Oncology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany;
| | - Christian Doll
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany; (M.H.); (C.D.); (B.B.-B.)
| | - Annekatrin Coordes
- Department of Otorhinolaryngology, Head and Neck Surgery, Campus Virchow-Klinikum and Campus Charité Mitte, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany;
| | - Benedicta Beck-Broichsitter
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany; (M.H.); (C.D.); (B.B.-B.)
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11
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Gong T, Liu Y, Jie H, Liang M, Wu W, Lu J. Retrospective analysis of clinical features and prognosis of nasopharyngeal carcinoma in children and adolescents. Front Pediatr 2022; 10:939435. [PMID: 36186630 PMCID: PMC9523006 DOI: 10.3389/fped.2022.939435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the clinical characteristics and prognosis of nasopharyngeal carcinoma (NPC) in children and adolescents in different age groups. MATERIALS AND METHODS The clinical data of 51 patients with NPC aged ≤ 18 years who were treated in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2012 to May 2017 were retrospectively analyzed. The patients were divided into children group (≤12 years old) and adolescent group (12-18 years old) with 12 years old as the boundary. The clinical characteristics, diagnosis, treatment, and prognosis of the children and adolescent groups were compared. RESULTS The symptoms of the first diagnosis in the children group were mainly nasal congestion (P = 0.043) and ear symptoms (P = 0.008). The diagnosis rate of nasopharyngeal biopsy in the children group was lower (P = 0.001), while the rate of diagnosis of cervical mass biopsy was significantly higher than that in the adolescent group (P = 0.009). The proportion of keratinizing squamous cell carcinoma of the children group was higher than that of the adolescent group (P = 0.006). There was no significant difference in TNM stage and risk stratification between the two groups, but the number of cases in the III-IVa children group who received induction chemotherapy + concurrent chemoradiotherapy was less than that in the adolescent group (P = 0.013). The proportion of radiotherapy in the upper and lower cervical lymph node drainage areas was lower than that in the adolescent group (P = 0.001). The percentage of recurrence and metastasis in the children group was higher than that in the adolescent group (P = 0.026). CONCLUSION The diagnosis in the children group depended on endoscopic biopsy and neck mass biopsy, and the proportion of keratinizing squamous cell carcinoma was higher. The number of cases of induction chemotherapy and concurrent chemoradiotherapy in the children group was less than that in the adolescent group, and the proportion of radiotherapy in the upper and lower cervical lymph node drainage areas was lower than that in the adolescent group. Clinically, it is necessary to improve the understanding of the clinical characteristics of children with NPC and take appropriate treatment strategies.
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Affiliation(s)
- Tianyu Gong
- Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Yupeng Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Huiqun Jie
- Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Min Liang
- Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Wenjin Wu
- Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jingrong Lu
- Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
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12
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Kebudi R, Buyukkapu SB, Gorgun O, Ozkaya K, Meral R, Ayan I, Altun M. Nasopharyngeal carcinoma in children: Multimodal treatment and long-term outcome of 92 patients in a single center over a 28-year period. Pediatr Blood Cancer 2021; 68:e29372. [PMID: 34582092 DOI: 10.1002/pbc.29372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 09/07/2021] [Accepted: 09/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the long-term outcome and late effects in pediatric patients with nasopharyngeal carcinoma (NPC) treated with neoadjuvant chemotherapy (NACT), followed by radiotherapy (RT). METHODS Ninety-two children (65 male, 27 female) diagnosed with NPC between 1989 and 2017 in the Istanbul University, Institute of Oncology were evaluated retrospectively. NACT consisted of three cycles of cisplatin-containing regimen every 3 weeks, followed by RT. RESULTS The median age was 13 years (5-18 years). Most had locoregionally advanced disease (stage III/IVA/IVB) and five had distant metastases at presentation. At a median follow-up of 108 months (3-332 months), 5- and 10-year overall survival rates and event-free survival rates were 87.5%, 79.7% and 82.1%, 78.9%, respectively. Three patients with distant metastasis are long-term survivors. Thirteen patients relapsed at a median of 8 months (2-23 months). Hypothyroidism (36%) and xerostomia (25%) were the most frequent long-term treatment-related toxicities. Nine second malignancies developed in eight patients, eight in the irradiated field at a median of 14 years (range 5-26 years), five of whom are long-term survivors after curative surgery. CONCLUSIONS Three courses of cisplatin-containing NACT, followed by RT lead to high survival and locoregional control rate in advanced stage NPC in children. Patients with distant metastasis should also be treated with curative intent by systemic chemotherapy and locoregional radiotherapy. Patients should be followed closely for recurrences and long-term morbidities including second malignancies, which may be treated with curative surgeries if diagnosed early.
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Affiliation(s)
- Rejin Kebudi
- Division of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Sema Bay Buyukkapu
- Division of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Omer Gorgun
- Division of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Kübra Ozkaya
- Division of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Rasim Meral
- Division of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Inci Ayan
- Division of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Musa Altun
- Division of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey.,Department of Radiation Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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13
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Jin YN, Yang QQ, Li ZQ, Ou XQ, Zhang WJ, Marks T, Yao JJ, Xia LP. Development of a web-based prognostic model to quantify the survival benefit of cumulative cisplatin dose during concurrent chemoradiotherapy in childhood nasopharyngeal carcinoma. Radiother Oncol 2021; 166:118-125. [PMID: 34838885 DOI: 10.1016/j.radonc.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To quantify and predict the survival benefits of cumulative cisplatin dose during concurrent chemoradiotherapy (CC-CCD) in children and adolescents with locoregionally advanced nasopharyngeal carcinoma (CA-LANPC). MATERIALS AND METHODS Patients with CA-LANPC who received first-line neoadjuvant chemotherapy (NAC) followed by concurrent chemoradiotherapy (CCRT) between September 2007 and April 2018 were evaluated. Recursive partitioning analyses (RPAs) helped identify the ideal thresholds of CC-CCD on disease-free survival (DFS). We then developed a web-based predictive model to quantify the survival benefit of CC-CCD for CA-LANPC. RESULTS In total, 139 patients were eligible for the analysis. The median CC-CCD was 162 mg/m2 (IQR, 138-192 mg/m2). The optimum cut-off point of CC-CCD was 160 mg/m2 for DFS. Hence, we selected 160 mg/m2 as the cut-off to classify CA-LANPC into either high or low CC-CCD groups for survival analysis. The 5-year DFS rates were 91.6% in the high (≥160 mg/m2) CC-CCD group and 77.8% in the low (<160 mg/m2) CC-CCD group (P = 0.011). Multivariate analysis indicated CC-CCD (HR, 0.34; 95%CI, 0.13-0.87; P = 0.024), T stage (HR, 3.72; 95%CI, 1.35-10.22; P = 0.011), and EBV DNA (HR, 3.00; 95%CI, 1.00-8.97; P = 0.049) were independent prognostic factors and were incorporated into the prognostic model. N stage was also included due to its clinical importance. The predictive model was demonstrably accurate (C-index, 0.741) when predicting 5-year DFS rates. CONCLUSIONS We built a predictive model to quantify the survival benefit of CC-CCD for CA-LANPC treated with NAC plus CCRT. This tool may improve individual treatment consultations and facilitate evidence-based decision-making.
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Affiliation(s)
- Ya-Nan Jin
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qian-Qiong Yang
- Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zi-Qian Li
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xue-Qing Ou
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, China
| | - Wang-Jian Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Tia Marks
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, United States
| | - Ji-Jin Yao
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, China.
| | - Liang-Ping Xia
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
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14
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Supplemental folic acid and/or multivitamins in pregnancy is associated with a decreased risk of childhood and adolescent nasopharyngeal carcinoma. J Dev Orig Health Dis 2021; 13:550-555. [PMID: 34779376 DOI: 10.1017/s2040174421000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this study was to evaluate the association between prenatal and neonatal period exposures and the risk of childhood and adolescent nasopharyngeal carcinoma (NPC). From January 2009 to January 2016, a total of 46 patients with childhood and adolescent NPC (i.e., less than 18 years of age) who were treated at Sun Yat-sen University Cancer Center were screened as cases, and a total of 45 cancer-free patients who were treated at Sun Yat-sen University Zhongshan Ophthalmic Center were selected as controls. The association between maternal exposures during pregnancy and obstetric variables and the risk of childhood and adolescent NPC was evaluated using logistic regression analysis. Univariate analysis revealed that compared to children and adolescents without a family history of cancer, those with a family history of cancer had a significantly higher risk of childhood and adolescent NPC [odds ratios (OR) = 3.15, 95% confidence interval (CI) = 1.02-9.75, P = 0.046], and the maternal use of folic acid and/or multivitamins during pregnancy was associated with a reduced risk of childhood and adolescent NPC in the offspring (OR = 0.07, 95% CI = 0.02-0.25, P < 0.001). After multivariate analysis, only the maternal use of folic acid and/or multivitamins during pregnancy remained statistically significant. These findings suggest that maternal consumption of folic acid and/or multivitamins during pregnancy is associated with a decreased risk of childhood and adolescent NPC in the offspring.
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15
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Liang YJ, Wen DX, Luo MJ, Tang LQ, Guo SS, Wang P, Chen QY, Liu LT, Mai HQ. Induction or adjuvant chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in paediatric nasopharyngeal carcinoma in the IMRT era: A recursive partitioning risk stratification analysis based on EBV DNA. Eur J Cancer 2021; 159:133-143. [PMID: 34743068 DOI: 10.1016/j.ejca.2021.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 12/08/2022]
Abstract
PURPOSE To compare the prognosis and adverse effects of induction or adjuvant chemotherapy (IC or AC) plus concurrent chemoradiotherapy (CCRT) versus CCRT alone in paediatric nasopharyngeal carcinoma (NPC) patients in the intensity-modulated radiotherapy (IMRT) era. METHODS AND MATERIALS 549 patients diagnosed from 2005 to 2021 were enrolled. Our primary endpoint was progression-free survival (PFS). The recursive partitioning analysis (RPA) was applied to derive a risk stratification system. Kaplan-Meier survival curves were used to assess the cumulative survival rates, and cox analysis was applied to evaluate the relationship between variables and endpoints. RESULTS The RPA-based risk stratification identified three different risk groups. In the intermediate-risk (stage IVa and EBV<4000 copies/ml) group, patients who received IC followed by CCRT achieved a significantly better 3-year PFS rate than those treated with CCRT alone (87.35% versus 75.89%; P = 0.04). But survival benefit was not obtained from the additional IC or AC in the low-risk (stage II-III and EBV<4000 copies/ml) or high-risk (stage II-IVa and EBV≥4000 copies/ml) group. The most common grade 3 or 4 adverse events in patients treated with CCRT, IC + CCRT, and CCRT + AC were neutropenia (8.1%, 33.0% versus 36.9%, respectively) and leukopenia (14.1%, 26.8% versus 32.3%, respectively) with statistically significant difference. CONCLUSIONS Paediatric NPC patients in the intermediate-risk group treated with IC followed by CCRT had significantly better PFS compared with patients treated with CCRT alone. And the overall incidence of acute adverse events in patients treated with IC or AC plus CCRT was higher than in patients treated with CCRT alone.
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Affiliation(s)
- Yu-Jing Liang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Dong-Xiang Wen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Mei-Juan Luo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China; Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Lin-Quan Tang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Shan-Shan Guo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Pan Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Qiu-Yan Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Li-Ting Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hai-Qiang Mai
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
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16
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Allen DZ, Aljabban J, Silverman D, McDermott S, Wanner RA, Rohr M, Hadley D, Panahiazar M. Meta-Analysis illustrates possible role of lipopolysaccharide (LPS)-induced tissue injury in nasopharyngeal carcinoma (NPC) pathogenesis. PLoS One 2021; 16:e0258187. [PMID: 34648530 PMCID: PMC8516236 DOI: 10.1371/journal.pone.0258187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 09/21/2021] [Indexed: 12/20/2022] Open
Abstract
Background Nasopharyngeal carcinoma (NPC) is a cancer of epithelial origin with a high incidence in certain populations. While NPC has a high remission rate with concomitant chemoradiation, recurrences are frequent, and the downstream morbidity of treatment is significant. Thus, it is imperative to find alternative therapies. Methods We employed a Search Tag Analyze Resource (STARGEO) platform to conduct a meta-analysis using the National Center for Biotechnology’s (NCBI) Gene Expression Omnibus (GEO) to define NPC pathogenesis. We identified 111 tumor samples and 43 healthy nasopharyngeal epithelium samples from NPC public patient data. We analyzed associated signatures in Ingenuity Pathway Analysis (IPA), restricting genes that showed statistical significance (p<0.05) and an absolute experimental log ratio greater than 0.15 between disease and control samples. Results Our meta-analysis identified activation of lipopolysaccharide (LPS)-induced tissue injury in NPC tissue. Additionally, interleukin-1 (IL-1) and SB203580 were the top upstream regulators. Tumorigenesis-related genes such as homeobox A10 (HOXA10) and prostaglandin-endoperoxide synthase 2 (PTGS2 or COX-2) as well as those associated with extracellular matrix degradation, such as matrix metalloproteinases 1 and 3 (MMP-1, MMP-3) were also upregulated. Decreased expression of genes that encode proteins associated with maintaining healthy nasal respiratory epithelium structural integrity, including sentan-cilia apical structure protein (SNTN) and lactotransferrin (LTF) was documented. Importantly, we found that etanercept inhibits targets upregulated in NPC and LPS induction, such as MMP-1, PTGS2, and possibly MMP-3. Conclusions Our analysis illustrates that nasal epithelial barrier dysregulation and maladaptive immune responses are key components of NPC pathogenesis along with LPS-induced tissue damage.
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Affiliation(s)
- David Z. Allen
- The Ohio State College of Medicine, Columbus, Ohio, United States of America
- * E-mail:
| | - Jihad Aljabban
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, United States of America
| | - Dustin Silverman
- Department of Otolaryngology, The Ohio State Wexner Medical Center, Columbus, Ohio, United States of America
| | - Sean McDermott
- The Ohio State College of Medicine, Columbus, Ohio, United States of America
| | - Ross A. Wanner
- The Ohio State College of Medicine, Columbus, Ohio, United States of America
| | - Michael Rohr
- University of Central Florida, Orlando, Florida, United States of America
| | - Dexter Hadley
- Department of Pathology, University of Central Florida, Orlando, Florida, United States of America
| | - Maryam Panahiazar
- Department of Surgery, University of California San Francisco, San Francisco, California, United States of America
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17
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Does three cycles of neoadjuvant chemotherapy prior to concurrent chemoradiotherapy provide benefits for all childhood patients with locoregionally advanced nasopharyngeal carcinoma? J Cancer Res Clin Oncol 2021; 148:2569-2579. [PMID: 34618220 DOI: 10.1007/s00432-021-03817-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/24/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Adding neoadjuvant chemotherapy (NAC) to concurrent chemoradiotherapy (CCRT) is the main strategy in treatment of children and adolescents with locoregionally advanced nasopharyngeal carcinoma (CA-LANPC). Yet, an optimal number of NAC cycles remains unknown. We aimed to optimize the NAC cycle and potentially contribute to clinical decision making for the individual treatment of CA-LANPC. PATIENTS AND METHODS Utilizing an NPC-specific database through an acknowledged big-data information system at our center, we identified 143 CA-LANPC treated with NAC followed by CCRT between September 2007 through April 2018. Recursive partitioning analysis (RPA) was performed to categorize the patients and predict disease-free survival (DFS). The clinical benefits of NAC cycles (two cycles vs three cycles) were assessed in each risk group. RESULTS Independent factors derived from multivariable analysis to predict DFS were T stage (T1-3 vs T4) and plasma Epstein-Barr virus (EBV) DNA (< 4000 vs ≥ 4000 copies/mL) for risk stratification. Consequently, 87 (61%) participants were classified as low-risk group (T1-3 with low or high EBV DNA, and T4 with low EBV DNA) and the other 56 patients (39%) were classified as a high-risk group (T4 with high EBV DNA) through RPA, and corresponding 5-year DFS rates of 91.9% and 71.2%, respectively (p = 0.001). Among the high-risk group, patients receiving three cycles of NAC had statistically significant improvement in 5-year DFS over those who received two cycles of NAC (86.7% vs 59.1%; p = 0.020), while the survival benefit of three cycles NAC for low-risk groups were not observed (94.7% vs 89.7%; p = 0.652). CONCLUSIONS We found three cycles of NAC with CCRT was a positive prognostic indicator for improved DFS for the high-risk group among CA-LANPC. However, whether low-risk patients could benefit from three cycles NAC needs further study.
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Zeng Z, Chen C, Guo L, Zhang C, Chen L, Yuan C, Lu L. Exploring the Optimal Chemotherapy Strategy for Locoregionally Advanced Children and Adolescent Nasopharyngeal Carcinoma Based on Pretreatment Epstein-Barr Virus DNA Level in the Era of Intensity Modulated Radiotherapy. Front Oncol 2021; 10:600429. [PMID: 33489902 PMCID: PMC7817979 DOI: 10.3389/fonc.2020.600429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/20/2020] [Indexed: 12/08/2022] Open
Abstract
Background The present study aimed to explore the optimal chemotherapy strategy for locoregionally advanced children and adolescent nasopharyngeal carcinoma (LcaNPC), based on the level of pretreatment plasma Epstein-Barr virus DNA (pEBV-DNA) in the era of intensity modulated radiation therapy (IMRT). Methods This real-world, retrospective study consecutively reviewed locoregionally advanced nasopharyngeal carcinoma patients younger than 22 years old from 2006 to 2016 in the Sun Yat-sen University Cancer Center. The Kaplan–Meier method with the log-rank test and the Cox regression model were used to investigate the survival outcomes of different chemotherapy intensities and pEBV-DNA. Treatment-related toxicity was also evaluated using the chi-squared test or Fisher’s exact test. Results A total of 179 patients were enrolled, including 86 patients in the high-risk group (pEBV-DNA ≥7,500 copies/ml) and 93 patients in the low-risk group (pEBV-DNA <7,500 copies/ml). Among all patients, those receiving low intensity induction chemotherapy (IC courses = 2) had a better 5-year overall survival (OS) than those receiving no IC (P = 0.025) and high intensity IC (IC courses >2) (P = 0.044). In the high-risk group, receipt of low intensity IC showed significant 5-year OS (P = 0.032), progression-free survival (PFS) (P = 0.027), and 5-year distant metastasis-free survival (DMFS) (P = 0.008) benefits compared with not receiving IC. Multivariate analyses identified that not receiving IC was a risk factor compared with low intensity IC for OS (hazard ratio (HR) = 10.933, P = 0.038) among all patients. Moreover, in the high-risk group, not receiving IC was a risk factor for 5-year OS (HR = 10.878, P = 0.038), 5-year PFS (HR = 5.705, P = 0.041), and 5-year DMFS (HR = 10.290, P = 0.040) compared to low intensity IC. There were no differences in survival for patients treated with or without concurrent chemotherapy. Conclusion Two courses of platinum-based IC might be the optimal induction chemotherapy intensity to reduce risk of death, progression, and distant metastasis in patients with high pEBV-DNA levels.
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Affiliation(s)
- Ziyi Zeng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chen Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lanlan Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Cheng Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lei Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chuanping Yuan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Oncology, Xinyu People's Hospital, Xinyu, China
| | - Lixia Lu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
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19
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Swain SK, Samal S, Mohanty JN, Choudhury J. Nasopharyngeal carcinoma among the pediatric patients in a non-endemic region: our experience at a tertiary care teaching hospital in Eastern India. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2020. [DOI: 10.1186/s43054-020-00036-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nasopharyngeal carcinoma (NPC) is an extremely rare malignant lesion among the pediatric age group. The relative rarity of pediatric NPC makes the diagnosis difficult. This rarity is often associated with delayed diagnosis which may lead to advanced loco-regional disease. Here, we study the clinical presentations, investigations, and treatment of nasopharyngeal carcinoma in the pediatric age group in a non-endemic region.
Result
This is a retrospective study where 21 pediatric patients were enrolled with age under 18 years. They were managed at a tertiary care teaching hospital between December 2010 and January 2019. Majority of the patients in this study were boys (66.7%). All children diagnosed with NPC were treated with radiotherapy covering entire nasopharynx and some children with chemotherapy. Until the patient is in a late stage, most children diagnosed with NPC were presenting with symptoms of neck mass (90.5%), bleeding from the nose (66.7%), nasal blockage (57.1%), and hearing loss (47.6%). Pathological report revealed WHO type III in the majority of the patients. All patients were treated with radiotherapy to primary and enlarged neck nodes.
Conclusion
Children with NPC have excellent survival except for those with distant metastatic disease. NPC in the pediatric age is usually not suspected clinically until patient in late stage. The TNM staging has the most relevant prognostic factor. Unfortunately, NPC tends to be locally advanced at the time of diagnosis in the pediatric age group and is sometimes associated with distant metastasis. In our study, most children were diagnosed with NPC along with neck node enlargement and were treated with radiotherapy. The diagnosis of pediatric NPC should prompt timely treatment.
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Pontoriero F, Silverman AM, Pascasio JM, Bajaj R. Nonkeratinizing Nasopharyngeal Carcinoma, Undifferentiated Type With Trisomy 2: A Case Report and Short Review of Cytogenetic and Molecular Literature. Pediatr Dev Pathol 2020; 23:448-452. [PMID: 32755442 DOI: 10.1177/1093526620945861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Carcinoma originating from the surface epithelium of the nasopharynx is classified by the World Health Organization (WHO) as nasopharyngeal carcinoma (NPC) and has 3 main types: keratinizing squamous cell carcinoma (WHO type 1) and nonkeratinizing carcinoma, differentiated (WHO type II), and undifferentiated (WHO type III). Nonkeratinizing NPC is strongly associated with prior Epstein-Barr virus (EBV) infection. These tumors may be divided into differentiated and undifferentiated carcinoma. Histologically, the tumor is characterized by syncytia of large malignant cells with vesicular nuclei, conspicuous nucleoli, and easily observed mitotic figures. We report a case of a 14-year-old boy diagnosed with EBV and human papillomavirus (HPV)-positive NPC (WHO type 3) with cytogenetics showing the presence of mosaic trisomy 2. This case report brings to light a rare cytogenetic aberration to our knowledge only reported once before in the literature in a xenograft model.
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Affiliation(s)
- Francesco Pontoriero
- St. Christopher's Hospital for Children-Department of Pathology and Laboratory Medicine, Philadelphia, Pennsylvania
| | - Ayaka M Silverman
- St. Christopher's Hospital for Children-Department of Pathology and Laboratory Medicine, Philadelphia, Pennsylvania
| | - Judy M Pascasio
- St. Christopher's Hospital for Children-Department of Pathology and Laboratory Medicine, Philadelphia, Pennsylvania
| | - Renu Bajaj
- St. Christopher's Hospital for Children-Department of Pathology and Laboratory Medicine, Philadelphia, Pennsylvania
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Hasnaoui M, Lahmar R, Ben Mabrouk A, Masmoudi M, Mighri K, Driss N. Predictive epidemiological and clinical factors of nasopharyngeal carcinoma diagnosis: Adult versus pediatric population. Int J Pediatr Otorhinolaryngol 2020; 137:110203. [PMID: 32658801 DOI: 10.1016/j.ijporl.2020.110203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study is to compare the clinical presentation and the cancer staging of nasopharyngeal carcinoma (NPC) between pediatric and adult populations to highlight the main characteristics of this disease within the two subgroups. MATERIEL AND METHODS It is a retrospective study including all patients with a primary diagnosis of NPC over a period of 19 years. The pediatric group included patients aged less then 16 years old. RESULTS A total of 80 patients were included. The pediatric population represented 22.5% of the cases. No difference in gender distribution was found (p˃.05). The most common presenting symptom was neck mass in children (77.8% vs. 48.4%, p = .02), and nasal obstruction in adult patients (64.5% vs. 16.7%, p < .01). The median time between the presenting symptom's onset and the diagnosis was 5 months. The diagnosis of NPC was delayed in pediatric patients compared to adults (<0.05). We noted a predominance of patients with stages III and IV (32.5% and 40%, respectively) with no difference between the two subgroups (p˃.05). CONCLUSION Our study showed some differences in NPC clinical features between pediatric patients and adults. Neck mass was the most common symptom in children. The initial presentation is sometimes misleading. NPC was mainly diagnosed in advanced locoregional stages in both pediatric and adult patients. Efforts toward early diagnosis are of great importance.
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Affiliation(s)
- Mehdi Hasnaoui
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia 5100, Tunisia.
| | - Rihab Lahmar
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia 5100, Tunisia.
| | - Asma Ben Mabrouk
- Pediatric Department, Tahar Sfar Hospital, Mahdia 5100, Tunisia.
| | - Mohamed Masmoudi
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia 5100, Tunisia.
| | - Khalifa Mighri
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia 5100, Tunisia.
| | - Nabil Driss
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia 5100, Tunisia.
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Chen C, Chen Q, Xu Y, Zheng W, Lin Z, Wu Z, Ye W, Huang X, Lin X, Bai P. Comparison of Prognosis Between Juvenile and Adult Nasopharyngeal Carcinoma: A Propensity Score-Matched Analysis. Cancer Manag Res 2020; 12:8613-8621. [PMID: 32982452 PMCID: PMC7509313 DOI: 10.2147/cmar.s260402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose To investigate whether juvenile patients with nasopharyngeal carcinoma (NPC) in China have better prognosis than their adult counterparts in the intensity-modulated radiation therapy (IMRT) era, after controlling for potential confounding variables. Methods Data pertaining to 1139 patients with newly diagnosed NPC without metastasis, who were treated with IMRT at our hospital, were retrospectively analyzed. Of these, 60 patients were juvenile (age ≤18 years) diagnosed between January 2003 and December 2018, while 1079 patients were adults (≤65 years) diagnosed between January 2013 and December 2014. To minimize the influence of selection and confounding bias, 1:2 propensity score matching (PSM) was used. Overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated using the Kaplan–Meier method and between-group differences assessed using the Log rank test. The long-term toxicity of the juvenile patients was evaluated according to the criteria of the Radiation Therapy Oncology Group (RTOG) and the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results Five-year OS of juvenile and adult patients were 88.07% and 85.08%, respectively. Before PSM, OS, PFS, DMFS, or LRFS were comparable in the two groups (all P > 0.05). After PSM, OS, DFS, and LRFS in the juvenile group were markedly longer than that in adults (P = 0.005, P = 0.027, and P = 0.024, respectively). With respect to long-term toxicity, the most common adverse effects in juvenile patients were cervix fibrosis, ototoxicity, and xerostomia. However, except for two patients who developed grade 3 ototoxicity, all adverse effects were within grade 2. Conclusion In the IMRT era, juvenile Chinese patients with NPC had better 5-year OS, DFS, and LRFS than their adult counterparts. The adverse events in the juvenile cohort were relatively mild; however, the risk of severe ototoxicity should not be neglected.
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Affiliation(s)
- Chuanben Chen
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People's Republic of China
| | - Qinyan Chen
- Graduate School, Fujian Medical University, Fuzhou 350000, Fujian Province, People's Republic of China
| | - Yuanji Xu
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People's Republic of China
| | - Wei Zheng
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People's Republic of China
| | - Zhizhong Lin
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People's Republic of China
| | - Zijie Wu
- Graduate School, Fujian Medical University, Fuzhou 350000, Fujian Province, People's Republic of China
| | - Wangzhong Ye
- Graduate School, Fujian Medical University, Fuzhou 350000, Fujian Province, People's Republic of China
| | - Xinyi Huang
- Graduate School, Fujian Medical University, Fuzhou 350000, Fujian Province, People's Republic of China
| | - Xiurong Lin
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People's Republic of China
| | - Penggang Bai
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People's Republic of China
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Ben-Ami T, Ash S, Ben-Harosh M, Gavriel H, Weintraub M, Revel-Vilk S, Ben-Arush M. Nasopharyngeal carcinoma in children and young adults-Beyond 5-year survival. Pediatr Blood Cancer 2020; 67:e28494. [PMID: 32573923 DOI: 10.1002/pbc.28494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/08/2020] [Accepted: 05/26/2020] [Indexed: 11/06/2022]
Abstract
Nasopharyngeal carcinoma (NPC) is a rare and locally aggressive form of childhood cancer. Treatment of NPC includes chemotherapy and radiotherapy. With current treatment protocols, survival rates for patients with nonmetastatic disease is over 80%. Data regarding very late events including long-term treatment-related morbidities and second malignancies are scarce. We present our data on 42 patients with NPC treated in Israel between 1989 and 2014, and followed until 2019. During follow up, five patients had disease recurrence, and four children developed secondary malignancy. Median time to diagnosis of secondary malignancy was 105 months. Eighty-eight percent of patients have long-term treatment-related morbidities.
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Affiliation(s)
- Tal Ben-Ami
- Pediatric Hematology-Oncology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Shifra Ash
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Miri Ben-Harosh
- Department of Pediatric Hematology-Oncology, Soroka Medical Center, Beer-Sheva, Israel
| | - Herzel Gavriel
- Pediatric Hematology-Oncology Unit, Haemek Medical Center, Afula, Israel
| | - Michael Weintraub
- Pediatric Oncology, ALYN Hospital Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | - Shoshana Revel-Vilk
- Pediatric Hematology, Sharee Zedek Medical Center, Affiliated with Hadassah - Hebrew University Medical School, Jerusalem, Israel
| | - Myriam Ben-Arush
- Division of Pediatric Hematology/Oncology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
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24
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Orman G, Tran BH, Desai N, Meoded A, Kralik S, Smith V, Hicks J, Kirsch C, Huisman TAGM. Neuroimaging Characteristics of Nasopharyngeal Carcinoma in Children. J Neuroimaging 2020; 31:137-143. [PMID: 32862510 DOI: 10.1111/jon.12780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/18/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Pediatric nasopharyngeal carcinoma (NPC) is a rare epithelial origin tumor associated with undifferentiated histology, Epstein-Barr virus (EBV) infection, and genetic risk factors. Childhood NPC is usually clinically silent, often presenting with advanced locoregional compromise, including skull base invasion and cervical lymphadenopathy, and has a better prognosis than adult NPC. This article describes computed tomography (CT) and magnetic resonance imaging (MRI) features in a cohort of 28 pediatric NPC patients. METHODS A retrospective review was performed among children with histopathology proven NPC diagnoses between 1996 and 2019 for this study. The electronic medical records were reviewed to determine demographics, EBV serology, and World Health Organization (WHO) type. Nasopharyngeal CT and/or MRI at presentation for tumor spread as well as density and/or intensity, lymphadenopathy, postcontrast enhancement and diffusion characteristics before treatment were evaluated. RESULTS Twenty-eight patients (21 males, 7 females) were included. The mean patient age at diagnosis was 13.3 (range 7 to 17) years. EBV was positive in 71.4% of patients. The majority of patients (78.6%) had a WHO type III tumor, unilateral fossa of Rosenmuller involvement (71.4%). Neuroimaging features were CT isodensity, T1-isointensity, T2-hyperintensity, and heterogeneous postcontrast enhancement for all patients (100%) and restricted diffusion (90%). CONCLUSIONS Although uncommon in pediatric patients, NPC should be in the differential diagnosis of adolescents presenting with a nasopharyngeal mass. Recognizing key imaging characteristics is helpful in the diagnosis of NPC.
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Affiliation(s)
- Gunes Orman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, TX
| | - Brandon H Tran
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, TX
| | - Nilesh Desai
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, TX
| | - Avner Meoded
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, TX
| | - Stephen Kralik
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, TX
| | - Valeria Smith
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX
| | - John Hicks
- Department of Pathology, Baylor College of Medicine, One Baylor Plaza, Houston, TX
| | - Claudia Kirsch
- Department of Radiology, Northwell Health Zucker Hofstra School of Medicine at Northwell North Shore University Hospital, Manhasset, NY
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Cui Z, Pu T, Zhang Y, Wang J, Zhao Y. Long non-coding RNA LINC00346 contributes to cisplatin resistance in nasopharyngeal carcinoma by repressing miR-342-5p. Open Biol 2020; 10:190286. [PMID: 32397872 PMCID: PMC7276527 DOI: 10.1098/rsob.190286] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/25/2020] [Indexed: 12/28/2022] Open
Abstract
Cisplatin has been used as the first-line chemotherapy to treat advanced nasopharyngeal carcinoma (NPC), while acquired cisplatin resistance resulting from epigenetic regulation is not well understood. The relative expression of LINC00346 was detected in healthy persons, cisplatin-sensitive (CS) patients and cisplatin-resistant (CR) patients. The regulatory effect of LINC00346 on the proliferation was detected by cell-counting kit-8. Apoptosis was assayed by histone/DNA ELISA and Caspase-3 activity. Clonal formation and cisplatin resistance were also deciphered. Luciferase reporter and RNA immunoprecipitation assay were adopted to study the interaction between LINC00346 and miR-342-5p. LINC00346 was highly expressed in NPC patients, especially in CR patients, which was associated with cisplatin resistance and poor prognosis. Inhibition of LINC00346 expression promoted cisplatin sensitivity of NPC cells, while LINC00346 over-expression promoted cisplatin resistance of NPC cells. miR-342-5p expression was negatively correlated with cisplatin resistance, and microRNA-342-5p siRNAs treatment could rescue the cisplatin resistance diminished by LINC00346 inhibition. It was further found that miR-342-5p was negatively regulated by LINC00346. In conclusion, LINC00346 regulates the cisplatin resistance of NPC cells by inhibiting miR-342-5p, which could provide a potential target for chemotherapy resistance.
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Affiliation(s)
- Zheqing Cui
- Department of Rhinology, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan 450052, People's Republic of China
| | - Tian Pu
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan 450052, People's Republic of China
| | - Yujie Zhang
- Department of Rhinology, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan 450052, People's Republic of China
| | - Jia Wang
- Department of Rhinology, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan 450052, People's Republic of China
| | - Yulin Zhao
- Department of Rhinology, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan 450052, People's Republic of China
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Pediatric Nasopharyngeal Carcinoma: A Rare Tumor in a Developing Country-What Do We Learn? J Pediatr Hematol Oncol 2020; 42:e140-e146. [PMID: 31789781 DOI: 10.1097/mph.0000000000001676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIM Nasopharyngeal carcinoma (NPC) is rare in children, accounting for 1% of pediatric malignancies. The 5-fluorouracil Cisplatin regimen could be considered as a standard of care induction chemotherapy followed by concomitant chemoradiotherapy. This study aimed at detecting the survival outcome in correlation with different prognostic factors together with the toxicity of different treatment modalities. PATIENTS AND METHODS This was a retrospective study carried out from 2007 to 2016 that included all NPC patients below 18 years treated at the National Cancer Institute, Egypt. RESULTS A total of 21 patients were included with a median follow-up period of 33.9 months. The median age was 14.8 years (range: 9 to 18). All patients were treated by neoadjuvant chemotherapy with cisplatin and 5- fluorouracil, followed by concurrent radiotherapy (median dose: 61.2 Gy) and cisplatin as a radiosensitizer. After induction chemotherapy, the response rate was 53%. After completion of treatment, 67% had a complete response; partial response was seen in 14%; and progressive disease was seen in 19%. By the end of the study, 7 (33.3%) patients had progression/relapse; 4 of them died from disease. The 3-year overall survival and event-free survival were 85.7% and 66.7%, respectively. CONCLUSIONS Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy was an effective strategy in the treatment of pediatric NPC with good overall survival and event-free survival. High systemic failure (33.3%) remains another challenge to solve. More efforts should be made to improve survival by developing more efficient systemic treatment modalities, especially for progressive/relapsed disease. Multicenter studies on a larger number of patients are needed to identify different prognostic factors and standardize treatment strategies.
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27
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Qiu W, Lv X, Guo X, Yuan Y. Clinical Implications of Plasma Epstein-Barr Virus DNA in Children and Adolescent Nasopharyngeal Carcinoma Patients Receiving Intensity-Modulated Radiotherapy. Front Oncol 2020; 10:356. [PMID: 32296633 PMCID: PMC7136458 DOI: 10.3389/fonc.2020.00356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Plasma Epstein–Barr virus (EBV) DNA has been determined as a prognostic factor in adult nasopharyngeal carcinoma (NPC) patients. This study was designed to evaluate the prognostic value of plasma pretreatment EBV DNA in children and adolescent NPC patients receiving intensity-modulated radiotherapy (IMRT). Methods: Pretreatment EBV DNA was retrospectively assessed in 147 children with newly diagnosed, non-metastatic NPC. All patients were treated using IMRT. Receiver operating characteristic (ROC) curve was used to identify the optimal EBV DNA cutoff point. Prognostic value was examined using a multivariate Cox proportional hazards model. Results: The median follow-up for the entire cohort was 58 months (range, 10–119 months), and the 5-year survival rates for all patients were as follows: overall survival (OS), 88.7%; locoregional relapse-free survival, 95.2%; distant metastasis-free survival (DMFS), 84.8%; and disease-free survival (DFS), 81.5%. For ROC curve analysis, the optimal cutoff value of pretreatment EBV DNA load for DFS was 40,000 copies/mL. High plasma EBV DNA was significantly associated with poorer 5-year DMFS (70.6 vs. 89.1%, P = 0.003) and DFS (63.9 vs. 86.9%, P < 0.001). In multivariate analysis, high plasma EBV DNA was an independent predictor for DMFS and DFS. Conclusions: Pretreatment EBV DNA level was a powerful prognostic discriminator for DMFS and DFS in children and adolescent NPC patients treated with IMRT.
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Affiliation(s)
- Wenze Qiu
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xing Lv
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiang Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yawei Yuan
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
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Comparison of Long-Term Outcomes and Sequelae Between Children and Adult Nasopharyngeal Carcinoma Treated With Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 106:848-856. [DOI: 10.1016/j.ijrobp.2019.11.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 10/29/2019] [Accepted: 11/26/2019] [Indexed: 12/24/2022]
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Mohebbi S, Aghajanpour M. From Juvenile Nasopharyngeal Angiofibroma to Nasopharyngeal Carcinoma; A Rare Case Report of Nasopharyngeal Mass. Bull Emerg Trauma 2019; 7:424-426. [PMID: 31858008 PMCID: PMC6911716 DOI: 10.29252/beat-070414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Nasopharyngeal masses in young males, first of all presumes Juvenile Nasopharyngeal Angiofibroma (JNA) in the mind, but other benign or malignant tumors should be considered for successful and adequate management of patients and also for minimizing morbidity from unnecessary interventions. We herein present a patient with nasopharyngeal carcinoma (NPC) mimicking JNA. The patient was presumed as JNA and underwent excessive surgical intervention and the final histopathology report was NPC. The aim of our case report is to highlight the importance of complete clinical examination and preoperative imaging in differentiating and ideal management of nasopharyngeal masses.
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Affiliation(s)
- Saleh Mohebbi
- Department of Rhinology and Skull Base Surgery, ENT and Head and Neck Research Center, Hazrat Rasoul Hospital, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Aghajanpour
- Department of Rhinology and Skull Base Surgery, ENT and Head and Neck Research Center, Hazrat Rasoul Hospital, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
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Uezono H, Indelicato DJ, Rotondo RL, Sandler ES, Katzenstein HM, Dagan R, Mendenhall WM, Mailhot Vega R, Brennan BM, Bradley JA. Proton therapy following induction chemotherapy for pediatric and adolescent nasopharyngeal carcinoma. Pediatr Blood Cancer 2019; 66:e27990. [PMID: 31524334 DOI: 10.1002/pbc.27990] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/16/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE In children treated for nasopharyngeal carcinoma, proton therapy and postchemotherapy target volumes can reduce the radiation dose to developing tissue in the brain and the skull base region. We analyzed outcomes in children with nasopharyngeal carcinoma treated with induction chemotherapy followed by moderate-dose proton therapy. METHODS/MATERIALS Seventeen patients with nonmetastatic nonkeratinizing undifferentiated/poorly differentiated nasopharyngeal carcinoma underwent double-scattered proton therapy between 2011 and 2017. Median age was 15.3 years (range, 7-21). The American Joint Committee on Cancer T and N stage distribution included the following: T1, one patient; T2, five patients; T3, two patients; and T4, nine patients; and N1, six patients; N2, nine patients; and N3, two patients. Median radiation dose to the primary target volume and enlarged lymph nodes was 61.2 Gy (range, 59.4-61.2). Uninvolved cervical nodes received 45 Gy (range, 45-46.8). All radiation was delivered at 1.8 Gy/fraction daily using sequential plans. In 11 patients, photon-based intensity-modulated radiotherapy was used for elective neck irradiation to optimize dose homogeneity and improve target conformity. All patients received induction chemotherapy; all but one received concurrent chemotherapy. Five received adjuvant beta-interferon therapy. RESULTS Median follow-up was 3.0 years (range, 1.6-7.9). No patients were lost to follow-up. Overall survival, progression-free survival, and local control rates were 100%. Fifteen patients developed mucositis requiring enteral feeding (n = 14) or total parenteral nutrition (n = 1) during radiotherapy. Serious late side effects included cataract (n = 1), esophageal stenosis requiring dilation (n = 1), sensorineural hearing loss requiring aids (n = 1), and hormone deficiency (n = 5, including three with isolated hypothyroidism). CONCLUSION Following induction chemotherapy, moderate-dose proton therapy can potentially reduce toxicity in the brain and skull base region without compromising disease control. However, further follow-up is needed to fully characterize and evaluate any reduction in long-term complications.
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Affiliation(s)
- Haruka Uezono
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Ronny L Rotondo
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Eric S Sandler
- Department of Pediatric Oncology, Nemours Children's Specialty Clinic, Jacksonville, Florida
| | - Howard M Katzenstein
- Department of Pediatric Oncology, Nemours Children's Specialty Clinic, Jacksonville, Florida
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Raymond Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Bernadette M Brennan
- Department of Pediatric Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
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Rodriguez-Galindo C, Krailo MD, Krasin MJ, Huang L, McCarville MB, Hicks J, Pashankar F, Pappo AS. Treatment of Childhood Nasopharyngeal Carcinoma With Induction Chemotherapy and Concurrent Chemoradiotherapy: Results of the Children's Oncology Group ARAR0331 Study. J Clin Oncol 2019; 37:3369-3376. [PMID: 31553639 DOI: 10.1200/jco.19.01276] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The treatment of childhood nasopharyngeal carcinoma has been adapted from adult regimens; pediatric-specific studies are limited. The ARAR0331 study sought to evaluate the impact of induction chemotherapy (IC) and concurrent chemoradiotherapy (CCR). PATIENTS AND METHODS Patients with American Joint Committee on Cancer stages IIb to IV were scheduled to receive three cycles of IC with cisplatin and fluorouracil, followed by CCR with three cycles of cisplatin. Patients with complete or partial response to IC received 61.2 Gy to the nasopharynx and neck, and patients with stable disease received 71.2 Gy. RESULTS Between February 2006 and January 2012, 111 patients (75 male) were enrolled. Median age was 15 years, and 46.8% of the patients were African American. After a feasibility analysis, the study was amended to reduce cisplatin to two cycles during CCR. The 5-year event-free survival (EFS) and overall survival estimates were 84.3% and 89.2%, respectively. The 5-year EFS for stages IIb, III, and IV were 100%, 82.8%, and 82.7%, respectively. The 5-year cumulative incidence estimates of local, distant, and combined relapse were 3.7%, 8.7%, and 1.8%, respectively. Patients treated with three versus two CCR cycles of cisplatin had improved 5-year postinduction EFS (90.7% v 81.2%, P = .14). CONCLUSION Patients in ARAR0331 were characterized by advanced disease and by a high proportion of black children and adolescents. Treatment with IC and CRT resulted in excellent outcomes. A radiation dose reduction is possible for patients responding to IC. Although the outcomes are comparable, we observed a trend toward decreased EFS for patients assigned to receive fewer doses of cisplatin during CCR.
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Affiliation(s)
| | - Mark D Krailo
- Children's Oncology Group, Monrovia, CA.,University of Southern California, Los Angeles, CA
| | | | - Li Huang
- Children's Oncology Group, Monrovia, CA
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Argirion I, Zarins KR, Ruterbusch JJ, Vatanasapt P, Sriplung H, Seymour EK, Rozek LS. Increasing incidence of Epstein-Barr virus-related nasopharyngeal carcinoma in the United States. Cancer 2019; 126:121-130. [PMID: 31524955 DOI: 10.1002/cncr.32517] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/17/2019] [Accepted: 08/09/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND The incidence of nasopharyngeal carcinoma (NPC) has been historically low in the United States. Although etiological factors differ by histological subtype, Epstein-Barr virus is accepted as the primary risk factor for nonkeratinizing NPC. In light of the changing epidemiology of viral-associated cancers, it is important to evaluate the temporal incidence of NPC in the United States. METHODS Incidence and survival data from 1973 through 2015 were obtained from the Surveillance, Epidemiology, and End Results program. Stratified analyses were conducted to assess temporal trends in NPC by histological subtype, sex, and race. The data were analyzed using SAS and Joinpoint Regression Software to determine age-adjusted incidence rates, determine trends in the annual percent change, and calculate 5-year relative survival estimates and Kaplan-Meier curves. RESULTS Although overall NPC incidence is decreasing in the United States, the nonkeratinizing differentiated subtype is starkly increasing, with an annual percent change of approximately 4% among white males (95% CI, 2.5%-5.2%), white females (95% CI, 1.9%-6.2%), and black males (95% CI, 2.0%, 5.7%); 2.7% among black females (95% CI, 0.8%, 4.6%); and 1.8% among women in the "other" race category (95% CI, 0.4%-3.3%). Racial disparities were noted, with 32% of nonkeratinizing NPC cases among blacks occurring before the age of 40 years. In addition, black males displayed consistently worse survival across all histological subtypes, whereas individuals in the "other" race category, particularly females, experienced the highest 5-year relative survival estimates. CONCLUSIONS The current results indicate that the Epstein-Barr virus-related, differentiated NPC subtype is increasing across all sexes and races in the United States, with distinct incidence and survival disparities among blacks.
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Affiliation(s)
- Ilona Argirion
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Katie R Zarins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Julie J Ruterbusch
- Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan
| | - Patravoot Vatanasapt
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Thailand.,Khon Kaen Head and Neck Oncology Research, Khon Kaen University, Thailand
| | - Hutcha Sriplung
- Songkhla Cancer Registry, Prince of Songkla University, Songkhla, Thailand
| | - Erlene K Seymour
- Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan
| | - Laura S Rozek
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
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Claude L, Jouglar E, Duverge L, Orbach D. Update in pediatric nasopharyngeal undifferentiated carcinoma. Br J Radiol 2019; 92:20190107. [PMID: 31322911 DOI: 10.1259/bjr.20190107] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Many of the principles established in adults with undifferentiated nasopharyngeal carcinoma (NPC) apply to children, adolescents and young adults. However, NPC in young patients should be distinguished from the adult form by several points. This review focuses mainly on differences between adult and pediatric NPC. The role of biology and genetics in pediatric NPC is discussed. Systemic treatment modalities including type of chemotherapy induction, timing of treatment, role of immunotherapy as adjuvant treatment, or in relapsing/ metastatic diseases are reported. Radiation modalities (doses, techniques…) in children are also reviewed. Long-term effects including secondary cancers are finally be discussed in this young NPC population.
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Affiliation(s)
- Line Claude
- Department of radiotherapy, Centre Léon Bérard, Lyon, France
| | - Emmanuel Jouglar
- Department of radiotherapy, Institut de Cancérologie de l'Ouest - Centre René Gauducheau, Saint-Herblain, France
| | - Loig Duverge
- Department of radiotherapy, Centre Léon Bérard, Lyon, France.,Department of radiotherapy, Centre Eugène Marquis, Rennes, France
| | - Daniel Orbach
- SIREDO oncology center (Care, Innovation and Research for Children, Adolescents and Young Adults with cancer), Institut Curie, PSL university, Paris, France
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Lu S, Wei J, Sun F, Xiao W, Cai R, Zhen Z, Zhu J, Wang J, Huang J, Lu L, Sun X, Gao Y. Late Sequelae of Childhood and Adolescent Nasopharyngeal Carcinoma Survivors After Radiation Therapy. Int J Radiat Oncol Biol Phys 2019; 103:45-51. [DOI: 10.1016/j.ijrobp.2018.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/25/2022]
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Treatment outcome of childhood nasopharyngeal carcinoma: A single institution experience. Int J Pediatr Otorhinolaryngol 2018; 113:168-172. [PMID: 30173978 DOI: 10.1016/j.ijporl.2018.07.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Nasopharyngeal carcinoma is a rare malignancy in children. The aim of this study was to provide analysis of children with nasopharyngeal carcinoma treated in a single institution. METHODS AND MATERIALS Between 1999 and 2016, fourteen pediatric patients with a diagnosis of undifferentiated nasopharyngeal carcinoma were treated in our institution, and the patients' clinical characteristics, treatment modality, outcome, and toxicity were analyzed. RESULTS The median age at diagnosis was 15,5 years. The gender ratio was 1:1. The majority of patients had regionally and/or locally advanced tumors and one had bone metastases at the time of diagnosis. All patients received chemotherapy before radiotherapy, with partial response in thirteen patients and complete response in one. Radiation dose to the primary tumor and involved cervical lymph nodes was 55-60 Gy, uninvolved cervical and supraclavicular regions received prophylactic radiation with dose of 45-50 Gy. Ten patients received adjuvant chemotherapy. Three-year progression-free rate and three-year overall survival (OS) rates were 75% and 73% respectively. Five-year progression-free rate was 65% and OS 63% respectively, and after ten years progression-free rate and OS remained the same. At the end of follow-up period, ten patients were alive, and four died. All of the patients that had distant metastases died. Most common late complications were skin fibrosis and xerostomia. CONCLUSIONS Multimodal therapy of children with nasopharyngeal carcinoma is associated with long-term survival. It is expected that further advances in the management of these patients, with improved radiotherapy and chemotherapy, will reduce acute and late toxicity and improve quality of life of treated children.
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Abstract
In children, nasopharyngeal carcinoma (NPC) is a very rare tumor, mostly Epstein-Barr Virus related and quite always diagnosed at a locally advanced stage. With current protocols associating induction cisplatin-based chemotherapy and concomitant chemoradiotherapy, prognosis is excellent with overall survival higher than 85%. However, long-term toxicities are frequent. Improvement in radiation therapy modalities like intensity-modulated radiation therapy and new strategies with radiation dose adaptation to chemotherapy response have been introduced to reduce acute and long-term toxicities. Actually, 2 main questions remain: is it possible to pursue a therapeutic deescalation in children with low-risk NPC or very good response to induction chemotherapy in order to reduce the risk of late effects? Could an immunologic maintenance treatment improve prognosis of children with high-risk NPC? International collaborative groups and prospective trials including biological studies are necessary to answer these questions to improve childhood NPC treatment and knowledge.
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Li C, Wang Y. Factors associated with early diagnosis in pediatric vs adult nasopharyngeal carcinoma. Acta Otolaryngol 2018; 138:56-59. [PMID: 28875765 DOI: 10.1080/00016489.2017.1371330] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To improve understanding of the initial symptom between pediatric and adult nasopharyngeal carcinoma (NPC) and to improve the early diagnosis of NPC. METHODS This retrospective cohort study included all 353 patients with a primary diagnosis of NPC in the First Affiliated Hospital of Zhengzhou University from January 2010 to December 2016. Of these, 34 patients were 21 years or younger (pediatric); 319 patients, older than 21 years (adult). Data were analyzed after data collection. RESULTS We found no difference between pediatric and adult patients in terms of their sex distribution (p > .05).Type III, undifferentiated carcinoma is the most common subtype in Pediatric patients, while adult patients had more squamous cell tumors (p < .01). Pediatric patients were more likely to present with stage IV disease (p < .05). Of the 353 patients, 120 (34.0%) had only one presenting symptom initially; however, most patients presented two or more episodes. Neck mass was the most common presenting symptom initially in children and adolescents, while multiple ear symptoms in adult patients (p = .003). The median time from onset of the presenting symptom to diagnosis is three months, adult patient presented longer history (64.7% vs 44.55, p < .05). Of the 319 adult patients, there were 142 which the time from onset of the presenting symptom to diagnosis is less than 3 months and there were 177 more than 3 months, the difference was significant between the two groups (p < .05). There were no differences in the misdiagnosis rate between pediatric and adult (35.1 vs 31.0, p > .05). Among pediatric patients, 31 (91.2%) had positive EBV DNA in peripheral plasma. EBV DNA was significantly associated with stage (p < .05). CONCLUSIONS Although uncommon, pediatric NPC appears to affect a different patient demographic relative to adult NPC. NPC in children is associated with undifferentiated carcinoma and more advanced disease presentation.
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Affiliation(s)
- Chang Li
- Department of Otolaryngology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Ying Wang
- Department of Otolaryngology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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Xie C, Li J, Weng Z, He LJ, Yin S, Zhang J, Zhang J, Sun T, Li H, Liu Y. Decreased Pituitary Height and Stunted Linear Growth After Radiotherapy in Survivors of Childhood Nasopharyngeal Carcinoma Cases. Front Endocrinol (Lausanne) 2018; 9:643. [PMID: 30510539 PMCID: PMC6252907 DOI: 10.3389/fendo.2018.00643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 10/10/2018] [Indexed: 11/21/2022] Open
Abstract
To examine the morphological changes of the pituitary glands and linear growth of childhood nasopharyngeal carcinoma (NPC) cases who accepted radiotherapy. A total of 90 children (i.e., age less than 18 years) who were diagnosed as NPC at Sun Yat-sen University Cancer Center from January 2009 to January 2016 were identified by reviewing medical records. Two radiologists reviewed and measured the pre-radiation, post-radiation, and the latest available pituitary gland heights independently. Patients' current height information was collected by telephone interviews. We compared the pituitary height differences using paired t-tests and estimated the pituitary height trajectories within each sex by mixed regression models. Height-for-age Z-score was calculated for each patient using the WHO growth reference data for 5-19 years as reference. Most of the included participants were of male sex (75.6%) and over half were diagnosed at stage IV (58.4%). Among the 90 included participants, 89 had one repeated measurement of the pituitary height and 79 had two repeated measurements of the pituitary height. Seventy six of the 89 childhood NPC participants had reduced pituitary heights after radiation and accounted for 85.4% of the whole population. The means of the pituitary heights before and after radiotherapy were 6.4 ± 1.3 mm and 5.6 ± 1.2 mm (P < 0.001), respectively. The mean of height-for-age Z-score for childhood NPC cases was significantly below zero (-0.54, 95% CI = -0.74, -0.34). We concluded that childhood NPC cases had decreased pituitary heights and stunted linear growth after radiotherapy.
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Affiliation(s)
- Chuanbo Xie
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Cancer Prevention Research, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- *Correspondence: Chuanbo Xie
| | - Jiaoxing Li
- Department of Neurology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zijin Weng
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Long-Jun He
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Endoscopy, Collaborative Innovation Center for Cancer Medicine, y, Guangzhou, China
| | - Shaohan Yin
- State Key Laboratory of Oncology in South China, Department of Medical Imaging, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jingwen Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jing Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Tao Sun
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Haojiang Li
- State Key Laboratory of Oncology in South China, Department of Medical Imaging, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- Haojiang Li
| | - Yuying Liu
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Cancer Prevention, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Yuying Liu
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Induction Methotrexate, Cisplatin, and 5-Fluorouracil Versus Cisplatin and 5-Fluorouracil Followed by Radiotherapy in Pediatric Nasopharyngeal Carcinoma: A Retrospective Analysis in a Tertiary Cancer Center. J Pediatr Hematol Oncol 2017; 39:e437-e442. [PMID: 28816803 DOI: 10.1097/mph.0000000000000933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study is to compare treatment outcomes of methotrexate, cisplatin, and 5-fluorouracil (MPF) or cisplatin and 5-fluorouracil (PF) in pediatric NPC patients treated with sequential chemoradiotherapy. PATIENTS AND METHODS A total of 25 patients aged 18 years or below with stage II-IV NPC treated with IC using PF (n=16) or MPF (n=9) followed by radiotherapy between 2003 and 2009 were retrospectively reviewed. Radiotherapy dose was 61.2 to 66.6 Gy to the gross disease. Age, stage, radiation dose, and chemotherapy regimen were tested as prognostic factors for event-free survival (EFS) and overall survival (OS) on univariate and multivariate analyses. RESULTS The median age at diagnosis was 13.3 years. All patients completed planned chemotherapy. All patients who received MPF achieved PR whereas 15 patients (93.8%) who received PF achieved PR (P=1). There were no differences in EFS (68.75% vs. 66.67%; P=0.84) and OS (81.25% vs. 66.67%; P=0.39) at 5 years between PF and MPF, respectively. On multivariate analysis, only tumor stage (IV vs. II-III) predicted worse OS (hazard ratio, 10.3; 95% confidence interval, 1.197-88.974) but not EFS (hazard ratio, 4.805; 95% confidence interval, 0.95-24.336). Distant metastases was the predominant site of failure, seen in 5 patients (20%). CONCLUSIONS Omission of methotrexate from the induction chemotherapy regimen did not affect treatment outcome.
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Huang X, Liu T, Wang Q, Zhu W, Meng H, Guo L, Wei T, Zhang J. Inhibition of N-acetylglucosaminyltransferase V enhances the cetuximab-induced radiosensitivity of nasopharyngeal carcinoma cells likely through EGFR N-glycan alterations. Glycobiology 2017; 27:713-725. [DOI: 10.1093/glycob/cwx046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/29/2017] [Accepted: 05/17/2017] [Indexed: 12/16/2022] Open
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Does concurrent chemoradiotherapy preceded by chemotherapy improve survival in locally advanced nasopharyngeal cancer patients? Experience from Ghana. CANCERS OF THE HEAD & NECK 2017; 2:4. [PMID: 31093351 PMCID: PMC6460522 DOI: 10.1186/s41199-017-0023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/22/2017] [Indexed: 11/26/2022]
Abstract
Background To find out how chemotherapy given prior to concurrent chemoradiotherapy compares with concurrent chemoradiation alone in the treatment of locally advanced nasopharyngeal cancer. Methods Patient charts were examined and found to have submitted to one of two regimes as follows: Neoadjuvant chemotherapy consisting of Cisplatin and 5-fluorouracil followed by concurrent chemoradiotherapy with cisplatin (group1), or concurrent cisplatin based chemoradiotherapy only (group 2). Radiation treatment dose of 70Gy in 35 fractions was given in each group. Results Forty-seven patients were evaluated with 68% male. Stage 4 disease comprised 83%, WHO type 3 was the commonest histologic type (53.2%). Median follow up period was 20 months (4–129). The 3-year overall survival for group 1 was 52.1%, and for group 2:65.7% (p = 0.47). The 3-year disease free survival for group 1 was 61.4, and 81.4% for group 2 (p = 0.03). Conclusion The study revealed that concurrent chemoradiation alone yields better disease free survival compared to chemotherapy given prior to it. There is however no difference in overall survival between the two regimes.
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A retrospective study comparing the outcomes and toxicities of intensity-modulated radiotherapy versus two-dimensional conventional radiotherapy for the treatment of children and adolescent nasopharyngeal carcinoma. J Cancer Res Clin Oncol 2017; 143:1563-1572. [PMID: 28342002 PMCID: PMC5504129 DOI: 10.1007/s00432-017-2401-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 03/17/2017] [Indexed: 11/25/2022]
Abstract
Purpose To compare the clinical outcomes and toxicities of two-dimensional conventional radiotherapy (2D-CRT) and intensity-modulated radiotherapy (IMRT) for the treatment of children and adolescent nasopharyngeal carcinoma (NPC). Methods A total of 176 children with non-metastatic NPC treated at Sun Yat-sen University Cancer Center between October 2003 and September 2013 were included in this study. Of the 176 patients, 74 received 2D-CRT and 102 were treated with IMRT. The clinical outcomes and acute and late toxicities were determined and compared. Results The IMRT group achieved significantly higher overall survival (OS) (90.4% vs. 76.1% at 5 year, P = 0.007) and disease-free survival (DFS) (85.7% vs. 71.2%, P = 0.029) mainly due to an improvement in locoregional relapse-free survival (LRRFS) (97.9 vs. 88.3%, P = 0.049). After stratification by disease stage, IMRT provided significant benefits for patients with stage III–IV disease in terms of OS, LRRFS and DFS. Multivariate analyses indicated that the treatment group (2D-CRT vs. IMRT) was a prognostic factor for OS, LRRFS and DFS. A significant reduction in Grade 2–4 xerostomia (52.7 vs. 34.3%, P = 0.015) and hearing loss (40.5 vs. 22.5%, P = 0.010) was observed in patients treated by IMRT. Conclusion IMRT provides better locoregional relapse-free survival and overall survival, especially in late-stage children and adolescent NPC patients, and is associated with a lower incidence of Grade 2–4 xerostomia as well as hearing loss compared with 2D-CRT. Distant metastasis remains a challenge in the treatment of children and adolescent NPC.
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Sahai P, Mohanti BK, Sharma A, Thakar A, Bhasker S, Kakkar A, Sharma MC, Upadhyay AD. Clinical outcome and morbidity in pediatric patients with nasopharyngeal cancer treated with chemoradiotherapy. Pediatr Blood Cancer 2017; 64:259-266. [PMID: 27681956 DOI: 10.1002/pbc.26240] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the outcome and treatment-related morbidity in pediatric patients with nasopharyngeal carcinoma (NPC) treated with chemoradiotherapy. METHODS We did a retrospective review of 41 pediatric patients diagnosed with NPC between 2000 and 2013. The majority of the patients were treated with neoadjuvant chemotherapy followed by concurrent chemoradiation with the dose of 70 Gy in 35 fractions. Eight patients were treated with intensity-modulated radiation therapy, while the remaining with three-dimensional conformal radiation therapy or two-dimensional simulation technique. RESULTS The median age of the patients was 14 years (range 6-20 years). Most of the patients had locoregionally advanced disease (stage III/IVA/IVB). The histology of all the cases was undifferentiated carcinoma. Immunohistochemistry for the Epstein-Barr virus-Latent membrane protein 1 was positive in nine of the 13 tested cases. The median follow-up for all and the surviving patients was 26.6 months (range 2-140.8) and 51.2 months, respectively. The 3-year overall survival (OS) and event-free survival (EFS) rates were estimated at 83.7% (95% confidence interval [CI]: 64.8-93%) and 55.8% (95%CI: 38.7-69.8%), respectively. Distant metastases were the predominant pattern of failure. Treatment response showed an independent association with OS. T classification (T1/T2 vs. T3/T4) was significantly associated with EFS. Xerostomia, hypothyroidism, dental caries, neck fibrosis, trismus, and dysphagia were the common late effects in survivors. Radiation myelitis was observed in one patient. CONCLUSIONS Treatment with neoadjuvant chemotherapy followed by concurrent chemoradiation provides good survival outcomes in pediatric NPC. The quality of life of the survivors is a pertinent area that necessitates consideration.
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Affiliation(s)
- Puja Sahai
- Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Bidhu Kalyan Mohanti
- Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Datt Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Chemotherapy in Children with Head and Neck Cancers: Perspectives and Review of Current Therapies. Oral Maxillofac Surg Clin North Am 2016; 28:127-38. [PMID: 26614705 DOI: 10.1016/j.coms.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cancers of the head and neck in children represent a heterogeneous group of malignancies requiring a variety of treatment modalities. In many instances of childhood head and neck cancers, chemotherapy will be required for treatment, often in conjunction with surgery and/or radiation therapy. Chemotherapy in children with head and neck cancers poses unique challenges in terms of immediate as well as long-term toxicities. This article focuses on the common chemotherapeutic agents, with a particular focus on early and late effects, used in the treatment of children with head and neck cancers.
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Prognostic aspects in the treatment of juvenile nasopharyngeal carcinoma: a systematic review. Eur Arch Otorhinolaryngol 2016; 274:1205-1214. [DOI: 10.1007/s00405-016-4154-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/14/2016] [Indexed: 11/26/2022]
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M'hamdi H, Baizig NM, ELHadj OE, M'hamdi N, Attia Z, Gritli S, Gamoudi A, El May MV, A El May. Usefulness of IGF-1 serum levels as diagnostic marker of nasopharyngeal carcinoma. Immunobiology 2016; 221:1304-8. [PMID: 27312888 DOI: 10.1016/j.imbio.2016.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/12/2016] [Accepted: 05/23/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of IGF-1 in promoting cancer has been investigated for many years. The aim of this study is to explore the relationship between rates of IGF-1 and NPC and to evaluate association of IGF-1 with clinical parameters. MATERIALS AND METHODS IGF-1 levels was measured by Elisa test among 82 NPC patients and 60 healthy controls RESULTS Our results showed, for the first time, a significant increased levels of IGF-I in NPC by in comparison with healthy controls (p<0.01). According to the age, sex and tumor size of NPC patients, we demonstrated that IGF-1 concentrations are significantly higher in NPC aged over 30 years compared to patients aged less than 30 years (p<0.01). The IGF-1 levels are, also, higher among women compared to men (p<0.01). The concentrations of IGF-1 were positively correlated with tumor size of NPC patients (p<0.01). CONCLUSION IGF-I could be a good nasopharyngeal cancer diagnostic marker.
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Affiliation(s)
- H M'hamdi
- Laboratory of Immuno-Histo-Cytology, Institute of Carcinology; Salah Azaiz, Tunis, Tunisia.
| | - N Mokni Baizig
- Laboratory of Immuno-Histo-Cytology, Institute of Carcinology; Salah Azaiz, Tunis, Tunisia.
| | - O ElAmine ELHadj
- Laboratory of Immuno-Histo-Cytology, Institute of Carcinology; Salah Azaiz, Tunis, Tunisia.
| | - N M'hamdi
- Department of Animal Sciences National Institute of Agronomy of Tunis, Tunisia.
| | - Z Attia
- Department of ORL. Institute of Carcinology Salah Azaiz of Tunis, Tunisia.
| | - S Gritli
- Department of ORL. Institute of Carcinology Salah Azaiz of Tunis, Tunisia.
| | - A Gamoudi
- Laboratory of Immuno-Histo-Cytology, Institute of Carcinology; Salah Azaiz, Tunis, Tunisia.
| | - M Veronique El May
- Research Unit 01/UR/08-07.Faculty of Medicine, Tunis, University of Tunis El Manar,Tunisia.
| | - A El May
- Laboratory of Immuno-Histo-Cytology, Institute of Carcinology; Salah Azaiz, Tunis, Tunisia.
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Lu S, Chang H, Sun X, Zhen Z, Sun F, Zhu J, Wang J, Huang J, Liao R, Guo X, Lu L, Gao Y. Long-Term Outcomes of Nasopharyngeal Carcinoma in 148 Children and Adolescents. Medicine (Baltimore) 2016; 95:e3445. [PMID: 27124036 PMCID: PMC4998699 DOI: 10.1097/md.0000000000003445] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to investigate the survival and long-term morbidities of nasopharyngeal carcinoma (NPC) in children and adolescents.We retrospectively reviewed children and adolescents with NPC treated at Sun Yat-sen University Cancer Center from February 1991 to October 2010, where the prognostic factors and long-term effects of therapy were analyzed.A total of 148 patients were identified. The median age was 15 years old (range, 5-18 years) and the male to female ratio was 3.6:1. Most of the tumor histopathology was undifferentiated nonkeratinizing carcinoma (97.3%). The number of patients staged with IVa, IVb, IVc, III, and II were 45 (30.4%), 12 (8.1%), 5 (3.4%), 70 (47.3%), and 16 (10.8%), respectively. For the whole series with a median follow-up of 81 months (range, 6-282 months), the 5-year overall survival (OS) and disease-free survival (DFS) ratios were 79.3% and 69.7%, respectively. We observed significant differences in the 5-year OS (81.1% vs 25.0%, P = 0.002) and the DFS rates (72.2% vs 0.0%, P = 0.000) between patients with stage II to IVb disease and stage IVc disease. For patients with stage II, III, IVa, and IVb disease, we found a high radiation dose (dose > 66 Gy to the primary lesion) would not significantly improve the survival compared to the sub-high radiation dose group (dose = 60-66 Gy to the primary lesion), even considering the type of radiation therapy technologies. However, the incidences of sequelae (grades I-IV) in patients with high radiation dose were apparently higher than those in patients with low radiation dose.Considering the late sequelae, a dose of 60 to 66 Gy to the primary lesions seems to be enough for children and adolescents with NPC.
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Affiliation(s)
- Suying Lu
- From the State Key Laboratory of Oncology in South China (SL, HC, XS, ZZ, FS, JZ, JW, JH, RL, XG, LL, YG); Collaborative Innovation Center of Cancer Medicine (SL, HC, XS, ZZ, FS, JZ, JW, JH, RL, XG, LL, YG); and Departments of Pediatric Oncology (SL, XS, ZZ, FS, JZ, JW, JH, RL, XG) and Radiation Oncology (HC, LL, YG), Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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González-Motta A, González G, Bermudéz Y, Maldonado MC, Castañeda JM, Lopéz D, Cotes-Mestre M. Pediatric Nasopharyngeal Cancer: Case Report and Review of the Literature. Cureus 2016; 8:e497. [PMID: 27014531 PMCID: PMC4794385 DOI: 10.7759/cureus.497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pediatric nasopharyngeal carcinoma, also referred to as cavum carcinoma, is a rare pediatric disease with an infrequent incidence rate. We present the case of a pediatric patient with nasopharyngeal cancer who received an adult schedule of concomitant chemotherapy and conformal radiotherapy with a brachytherapy boost. Adult protocols with high radiotherapy doses are not commonly used in pediatric patients due to the high comorbidity associated with this practice. In this case, the patient displayed excellent overall survival, a longer disease-free period, and fewer side effects and comorbidities, even in the absence of interferon therapy, which is not easily available in low-income countries. In addition, this case shows that conformal radiotherapy and brachytherapy are options that can be used to escalate the radiotherapy dose and decrease side effects. A 12-year-old female pediatric patient presented to our outpatient clinic with an eight-month history of moderate-to-severe otalgia, intermittent hyaline rhinorrhea, asthenia, adynamia, nasal congestion, epistaxis in the previous months, and local pruritus. Upon physical examination, a 60x60 mm mass was detected at level II of the neck, and a biopsy of the lesion confirmed a histopathological diagnosis of undifferentiated carcinoma compatible with nasopharyngeal carcinoma. The patient was considered to have clinical Stage III cancer, and she received an adult Al-Sarraf protocol with chemoradiotherapy and an intracavitary brachytherapy boost. The patient had a complete response, and she remains without local or distance relapse. Treating pediatric nasopharyngeal carcinoma patients with the Al-Sarraf protocol could be a feasible modality, as observed in this clinical case, despite the elevated cost of using interferon-beta in low-income countries when using more advanced radiotherapy techniques such as conformal radiotherapy and now, modulated intensity radiotherapy. It should be noted that brachytherapy boosts should be used with caution in pediatric patients; the potential side effects should be weighed against improved local control.
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Affiliation(s)
- Alejandro González-Motta
- Department of Radiation Oncology, Instituto Nacional de Cancerologia, Universidad Militar Nueva Granada, Bogota, D.C., Colombia
| | - Garvin González
- Department of Radiation Oncology, Instituto Nacional de Cancerologia, Universidad Militar Nueva Granada, Bogota, D.C., Colombia
| | - Yurany Bermudéz
- Department of Radiation Oncology, Instituto Nacional de Cancerologia, Universidad Militar Nueva Granada, Bogota, D.C., Colombia
| | - Maria C Maldonado
- Department of Radiation Oncology, Instituto Nacional de Cancerologia, Universidad Militar Nueva Granada, Bogota, D.C., Colombia
| | - Javier M Castañeda
- Clinical Research Group, Instituto Nacional de Cancerologia, Bogota, D.C., Colombia
| | - David Lopéz
- Clinical Research Group, Instituto Nacional de Cancerologia, Bogota, D.C., Colombia
| | - Martha Cotes-Mestre
- Department of Radiation Oncology, Instituto Nacional de Cancerologia, Universidad Militar Nueva Granada, Bogota, D.C., Colombia
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