[Undifferentiated nasopharyngeal carcinoma in adolescent and children]

Nasopharyngeal Carcinoma in Children, Current Treatment Approach

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.

[Therapeutic outcomes of nasopharyngeal carcinomas: a single-center study conducted at the Fattouma Bourguiba University Hospital in Monastir, Tunisia]

INTRODUCTION

nasopharyngeal carcinomas (NPCs) are relatively common in the Mediterranean basin. Survival has been greatly improved by new radiation techniques and new molecular-targeted chemotherapy. The purpose of our study was to analyze the therapeutic outcomes and to describe the prognostic factors of NPCs.

METHODS

we conducted a retrospective study of patients with nasopharyngeal carcinoma on treatment and follow-up in our department between January 1995 and December 2014. Data were collected using a standardized sheet. Statistical analysis was performed using SPSS software. Kaplan-Meier method was used to determine patient´s overall survival.

RESULTS

seventy-three cases of NPC were reported. The average age of patients was 48 years. A male predominance was noted. The majority of cancers (56%) were locally advanced tumors (T3-T4). After an average follow-up of 45.5 months, the rate of locoregional recurrences was 19.4%. Three patients (4%) had bone metastases. Five-year overall survival was 65%. Factors positively influencing overall survival were early-stage tumor (TNM classification) and 1.8 Gy single fraction radiotherapy. Local and lymph node recurrence rates were 13.8% and 5.5% respectively, mainly for T4 N2 tumors. Therapeutic sequelae were dominated by seromucous otitis (42.7%), trismus (38.7%), and xerostomia (32%).

CONCLUSION

overall survival in patients with NPC has improved, in particular with the advent of concomitant radiotherapy and chemotherapy; however, disabling late toxicity is significant. Good prognostic factors reported in this study include early tumor stage as well as radiotherapy fractionation.

Pediatric Nasopharyngeal Carcinoma: A Rare Tumor in a Developing Country-What Do We Learn?

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.

Childhood Nasopharyngeal Carcinoma: State-of-the-Art, and Questions for the Future

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.

Epidemiology of Nasopharyngeal Cancers in Iran: A 6-year Report

BACKGROUND

Nasopharyngeal cancer is a disease with distinct ethnic and geographical distribution. The aim of this review was to describe the epidemiological characteristics of nasopharyngeal cancer in Iran from 2004 to 2009 because no systematic study has been performed to evaluate the trends of its incidence yet.

MATERIALS AND METHODS

The data were derived from the databases of the National Cancer Data System Registry in the period of 2004-2009. Nasopharyngeal cancers were classified according to the International Classification of Diseases for Oncology. Incidence rates and trends were calculated and evaluated by gender, age decade, and histopathology types.

RESULTS

A total of 1,637 nasopharyngeal cancers were registered in Iran from 2004 to 2009 giving an incidence of 0.38 per 100,000. The male-to-female ratio was 2.08:1. The trend of incidence was found to have increased, with a significant increase observed in males. Undifferentiated carcinoma was the most common histopathology type in all the age decades.

CONCLUSIONS

Because the incidence of nasopharyngeal cancers in Iran has increased, especially in males, further studies are recommended for understanding of the etiological factors involved in the rise of the disease.