Nasopharyngeal cancer in children: Long term results the experience of the university hospital of Sfax (Tunisia)

Abstract

Background: Nasopharyngeal carcinoma in children is frequent in Mediterranean area. We aimed to report our experience in the treatment of this entity. Method(s): We retrospectively review the records of 76 young patients (<21 years) presenting with nasopharyngeal cancer during the period 1993 -2015. Diagnosis was confirmed with histological study of the biopsy of nasopharynx. Initial work-up included nasofibroscopy, CT scan and/or MRI of the nasopharynx and neck, chest X-ray, abdominal ultrasonography and bone scan. TNM2009 classification was used. Patients treated before 2009 were retrospectively reclassified. Metastatic patients were excluded. Patients had cisplatin based regimen chemotherapy (neoadjuvant, concomitant or both). Radiotherapy was delivered at the dose of 70 to 75 Gy targeting the nasopharynx and involved cervical nodes. Prophylacting dose up to 50 Gy was delivered to the remaining cervical areas. Survival was studied with Kaplan Meier test. Late toxicities were assessed according to SOMA-LENT and RTOG scales in patients with a minimal follow-up of 24 months. Result(s): Mean age was 16 years (9-20). Sex-ratio was 1,1. Seventy two percent of patients (n=55) had locally advanced tumor (T3 or T4). Cervical nodal involvement was seen in 95% of cases (n=71). There were 52 cases (68%) of N2 or N3. Sixty-six patients had neoadjuvant chemotherapy, 10 had concomitant and 5 had both. Five patients had exclusive irradiation. Radiotherapy was monofractionated in 45 cases and bifractionated in the remaining cases. Acute toxicities were tolerable. Mean follow-up was 198 months (28- 289). One patient experienced a local failure. Twenty-six presented metastatic failures. Overall survival rate at 10 years is 67,4%. Disease free survival rate at 10 years is 66,7%. Xerostomia was the most frequent late toxicity (97%). Patients experienced endocrine troubles (hypothyroidism in 19%, amenorrhea in 13%), cerebral necrosis (5cases), osteoradionecrosis (10 cases) and secondary cancer (3 cases). Conclusion(s): Pediatric nasopharyngeal carcinoma has good prognosis despite frequent locally advanced disease at presentation. Combining radiotherapy and chemotherapy is the standard of care. Late toxicities are often severe and affect the quality of life.