Nasopharyngeal carcinoma in children and adolescents

Abstract EN

Purpose : To evaluate the clinicopathological features and the prognostic factors for nasopharyngeal carcinoma in young patients treated at King Faisal Specialist Hospital.

Materials and methods : Fifty-four patients ≤18 years of age, with the diagnosis of nasopharyngeal carcinoma were treated at King Faisal Specialist Hospital during the period between 1975-1996.

They accounted for 5% of all patients with nasopharyngeal carcinoma treated within this period.

There were 34 males and 20 females; the median age at diagnosis was 14 years.

Twenty seven patients (50 %) had undifferentiated carcinoma (WHO type III).

Fifty two patients (96 %) had stage IV disease.

Thirty one out of forty patients (78 %) in whom parapharyngeal extension could be assessed, had involvement of that region.

Eleven patients were treated with palliative intent and were excluded from survival analysis.

The survival and prognostic factor analysis focused on the remaining 43 patients treated with radical intent (31 with radiation alone and 12 with chemo-radiotherapy).

The total radiation dose ranged from 44-70 Gy.

The median follow up was 58 (2.5- 216) months.

Results : The 5 and 10 year overall survival rates of the whole group were 45% and 39 %, respectively.

No patients with metastatic disease survived more than 14 months.

For the 43 patients treated with radical intent the 5 and 10 year survival rates were 57 % and 49 %, respectively.

The disease free survival (DFS) of 38 patients who attained complete remission (CR) was 68 % at 5 and 10 years.

In univariate analysis WHO type II tumors, lymph node fixation and persistent disease were poor prognostic factors in terms of overall survival.

In multivariate analysis, WHO type II tumors (p = 0.04) and patients with persistent disease after initial treatment (p = 0.006) were significant adverse factors.

Conclusion : The majority of young patients with nasopharyngeal carcinoma present with advanced disease.

The response to initial therapy as well as the pathologic subtype were the most important independent prognostic factors affecting overall survival.