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Improved long-term survival with combined modality therapy for pediatric nasopharynx cancer
S L Wolden1, P G Steinherz, D H Kraus
1Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. woldens@mskcc.org
Insights
This study on childhood nasopharynx cancer found that higher radiation doses improve local control. Chemotherapy addition reduces distant metastases and improves survival rates in pediatric patients.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Medical Research
Background:
- Nasopharynx cancer is a rare childhood malignancy.
- Understanding optimal treatment strategies is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the role of chemotherapy in pediatric nasopharynx cancer.
- To determine the optimal radiation dose for locoregional control.
- To assess long-term outcomes for children with this disease.
Main Methods:
- Retrospective analysis of 33 patients (12-20 years) with Stage I-IVB nasopharynx cancer.
- Comparison of radiotherapy alone versus combined chemotherapy and radiotherapy.
- Analysis of radiation doses (median 66 Gy) and follow-up (median 8.4 years).
Main Results:
- Higher radiation doses (>60 Gy) significantly improved locoregional control (93% vs. 60%).
- Chemotherapy addition reduced distant metastases (16% vs. 57%) and improved survival.
- Combined modality therapy resulted in higher 10-year disease-free (84%) and overall survival (78%) rates compared to radiation alone.
Conclusions:
- Radiation doses exceeding 60 Gy are recommended for gross disease in pediatric nasopharynx cancer.
- Combined chemotherapy and radiotherapy improve survival outcomes by reducing distant metastases.
- Long-term severe complications occurred in 24% of patients.
Purpose:
Nasopharynx cancer is a rare malignancy in childhood. This study aims to determine the role of chemotherapy, the optimal dose of radiation, and the long-term outcome for children with locoregional disease.
Methods And Materials:
Thirty-three patients [median age 14 (range: 12-20) years] were treated for Stage I-IVB nasopharynx cancer. Thirteen patients (39%) received radiotherapy alone and 20 patients (61%) had chemotherapy and radiotherapy. The median radiation dose to the primary tumor was 66 Gy (range: 54-72 Gy). The median follow-up time for surviving patients was 8.4 years (range: 0.5-23.6 years). RESUL TS: The actuarial 10-year locoregional relapse-free survival, distant metastases-free survival, and overall survival rates were 77%, 68%, and 58% , respectively. Locoregional control was improved for patients treated with radiation doses > 60 Gy compared to those receiving < or = 60 Gy (93% vs. 60%, p < 0.03). The addition of chemotherapy had no significant effect on locoregional control but did reduce the development of distant metastases (16% vs. 57%, p = 0.01). Combined modality therapy improved 10-year disease-free survival (84% vs. 35%, p < 0.01) and survival (78% vs. 33%, p < 0.05) over radiation alone. The 10-year actuarial rate of severe complications was 24%.60 Gy are used for gross disease. The addition of chemotherapy decreases the risk of distant metastases and increases survival.