Childhood Nasopharyngeal Carcinoma: A Rare Disease With Distinct Features and Favorable Prognosis

This study aims to compare clinical features, treatment responses, radiosensitivity, and failure patterns between childhood and adult nasopharyngeal carcinoma (NPC) patients in the era of intensity modulated radiation therapy.

A retrospective review was conducted on 140 childhood NPC patients, aged <21 years, treated at a single institution between January 2004 and November 2019. A propensity score matching method was used to select 280 matched adult NPC patients in a 1:2 ratio. Comparative analysis was performed between the childhood and adult cohorts.

Childhood NPC is associated with more advanced clinical stages, heightened radiosensitivity, and improved prognostic outcomes compared to adult NPC. The 5-year rates for overall survival (OS), progression-free survival (PFS) were significantly higher in the childhood group compared with the adult group: 83.1% versus 71.9% (P = .001) for OS, 71.6% versus 60.9% (P = .023) for PFS, but significantly lower for locoregional relapse (LRR): 3.1% versus 12.6% (P = .002). Childhood NPC exhibited heightened radiosensitivity, and high locoregional control can be achieved even in cases that showed no response to induction chemotherapy, which is unlike in adults. In children receiving induction chemotherapy, no significant differences were found in OS (84.0% vs 75.7%, P = .289), PFS (75.2% vs 57.7%, P = .123), LRR (4.4% vs 3.8%, P = .656), and distant metastasis (22.4% vs 38.5%, P = .122) between those with complete/partial response and those with stable/progression disease. Late recurrence after 2 years was less frequent in children than in adults (13.6% vs 29.2%, P = .039), and a higher proportion of childhood patients were successfully salvaged (42.1% vs 21.7%, P = .015).

Childhood NPC often presents at an advanced stage but has a favorable prognosis with excellent locoregional control. Children's heightened radiosensitivity allows for potential dose reduction. Given the risk of late effects, individualized treatment and follow-up strategies are warranted for young patients.