Nasopharyngeal Carcinoma in Children and Adolescents

Journal of The Egyptian National Cancer Institute

Volume 12 - Number 3

Article Type: Original Article
Abstract: Purpose: To evaluate the clinicopathological features and the prognostic factors for nasopharyngeal carcinoma in young patients treated at King Faisal Specialist Hospi-tal.
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 Ill). Fifty two patients (96%) had stage IV disease. Thirty one out of forty patients (78%) in whom parapharyngeal exten-sion 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 pa-tients 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 dis-ease free survival (DFS) of 38 patients who attained com-plete remission (CR) was 68% at 5 and 10 years. In uni-variate 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 dis-ease after initial treatment (p = 0.006) were significant ad-verse factors.
Conclusion: The majority of young patients with na-sopharyngeal 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.