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Radiation and chemotherapy combination for nasopharyngeal carcinoma in children: Radiotherapy dose adaptation after chemotherapy response to minimize late effects.

Orbach D, Brisse H, Helfre S, Klijanienko J, Bours D, Mosseri V, Rodriguez J

Pediatric Oncology Department, Institut Curie, Paris, France. daniel.orbach@curie.net

OBJECTIVES: To retrospectively report the clinical and therapeutic features of children with nasopharyngeal carcinoma (NPC) treated by chemotherapy and doses adapted of radiotherapy. PATIENTS AND METHODS: From 1978 to 2005, 34 children were treated for NPC. All histologic and/or cytologic samples and CT scans were reviewed. Cervical nodal irradiation was reduced (<50 Gy) in the case of a good response to chemotherapy (>/=90% of initial tumor volume). RESULTS: Thirty-two children had metastatic cervical nodes and one child had systemic metastases at diagnosis. All children had AJJC-TNM Stage IV. Thirty-one children received neoadjuvant chemotherapy with various regimens. The overall chemotherapy response rate was 78%. Fifteen patients had cervical nodal irradiation dose reduced: Median 47 Gy (range: 45-50). Nasopharyngeal radiotherapy was delivered at a dose of 59.4 Gy (range: 45-66). Local and distant failure rates were 10% and 18%, respectively. The 5-year overall survival was 73 +/- 8% and the event-free survival (EFS) was 75 +/- 8%. CONCLUSIONS: The overall prognosis was not influenced by TNM status, dose of local radiotherapy delivered or response to initial chemotherapy, but EFS was better in patients with a good response to chemotherapy. The cervical local failure rate was low despite radiotherapy dose reduction in the case of a good response to neoadjuvant chemotherapy. We also propose a reduction of nasopharyngeal radiation (</=50 Gy) in the case of good response to initial chemotherapy.

Published 25 February 2008 in Pediatr Blood Cancer, 50(4): 849-53.
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