Improved long-term survival with combined modality therapy for pediatric nasopharynx cancer

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). Results: 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 less than or equal to 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%. Conclusions: Excellent locoregional control is achieved with radiotherapy to the nasopharynx and neck when doses >60 Gy are used for gross disease. The addition of chemotherapy decreases the risk of distant metastases and increases survival. (C) 2000 Elsevier Science Inc.