Nasopharyngeal Carcinoma in Children: Comparison of Conventional and Intensity-Modulated Radiotherapy

Laskar, Siddhartha; Bahl, Gaurav; Muckaden, Maryann; Pai, Sheila R; Gupta, Tejpal; Banavali, Shripad; Arora, Brijesh; Sharma, Dayanand; Kurkure, Purna; Ramadwar, Mukta; Viswanathan, Seethalaxhmi; Rangarajan, Venkatesh; Qureshi, Sajid; Deshpande, Deepak D.; Shrivastava, Shyam Kishore; Dinshaw, Ketayun A.

doi:10.1016/j.ijrobp.2008.01.032

Cited by 58 publications

(54 citation statements)

References 17 publications

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“…10,[13][14][15][16][17][18][19][20][21][22] The results vary between 55% and 87% for OS and 60.6% and 77% for EFS or DFS, and the median length of observation for these cohorts was between 3.5 years and 15 years. Varan et al reported 10 retrospectively analyzed patients who received the same regimen (4 cycles of docetaxel/cisplatin plus irradiation 59.4 Gy) 23 : After a median observation of 2 years, the OS rate was 90%, and the EFS rate was 70%.…”

Section: Discussionmentioning

confidence: 99%

“…Reported survival rates vary between 55% and 90% for overall survival (OS) and between 60.6% and 77% for disease-free survival (DFS) and event-free survival (EFS). 10,[12][13][14][15][16][17][18][19][20][21][22][23] From 1992 to 2002, the first prospective NPC trial by the German Society of Pediatric Oncology and Hematology (NPC-91-GPOH), in which chemotherapy, radiotherapy, and interferon beta (IFN-b) were combined, was conducted within the GPOH. After a median follow-up of 48 months, an OS rate of 95% and an EFS rate of 91% were achieved, and the level of toxicity was acceptable.…”

Section: Introductionmentioning

confidence: 99%

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Multimodal treatment, including interferon beta, of nasopharyngeal carcinoma in children and young adults

Buehrlen

Zwaan

Granzen

et al. 2012

Cancer

110

150

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BACKGROUND:The authors report preliminary results from a prospective multicenter study (Nasopharyngeal Carcinoma [NPC] 2003 German Society of Pediatric Oncology and Hematology/German Children's Oncology Group [NPC‐2003‐GPOH/DCOG]).METHODS:From 2003 to 2010, 45 patients (ages 8‐20 years), including 1 patient with stage II NPC and 44 patients with stage III/IV NPC, were recruited to the study. The patient with stage II disease received radiotherapy (59.4 grays [Gy]). The patients with stage III/IV disease received 3 courses of neoadjuvant chemotherapy with cisplatin, 5‐fluorouracil, and folinic acid. The cumulative irradiation dose was 54 Gy in 5 patients, who achieved complete remission after neoadjuvant chemotherapy, and 59.4 Gy in the remaining 40 patients. All patients received concomitant cisplatin during the first week and last week of irradiation. After irradiation, all patients received interferon beta for 6 months. Tumor response was evaluated by magnetic resonance imaging studies and positron emission tomography scans.RESULTS:After the completion of treatment, 43 of 45 patients were in complete remission. In 2 patients, only a partial response was achieved, followed by distant metastases (1 patient) or local progression and distant metastases (1 patient), 6 months and 10 months after diagnosis, respectively. Another patient developed a solitary pelvic bone metastasis 21 months after diagnosis. After a median follow‐up of 30 months (range, 6‐95 months), the event‐free survival rate was 92.4%, and the overall survival was 97.1%. Acute toxicity consisted mainly of leucopenia, mucositis, and nausea; and late toxicity consisted of hearing loss and hypothyroidism.CONCLUSIONS:Combined therapy with neoadjuvant chemotherapy, radiochemotherapy, and interferon beta was well tolerated and resulted in a very good outcome that was superior to the outcomes of published results from all other pediatric NPC study groups. Cancer 2012. © 2012 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multimodal treatment, including interferon beta, of nasopharyngeal carcinoma in children and young adults

Buehrlen

Zwaan

Granzen

et al. 2012

Cancer

110

150

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“…Improved outcome and reduced toxicity could have been achieved by use of IMRT which provides superior target coverage and spares the normal tissue [15]. Immunotherapy as per NPC-91-GPOH protocol (Society of Paediatric Oncology and Haematology) which is considered as the standard of care for NPC and achieves very high survival rates, was not used in our study due to financial constraints.…”

Section: Discussionmentioning

confidence: 99%

Paediatric Nasopharyngeal Carcinoma: An 8-Year Study from a Tertiary Care Cancer Centre in South India

Guruprasad

Tanvir

Rohan

et al. 2013

Indian J Otolaryngol Head Neck Surg

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Nasopharyngeal carcinoma (NPC) accounts for less than 1 % of all paediatric cancers. Advances in imaging, radiation delivery, chemotherapy and improvement in multidisciplinary care have resulted in drastic changes in the outcome of this disease. Since NPC is extremely rare in paediatric population and there is paucity of data in Indian patients, we conducted the present study to analyze the outcome of paediatric NPC. Eighteen patients aged 18 years or less, who had pathologically proven diagnosis of NPC and had received treatment at our institute from 2003 to 2010 was included for analysis. These patients were treated with radiotherapy and chemotherapy. Event free survival, local and systemic relapse and progression were analysed. These outcomes were correlated with age, radiation dose and the stage of disease. Majority of patients presented with advanced stage and poor histological grade (94.4 % had WHO Type III disease). The median follow up was 38 months (range 3-91 months). The estimated event free survival at a follow up of 5 years was 64.28 %. Distant metastasis at presentation and lower radiation dose were predictive of poor outcome. Paediatric NPC usually presents in an advanced stage. Our results are comparable to studies which have used only chemoradiotherapy, are far inferior to studies which have used chemoradiotherapy and adjuvant immunotherapy. Larger prospective studies are required to define the role of adjuvant immunotherapy, the optimum dose and schedule of chemoradiotherapy and role of new agents like cetuximab in Indian paediatric patients.

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“…The local control rates with IMRT have been shown to be equivalent if not better than conventional RT in children (Table 3) [14,[35][36][37][38][39][40][41][42][43]. A comparison of 3-DCRT and IMRT in pediatric nasopharyngeal carcinoma showed no difference in the 2-year locoregional control but less grade 3 acute toxicities of the skin, mucous membrane and pharynx with IMRT [37]. In COG D9803, the 5-year locoregional failure rates were 18 % for 3D-CRT and 15 % for IMRT.…”

Section: Use Of Novel Rt Technologymentioning

confidence: 99%

Treatment strategies to reduce radiotherapy late effects in children

Paulino

2012

J Radiat Oncol

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Late effects of treatment are an important cause of morbidity and mortality in childhood cancer survivors. The use of radiotherapy has been implicated as a risk factor for the development of many late complications. Several strategies have been employed in pediatric oncology to minimize the late effects of radiotherapy. These have included (1) omitting or delaying radiotherapy until the child is older, (2) decreasing radiotherapy doses and volumes by incorporating chemotherapy in the treatment regimen, (3) alteration of radiotherapy fractionation, (4) use of novel techniques to spare or minimize radiation dose to surrounding normal tissues, and (5) elimination of radiotherapy in favorable subsets of patients. In infants with brain tumors, delaying radiotherapy and giving chemotherapy until the child is 3 years old was a popular approach three to four decades ago with limited success with respect to tumor control. With the advent of modern radiotherapy technology, younger patients are now able to be treated with conformal techniques and reasonable neurotoxicity. Using chemotherapy to reduce doses of radiation therapy has been employed in standard-risk medulloblastoma, intracranial germinoma, Hodgkin lymphoma, and Wilms' tumor. Likewise, the use of chemotherapy to reduce radiotherapy volumes has been employed in intracranial germinoma, Hodgkin lymphoma, and neuroblastoma and for the boost portion of treatments for rhabdomyosarcoma and Ewing sarcoma. There are a few phase III trials comparing conventional and hyperfractionated radiotherapy, but none of them have shown superiority of one over the other in terms of tumor control and late effects. Current protocols are testing the omission of radiotherapy in the most favorable subset of patients with Hodgkin lymphoma and Wilms' tumor. Intensity-modulated radiation therapy is currently used in many children in developed nations. Proton therapy is available in a few centers; clinical results of treatment are accumulating regarding the effectiveness and longterm toxicity of this radiation modality.

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Nasopharyngeal Carcinoma in Children: Comparison of Conventional and Intensity-Modulated Radiotherapy

Cited by 58 publications

References 17 publications

Multimodal treatment, including interferon beta, of nasopharyngeal carcinoma in children and young adults

Multimodal treatment, including interferon beta, of nasopharyngeal carcinoma in children and young adults

Paediatric Nasopharyngeal Carcinoma: An 8-Year Study from a Tertiary Care Cancer Centre in South India

Treatment strategies to reduce radiotherapy late effects in children

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