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

Abstract

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.

Locoregionally advanced nasopharyngeal carcinoma in childhood and adolescence: Analysis of 95 patients treated with combined chemotherapy and intensity‐modulated radiotherapy

“…Laskar et al 10 and Wolden et al 31 reported improved local control with higher doses. Ozyar et al 9 and Guruprasad et al 32 both reported that a higher RT dose of >66 Gy significantly correlated with better outcome. However, highdose RT in children has been associated with significant morbidity among long-term survivors.…”

Nasopharyngeal carcinoma presenting as proptosis in a child: a diagnostic dilemma

“…Therefore, high index of suspicion is required by all diagnosticians in detecting this malignancy which can present with varied signs and symptoms. 9 The diagnosis of pediatric NPC often produces clinicopathological dilemma since it is more aggressive biologically and often presents at an advanced stage. Late diagnosis in the NPC is because of ignoring or misdiagnosing the unspecific symptoms mimicking upper respiratory tract infection during early stages.…”

Modalitas Imejing pada Karsinoma Nasofaring

“…[2][3] Terapi KNF diberikan berdasarkan staging nya, dan radiologi memiliki peran penting karena semua langkah manajemen pasien KNF, mulai diagnosis, staging untuk pengobatan maupun tindak lanjutnya melibatkan peran pencitraan 4 Mengingat kasus KNF pada anak-anak hadir dengan gejala lanjut, diagnosis dan staging harus diketahui dengan cepat dan akurat, sehingga pengobatan yang bisa diberikan secara memadai dan baik tingkat ketahanan hidup 5 tahun dapat tercapai. [5][6] KNF disebabkan oleh interaksi dari kerentanan genetik, faktor lingkungan (misalnya, paparan karsinogen kimia) dan infeksi dengan virus Epstein-Barr. Titer antibodi yang tinggi untuk antigen virus Epstein Barr berguna sebagai marker diagnostik dan ada banyak tes untuk mendeteksi titer IgG dan IgA.…”

“…T1 weighted images dengan media kontras potongan aksial dan koronal (dengan dan tanpa fat suppression) digunakan untuk mendeteksi batas tumor, termasuk penyebaran perineural dan perluasan tumor ke intrakranial. Ketebalan tiap potongan adalah 3-5 mm [3][4][5][6][7] .…”

“…Delapan puluh dua persen KNF muncul di resesus posterolateral dinding faring (fossa Rosenmüller) (gambar 3) dan 12% muncul di midline. Pada 6-10% dari pasien, mukosa nasofaring muncul normal pada endoskopi [3][4][5] .…”