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

Abstract

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.

A retrospective study comparing the outcomes and toxicities of intensity-modulated radiotherapy versus two-dimensional conventional radiotherapy for the treatment of children and adolescent nasopharyngeal carcinoma

“…The relatively short time to systemic failure in the absence of locoregional failure might suggest that subclinical metastasis that likely existed at first treatment required early systemic treatment. Two prospective multicentre studies, NPC-91-GPOH (Mertens et al 2005) and NPC-2003-GPOH/DCOG (Buehrlen et al 2012), demonstrated favourable results for multimodal treatment (neoadjuvant chemotherapy, and radiotherapy followed by interferon-β) in patients with paediatric and adolescent NPC. After a median follow-up time of 30 months and 48 months, the overall survival and event-free survival rates were 95–97% and 91–92.4%, respectively.…”

Induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma

“…Liu et al [17] found that an unsatisfactory tumor response (stable disease or disease progression) or detectable EBV DNA levels after IC were predictors of poor prognosis for patients with locoregionally advanced NPC. In a prospective study of children and young adults with NPC, the radiation dose during CCRT was decreased to 54 Gy in patients who achieved complete remission and 59.4 Gy in those who achieved partial remission after three cycles of IC; after a median follow-up of 30 months, none of these patients experienced locoregional recurrence [18]. These findings warrant further risk stratification and early treatment modification after IC in patients with locoregionally advanced NPC.…”

Current Status of Cancer Care for Young Patients with Nasopharyngeal Carcinoma in Jakarta, Indonesia

“…Recently, Buehren et al published more promising results by adding adjuvant interferon beta after standard (chemo-) radiotherapy. This resulted in an event-free survival rate of 92.4% after a median follow-up of 30 months and an overall survival of 97.1% [7], [13].…”