Nasopharyngeal carcinoma in children: a challenging disease in a middle-income country, Tunisia

Semia Zarraa; Souheil Jebali; Mariem Ben Jdira; GHaeit El Fida Noubbigh; A. Mousli; Safia Yahyaoui; Said Gritli; Chiraz Nasr

doi:10.18502/ijpho.v14i2.15272

Semia Zarraa Department of radiotherapy, Salah, Azaiz institute, Tunis, Tunisia
Souheil Jebali Department of Otorhinolaryngology, Head and Neck Surgery, Salah Azaiz institute, Tunis, Tunisia
Mariem Ben Jdira Department of Otorhinolaryngology, Head and Neck Surgery, Salah Azaiz institute, Tunis, Tunisia
GHaeit El Fida Noubbigh Department of radiotherapy, Military Hospital of Tunis, Tunisia
A. Mousli Department of radiotherapy, Salah, Azaiz institute, Tunis, Tunisia
Safia Yahyaoui Department of radiotherapy, Salah, Azaiz institute, Tunis, Tunisia
Said Gritli Department of Otorhinolaryngology, Head and Neck Surgery, Salah Azaiz institute, Tunis, Tunisia
Chiraz Nasr Department of radiotherapy, Salah, Azaiz institute, Tunis, Tunisia

DOI: https://doi.org/10.18502/ijpho.v14i2.15272

Keywords: Chemotherapy, Children, Disease-free Survival, Nasopharyngeal Cancer, Radiotherapy

Abstract

Background: This study aimed to assess the epidemiological, clinical, and therapeutic aspects and prognosis of juvenile nasopharyngeal carcinoma in Tunis country.

Materials and Methods: This study included 68 patients, younger than 18 years of age. All the patients had a clinical and para-clinical tumoral assessment. The study of survival and prognostic factors was done after a descriptive analysis. These prognostic factors were studied through uni and multivariate analysis.

Results: The median age was 14.7 years and the sex ratio was 2 male to 1 female. The average time to first consultation was 4 months. Rhinological signs were the most frequent symptom for consultation (n= 41). The T3-T4 tumors accounted for 78% of patients and there was a lymph node invasion stage N2-N3 in 63% of cases. Non-metastatic patients had radiotherapy associated with chemotherapy in 97% of cases. Metastatic patients received hypofractionated radiotherapy on bone metastasis, and first-line chemotherapy followed by radiotherapy on the primitive tumor and lymph node areas in case of good response to chemotherapy ( n= 2). The mean follow-up was 94 months; 78% of these patients were alive and in complete remission, 19% were in therapeutic failure, and 16% of them had metachronous metastases. The five-year-overall survival was 95%. Hyposialia and skin dystrophy were the most frequent late complications.

In univariate analyses, significant prognostic factors were cranial nerve invasion, intracranial invasion, and infra-temporal fossa invasion. In multivariate analysis, the most parsimonious model associated extension to the infratemporal fossa, endo-cranial extension, and initial therapeutic modality (treatment failures were less frequent with neoadjuvant chemotherapy (p= 0.22)).

Conclusion: Treatment of nasopharyngeal carcinoma in children consists of chemotherapy and radiotherapy. Synchronous or metachronous metastases are common in this patient population. Modern radiotherapy techniques, including conformal radiotherapy with intensity modulation, are promising and could overcome toxicities in long-term survivors.