Prognostic Impact of Neoadjuvant Chemotherapy on Juvenile Nasopharyngeal Carcinoma
Objective: To study the efficiency of neoadjuvant chemotherapy (NACT) and the impact of CT response on prognosis of juvenile nasopharyngeal carcinoma (NPC). Materials and Methods: From 1995 to 2005, 108 non-metastatic NPC patients younger than 25 years old were treated with NACT at Salah Azaiz Institute.The Median age of patients was 17 year-old and the male/female ratio was 1.6. According to the 2002 TNM staging system, T3-T4 tumors and N3 nodal status rates were 64% and 52%, respectively. All patients had undifferentiated carcinoma and received three cycles of CT combining doxorubicin and cisplatin followed by conventional RT with a total dose of 70 Gy to the primary tumor and the cervical areas initially involved, and 54 Gy to the remaining cervical areas. Tumor response to NACT was assessed after the third cycle on the basis of clinical examination (100%) and CT-scan of the nasopharynx (66%). Response was evaluated according to WHO criteria. Results: The overall CT response rate was 88% at cervical lymph node (complete response (CR): 35%, partial response (PR): 53%) and 83% at primary tumor (CR: 20%, PR: 63%). A complete remission at the end of the treatment program was observed in 91% of cases. Five-year DFS and OS rates were 75% and 81%, respectively. A no response (NR) or progressive disease (PD) after NACT at both cervical nodes and primary tumor had a statistically significant pejorative impact on DFS (p<0.001 and p=0.04, respectively) and OS (p<0.001 and p=0.037). Five-year DFS and OS rates of patients in CR after initial CT at cervical nodes was significantly better than the other patients (PR, NR, or PD) (94% vs. 66% and 94% vs. 73%, respectively). Conclusion: Our results showed that NPC is a very chemosensitive neoplasm and suggest that a regimen of induction CT followed by RT is feasible and can provide excellent antitumor effect in juvenile NPC. The prognosis was influenced by response to initial CT; the DFS and OS were better in patients with a good response to CT. RT dose reduction to good responders could be an interesting therapeutic approach in order to limit long-term sequelae.
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