Frikha M, Toumi N, Ghorbel L, Ben Salah H, Khabir A, Karray H, Gargouri R, Boudawara T, Ghorbel A, Daoud J
CHU Habib-Bourguiba, Sfax, Tunisie.
Cancer Radiother. 2010 Jun;14(3):169-75. doi: 10.1016/j.canrad.2010.01.003. Epub 2010 Mar 27.
We retrospectively analyzed anatomoclinic, therapeutic and evolutive particularities of 74 young patients (< or =20 years) with nasopharyngeal carcinoma treated between 1993 and 2005.
Initial work-up included a fiberoptic nasofibroscopy with biopsy, tomodensitometry and/or MRI of nasopharynx and neck, chest X-ray, abdominal ultrasonography and bone scan. Patients were treated with either primary chemotherapy (epirubicin and cisplatin) followed by radiotherapy or concomitant radiochemotherapy (five fluorouracil and cisplatin). Radiotherapy was delivered to a total dose of 70 to 75 Gy to nasopharynx and involved cervical lymph nodes and 50 Gy to the remainder cervical areas.
The median age was 16 years. Sixty-three percent of patients had undifferentiated tumors. Sixty-six percent had locally advanced tumor. With a median follow-up of 107 months, one patient presented a local relapse, 24 patients developed distant metastases with a median delay of 7 months. The 5 years overall survival and disease-free survival were 66 and 65 %. Late complications were dominated by dry mouth and endocrine disorders.
Pediatric nasopharyngeal carcinoma is characterized by an early metastatic diffusion. Local control is excellent but with severe late toxicities. New techniques of radiotherapy and new molecules of chemotherapy could improve these results.
我们回顾性分析了1993年至2005年间接受治疗的74例年龄小于或等于20岁的鼻咽癌年轻患者的解剖临床、治疗及演变特点。
初始检查包括纤维鼻咽镜检查及活检、鼻咽部和颈部的计算机断层扫描和/或磁共振成像、胸部X线、腹部超声及骨扫描。患者接受的治疗方案为：先进行化疗（表柔比星和顺铂），随后进行放疗；或同步放化疗（氟尿嘧啶和顺铂）。鼻咽部放疗总剂量为70至75 Gy，包括受累的颈部淋巴结，其余颈部区域放疗剂量为50 Gy。
中位年龄为16岁。63%的患者患有未分化肿瘤。66%的患者患有局部晚期肿瘤。中位随访时间为107个月，1例患者出现局部复发，24例患者发生远处转移，中位转移延迟时间为7个月。5年总生存率和无病生存率分别为66%和65%。晚期并发症主要为口干和内分泌紊乱。
儿童鼻咽癌的特点是早期发生转移扩散。局部控制效果良好，但存在严重的晚期毒性反应。放疗新技术和化疗新分子可能会改善这些结果。
