Treatment and outcome of undifferentiated carcinoma of the nasopharynx in childhood: a 13-year experience.

Between 1970 and 1983, 22 pediatric patients diagnosed as having undifferentiated nasopharyngeal carcinoma (UNC) were treated at the National Children's Hospital of Costa Rica; primary tumor with local extension (T3-T4) was present in 45% of the patients, and metastasis of the cervical nodes (N1-N3) in 82%. Patients were divided into groups A and B according to the type of treatment received. A description of both groups is as follows. Ten patients were treated with 5,000 to 6,000 rads tumor dose to the primary and a 5,125-rad dose was administered to the lower neck between 1970 and 1977 (group A). Six patients received postradiation therapy with cyclophosphamide and vincristine and two patients also received 5-fluorouracil. The outcome in group A was as follows: four (40%) failed to respond, six (60%) achieved full remission initially with two subsequent relapses, and the remaining four are still alive and free of relapse after 90 to 160 months (average 130) (two were treated with Co60 alone and two with chemotherapy. Twelve patients were treated with chemotherapy pre- and postradiation with CPM and adriamycin for a total of 12 months (group B) between 1978 and 1984. All (100%) achieved complete initial remission; two patients relapsed and died. Ten patients have remained in relapse-free survival for 18-67 months (median 32). Though this is not a controlled study, our experience indicates that pre- and postradiation chemotherapy is effective in prolonging the disease-free survival in UNC and may allow a decrease of the radiation tumor dose.