Pediatric nasopharyngeal carcinoma: A Review of 27 Cases over 10 Years at Shaukat Khanum Memorial Cancer Hospital and Research Center, Pakistan

Purpose: This study aims to review the clinical features, treatment and outcome of pediatric nasopharyngeal Carcinoma at Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC) over ten years. Methods: Retrospective review of pediatric patients who were diagnosed with nasopharyngeal carcinoma and treated at SKMCH&RC from July 1996 to June 2006. Results: A total of 27 children with NPC were included. The male to female ratio was 4.4:1. The mean age at diagnosis was 14 years (8-18 years). The most common presenting symptom was neck swelling (81.5%, 22/27). The mean duration of symptoms before diagnosis was 10.3 months (3-36 months). The majority of patients (70%, 19/27) presented at stage IV. All received a combination of chemotherapy and radiotherapy. Survival analysis was performed for 22 patients; of these 8 patients died and 4 were lost to follow-up. The median follow-up time of the surviving patients was 53 months (5-116 months). At 5 years, the cumulative overall survival (OS) was 55% while the cumulative EFS was 54% with a flattening of the curve at 2 years. There was a significant difference in OS (p=0.001) and EFS (p=0.057) in patients diagnosed with NPC under 14 years of age (n=11) and those between 14 and 18 years (n=11). Conclusion: In our institutional study, NPC presents late and in advanced stage. The outcome is better in younger children. Our survival rates, while comparable to developing countries, are less than those seen in the developed world. We feel a strong need for collaborative studies in view of small numbers in individual centres.