Outcome of Pediatric Nasopharyngeal Carcinoma With Induction Chemotherapy and Concurrent Chemoradiotherapy—Experiences in a Tertiary Cancer Center, Bangladesh

Pediatric nasopharyngeal carcinoma has a better chance of survival, although most patients present with advanced disease stage and undifferentiated pathology. Radiation-related toxicity is a major concern for younger individuals. Induction chemotherapy followed by concurrent chemoradiotherapy with tailored radiation doses has become an acceptable treatment for pediatric cases. This quasi-experimental study was conducted at the National Institute of Cancer Research and Hospital in Bangladesh from July 2016 to June 2022. The enrolled children received 3 cycles of induction chemotherapy, followed by concurrent chemoradiotherapy. Patients with a complete or partial response to IC received 61.2 to 66 Gy to the nasopharynx and neck. Among the studied children (n=50), males (33) were predominant with a male-to-female ratio of 1.94:1. The age range was 8.00 to 17 years, with a mean±SD of 13.15±267. Most of the patients (64%, 32 cases) were younger than 15 years. Advanced-stage disease was observed in 82% of patients, and most cases (96%) had poor to undifferentiated histology. The 4-year OS and EFS rates for the studied children were 80% (95% CI, 70.4%-86.2%) and 76% (95% CI, 65.2%-83.3%), respectively, over a median follow-up of 48 months. Mucositis (74%) and xerostomia (50%) were the most common acute and late adverse effects, respectively. Induction chemotherapy followed by concurrent chemoradiotherapy, but with a reduced-dose RT strategy, provided better survival outcomes with acceptable adverse effects in resource-limited settings.