Preradiation chemotherapy with methotrexate, cisplatin, 5-fluorouracil, and leucovorin for pediatric nasopharyngeal carcinoma

Results of Pediatric Oncology Group (now Children's Oncology Group) study 9486

Authors

  • Carlos Rodriguez-Galindo M.D.,

    Corresponding author
    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee
    • Department of Hematology-Oncology, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38105
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    • Fax: (901) 521-9005

  • Marcia Wofford M.D.,

    1. Department of Pediatric Hematology-Oncology, Wake-Forest University School of Medicine, Winston-Salem, North Carolina
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  • Robert P. Castleberry M.D.,

    1. Department of Hematology Oncology, University of Alabama Children's Hospital, Birmingham, Alabama
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  • Gregory P. Swanson M.D.,

    1. Department of Radiation Oncology, Deaconess Medical Center, Spokane, Washington
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  • Wendy B. London M.D.,

    1. Children's Oncology Group, Department of Statistics, University of Florida, Gainesville, Florida
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  • James Fontanesi M.D.,

    1. Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi
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  • Alberto S. Pappo M.D.,

    1. Department of Hematology-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Edwin C. Douglass M.D.

    1. AstraZeneca Pharmaceuticals, Wilmington, Delaware
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    • Dr. Douglass is an employee of AstraZeneca Pharmaceuticals, which manufactures several oncology products. None of these products was involved in the current study.


Abstract

BACKGROUND

Nasopharyngeal carcinoma (NPC) is rare in children, accounting for < 1% of all cases. Treatment most commonly includes radiotherapy but long-term side effects of such treatment can produce devastating cosmetic and functional sequelae in children. Chemotherapy may help to decrease the radiotherapy dose and limit the side effects of local therapies. However, little is known regarding the chemosensitivity of NPC tumors in pediatric patients.

METHODS

Patients with American Joint Committee on Cancer (AJCC) Stage I/II disease (Stratum 01) received irradiation only. Patients with AJCC Stage III/IV disease (Stratum 02) received 4 courses of preradiation chemotherapy comprising methotrexate (120 mg/m2) on Day 1, with cisplatin (100 mg/m2) 24 hours later, 5-fluorouracil 1000 mg/m2 per day as a continuous infusion for 3 days, and leucovorin 25 mg/m2 every 6 hours for 6 doses. Irradiation was given after chemotherapy and consisted of 50.4 gray (Gy) to the upper neck and 45.0 Gy to the lower neck, with a boost to the primary tumor and positive lymph nodes for a total dose of 61.2 Gy.

RESULTS

One patient was enrolled in Stratum 01 and 16 evaluable patients were enrolled in Stratum 02. The median age of the patients was 13 years and 65% of the patients were black. All patients tested had evidence of Epstein–Barr virus infection. Two-thirds of the patients developed Grade 3–4 mucositis during chemotherapy. The overall response rate to induction chemotherapy was 93.7%. The overall 4-year event-free and overall survival rates (± the standard error) were 77% ± 12% and 75% ± 12%, respectively.

CONCLUSIONS

The current study demonstrated that childhood NPC was sensitive to chemotherapy and that chemotherapy before irradiation was feasible. Future trials should investigate equivalent efficacy with a reduced radiotherapy dose. Cancer 2005. © 2005 American Cancer Society.

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