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Nasopharyngeal Carcinoma (NPC) in childhood was seen rarely; the incidence rate was less than 1% among all childhood tumors. Although treatment was similar, tumor control (LC) and overall survival (OS) rates were better when compared with adults’ NPC. However, the toxicities were observed more frequently than adults. In this study; we retrospectively reported results in adolescence and childhood NPC patients previously treated with 61,2-63 Gy intensity modulated radiation therapy ( IMRT).

Between 2010-2020, 14 patients were included in our study. The median age was 16 and the female/ male ratio was 3:11. The primary tumor stage was T4 in 42,9%, and the nodal stage was N2 in 71,4%. TPF (Docetaxel-5FU-Cisplatin) was given for induction chemotherapy (ICT) before 2019 whereas GP (Gemcitabine-Cisplatin) was given for ICT after 2019. Twelve patients received ICT (TPF or GP) before chemoradiotherapy (10patients) or radiotherapy (2 patients), 2 patients were treated with only chemoradiotherapy.  PTV 61,2 (complete or good partial response) -63Gy (partial response)  included the primary tumor and metastatic lymph node for high-risk volume. PTV 54Gy included both the whole nasopharynx and whole involved nodal level. For low-risk volume; PTV 45Gy was covered high-risk regions and elective bilateral cervical lymph nodes. Survival analyses were made by Kaplan-Meier method. 

The median follow-up time was 80,5months (range:7-139). All patients had complete responses after chemoradiotherapy. The 5-year locoregional controls (LRC), disease-free survival (DFS), and OS were 100%. One patient developed distant metastasis (bone) 62 months after treatment. Grade 3 acute side effects were observed as mucositis 14%, dysphagia 14%, dermatitis 21%. There were no grade 4 acute side effects. Chronic side effects; there were grade 2 xerostomia in 50% and hearing impairment in 28%. Fibrosis was observed in only one patient, while hypopituitarism was observed in one patient. Radiation-induced trismus, cranial nerve palsy, aspiration, and alopecia were not observed.

Using the IMRT technique with dose reduction was compared with the historical series. Although lower dose radiotherapy was administered,  local-regional control was higher and the rate of side effects was lower in our study. Prospective multicenter studies are needed for further dose reduction, especially in patients with complete response after induction chemotherapy.