How does the management of nasopharyngeal cancer in kids/young adults differ from adult patients?
-The data on induction for adult H&N ca has been mixed (excluded NPX) but recent data suggest a benefit for adult NPX.
-Given that this is standard of care in pediatrics, should all NPX patients get induction? Should the induction be Gem/Cis or Cis/5FU?
-What are the differences in radiation target volumes/dosing?
-Given that the risk factors are different, does this change your impression on the need for elective nodal/regional radiation for the boost phase?
-Are EBV viral load levels more or less important in kids relative to adults?
-What is the best imaging to use for delineating each phase of radiotherapy?
Answer from: Radiation Oncologist at Academic Institution
The approach for managing pediatric patients with NPC has generally followed the recently published COG trial, at least in the United States. This approach uses induction chemotherapy with CDDP/5FU, followed by chemoradiation for the higher risk patients. Lower risk patients—Stage I/IIa or T2N...
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